Heading in the Right Direction

 Wednesday 5 October 2016

David Garbutt, Chairman of the Scottish Ambulance Service, reported at this year’s Annual Review that the evidence-based approach being taken to design and deliver Services is delivering real benefits to patients.

Speaking to an audience at Glasgow’s Golden Jubilee Conference Centre, he talked of the range of actions which have been put into practice over the last 12 months to ensure  a more clinically robust approach to patients from the initial 999 call to pre-hospital treatment to conveyance to hospital where necessary.

“Looking back over this short period of time, we have a lot to be proud of. We’ve not only looked at what we do, but how we do it. Moreover, where we’ve seen an opportunity to improve how we respond to our patients and improve the patient experience, we have acted on this.

“For example, we developed our Clinical Services Desk within our Ambulance Control Centres (ACC) to operate as a Clinical Hub. In practice, this means that our ACC clinicians can offer patients, who do not present with priority symptoms, alternatives to hospital attendance, such as providing telephone advice or referral to NHS24.  This development also affords our clinical staff another career opportunity as Clinical Advisors within the ACC. 

“We introduced Red Ring Back practice, where our clinicians call back patients to ensure they remain safe if we anticipate our arrival on scene will be longer than expected.

“We have also improved out collaboration with NHS24 to ensure serious cases which are passed are clinically safe and appropriate.

“We developed our low acuity model to more effectively manage requests from GPs, investing in additional dedicated capacity within divisions and establishing dedicated desks within our East and West Ambulance Control Centres. The aim of this to ensure we fully assess the requirement for an ambulance response both in terms of time and identifying the most appropriate resource and needs for that patient.

“We introduced Hospital Ambulance Liaison Officers in each of our area divisions to maintain a hospital based focus on ambulance turnaround times and patient flow.

“An extensive review of nearly half a million patient cases provided the evidence base we need to inform the adjustments to our new response model which we launched as a pilot last week.

“We have also introduced a new care bundle for stroke and cardiac arrest patients. This is a set of measures which our staff follow with the aim of improving outcomes.

“And we are seeing results. Just under 40% of patients who suffered a treatable cardiac arrest arrived at hospital with a pulse. This is a 16% improvement on the previous year’s figure. This can be attributed to the enhanced identification of such calls in our Ambulance Control Centres, enabling us to task the appropriate teams who can most effectively carry out resuscitation and give advanced life support, plus more awareness amongst bystanders and the general public of CPR, something which we have been pro-actively promoting at events and training sessions through our staff, our Community First Responder, our partnership with the Scottish Fire and Rescue Service, BASICS doctors and other partners the length and breadth of the country.

“We also continued working with our partners in the health and social care sector to develop new care pathways and treating people in their communities. For example, the Service responded to almost 69,000 cases of patients who fell. In the last 5 years, the number of falls-related incidents to the Service increased by 21% and falls are estimated to cost health and social care services in Scotland over ?470 million per year. Thanks to the work that has gone into the development of integrated care pathways in their communities, more elderly patients are being safely treated at home or in a homely setting, thus resulting in a reduction in the numbers of frail and elderly people being taken to hospital by ambulance. As part of the response we completed a review of the falls and frailty pathways across Scotland which will support our partnership with the Active and Independent Living Improvement Programme (AILIP).

“Last year, over 86,000 patients were treated safely at home, thus avoiding a trip to hospital and reducing the pressure on busy A&E departments. This is all part of our Towards 2020: Taking to the Patient strategy whose aims include the sending the right resource first time for patients as a result of better pre-hospital clinical care, resulting in better overall clinical outcomes”.

“Our first intakes on our new vocational training programme to become an Ambulance Technician are now out on placement in stations and we have developed a new specialist paramedic programme to support our strategy.

“We know where we want to be in the future. A world-leading provider of frontline healthcare. And we know what we need to do; continue to be led by the evidence and continue to invest in the skills of our staff”.