Oct 2018 - Transforming Patient Care stakeholder update

Supporting patients closer to home

North West Ambulance Service (NWAS) has introduced a number of new initiatives to support patients to receive the right care closer to home, reducing avoidable hospital attendances and admissions.

Under the Transforming Patient Care programme, which has been running for the last 18 months, the trust has been focusing on ways it can increase the number of patients it ‘see and treats’ (supports on scene), and ‘hear and treats’ (supports on the phone).

This has already led to a significant rise in the number of people who have received the right clinical advice over the telephone. In the first quarter of this year, when compared to the same time period last year, hear and treat rates had increased by 43% and almost 7,000 fewer patients were transported in an ambulance despite an increase in incidents overall.

There is a continuing focus on making the most of opportunities to provide the right care to people at home once ambulance service clinicians arrive on scene.

Staff training

A consolidated training programme has been rolled-out for staff, designed to support improved quality of care and outcomes for patients, while avoiding inappropriate conveyance to emergency departments.

This includes:

  • Mandatory training to all paramedics on the application of Manchester Triage System (MTS).  MTS is used worldwide to triage and assess patients and identify the most appropriate pathways of care for them i.e. emergency care, urgent care provision via primary or community care professionals or self-care, in their own home. NWAS is the first ambulance trust in the UK to roll out MTS across its entire footprint. An initial pilot showed an increase in patients provided with self-care advice at home or referred to alternative local healthcare provision.
  • Face-to-face training in Pathfinder; a clinically safe triage tool based upon MTS, for all Emergency Medical Technicians (EMTs), supporting them to provide care closer to home for patients that do not need to go to hospital.
  • Additional training in: NEWS2 - the aggregate scoring system against six physiological parameters\measurements, and the Paediatric Observation Priority Score (POPS) – a checklist which quickly scores acutely ill children on a combination of physiological, behavioural and risk identifiers using easy to collect data.
  • Additional training on the importance of identifying frailty in patients, by applying the Rockwood Clinical Frailty Scale. More than 12,000 pocket sized frailty scale cards have been cascaded to NWAS employees and North West commissioners and providers.

Initiatives to treat people closer to home

NWAS has also piloted new ways of working. A cohort of 12 nurses and paramedics have taken on a new Urgent Care Practitioner role, responding to lower acuity calls with the skills and resources required to effectively care for those people at home or refer on to other local health services.

An evaluation of the pilot after 90 days showed that 72% of incidents responded to by the urgent care practitioners were ‘closed’ on scene – meaning those patients received the care and support they needed in the community.  

Additional clinicians have been introduced in the Emergency Operations Centres (EOC) where 999 calls are handled. This has expanded the clinical hub, where clinicians will speak to patients to establish what level of support they need and provide self-care advice or refer on to other healthcare provision closer to home, instead of sending an ambulance.

Mark Newton, Assistant Director for Transformation, said: “This is just a flavour of the work that has taken place of the last couple of years and we’re pleased to be seeing positive outcomes for patients as a result of the Transforming Patient Care programme.

“These examples illustrate our continued commitment to providing patients with the right care, at the right time, in the right place; every time, and our support to the wider healthcare system by ensuring patients are cared for in the most appropriate setting and not taken to hospital unnecessarily.”

Visit www.nwas.nhs.uk/transformingpatientcare for more. If you have any questions about this ongoing programme of work, please email lb.transformation@nwas.nhs.uk