Scottish Ambulance Service Heather Kenney

Transcription

1 NHS Board Contact Scottish Ambulance Service Heather Kenney Title Category Background/ context Problem Aim Improving Care for Older People who Fall and Present to SAS Older People The Scottish Ambulance Service (SAS) responds to circa 25,000 calls for people aged 65+ who have fallen. SAS clinicians are largely unable to consider an alternative outcome to the emergency department for this group due to a lack of developed pathways and partnerships with local integrated care services. Patients often do not receive the care and service which best meets their needs which can result in an unnecessary attendance at the emergency department (increasing the pressure on that area) or, if the patient is well and uninjured, they remain at home without any on-going referral or notification to their primary care team (the risk of future falls is not addressed). Across Scotland the SAS aims to develop partnerships/pathways with local integrated care services to enable our clinical staff to offer the patient an outcome which better reflects their need. Action taken SAS operational managers supported by SAS service improvement facilitators have been engaging with local authority based integrated care teams. Through a multi-disciplinary task and finish group SAS has produced a toolkit to support our frontline managers to build sustainable partnerships and care pathways ( Making the Right call for a Fall booklet Appendix 1). Through a collaboration with NHS Education for Scotland (NES) a short film has been produced aimed at raising awareness and supporting a change in practice by Paramedics and Technicians.

2 Applying quality improvement methodology SAS managers and local partners have been undertaking tests of change to develop concepts into business as usual practice. Results Patient experience Staff experience Efficiency savings and productive gains Sustainability The SAS has around 25 active partnerships with integrated care service providers. While, for a national service, this provides significant complexity and challenge those partnerships who are undertaking tests of change have evidence which indicates: reduced conveyance to the emergency department from this patient group evidenced nationally by a 10per cent reduction since April 20 (appendix 2a) and further supported by local data (appendix 2b). increased instance of referral to falls prevention services evidenced, for example, in Edinburgh by referrals in three months during our PDSA test (appendix 3) reduction of repeat calls to SAS indicative cost benefits from reduced conveyance and emergency department attendance (circa 400 per case) improved identification and management of patients at risk Early informal feedback strongly suggests high levels of patient satisfaction with the outcomes provided from these partnerships. A more formal approach is planned to be undertaken. Significant cross system engagement, feedback and more formal review has been undertaken prior to and during any test of change. Consequently staff involved in the development of pathways have contributed positively. Evidence indicates a reduction in SAS journeys and emergency department attendances. Work is required to understand any associated change in in-patient stays off set against community health and social care costs. The partnerships and pathways themselves are fairly simple to sustain however the ability of the whole system to move resource from secondary care to community models will be challenging.

3 Lessons learned The models developed are more responsive, safer and more appropriate for this patient group than attendance at the emergency department. Developing partnerships across 32 areas is labour intensive and complex. Local partner capability and capacity is varied. Front line staff have relished the opportunity to develop effective systems and processes.

4 Appendix 1 SAS Managers and Local Falls Leads Toolkit

5 Appendix 2a National Example - Elderly Patients Conveyed to Hospital 90.0% Table 3: Elderly Conveyance Scotland from % 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%

6 Appendix 2b Local Example (Argyle and Bute) Elderly Patients Conveyed to Hospital

7 Appendix 3 Increased referrals example Edinburgh City Referrals Jan Feb Mar April May June Aug Sept Oct Nov Dec