An alternative model of pre-hospital care for 999 patients who require non-emergency medical assistance

Abstract

Purpose With the increasing demand on ambulance services, paramedics are tasked to arrange as much out of hospital care as possible, to develop integrated systems of care and work with hundreds of different providers – all in the 15 minutes allocated for assessment. A UK ambulance trust is navigating and leading much of this work as one of the first trusts to implement a general practitioner referral policy as an alternate to direct conveyance. The paper aims to discuss this issue. Design/methodology/approach Here the authors discuss the referral scheme, examine the limited evidence available and discuss what is needed to influence prospective success of implementing this scheme in other trusts. Findings Limited evidence for these schemes are described, however there is a clear gap in critical appraisal and methodologically rigorous evidence needed to implement these schemes in other ambulance schemes. Originality/value In order to facilitate collaboration of healthcare services and to minimize the burden of increasing numbers of patients, communication and discussion of alternate routes of care is crucial. This viewpoint piece is one of the first to emphasize the potential benefits of such schemes.

Piloting data linkage in a prospective cohort study of a GP referral scheme to avoid unnecessary emergency department conveyance

“…Even so, the high deflection a proportion (%) of sub-cohort (n = 143) and of those presenting at ED (n = 32) b see linear regression and Cox-regression in text rate here indicates scheme success as these patients may have otherwise been conveyed directly to ED without the availability of the alternative GP referral route, or referred using a less robust system. This is a higher deflection rate than has been noted before [3]. It is possible that patients who were referred to GP presented at an alternate ED department than SRFT within the 30 days; although this would be unusual as the patients reside in the Salford area.…”

“…As the number of 999 calls and the number of patients who present at Emergency Departments (EDs) increase each year [1], UK Ambulance services are under pressure to safely stream patients to alternative routes of care [2,3]. Hospitalisation for acute medical illness can frequently trigger short and long-term disability [4,5].…”

“…UK ambulance trusts have introduced schemes aimed at decreasing rates of conveyance to EDs by streaming patients to alternative treatment or referral options based on clinical acuity [3]. Although some trusts have formal mechanisms for referral, others leave the paramedic to make discretionary decisions [9].…”

“…In the 2015-2016 fiscal year, there were 1.15 million 999 calls leading to 1.03 million incidents attended to by NWAS paramedics. Paramedics attempted 66,836 referrals (~5%) to the GP AVS, of which 90% were accepted [3]; without the scheme, these patients would have been conveyed directly to ED or referred on an ad hoc basis without assurances. Qualitative studies have demonstrated both the paramedics and GPs' commitment to and belief in the scheme, and that Paramedic Pathfinder can successfully stream patients away from the ED.…”

“…Qualitative studies have demonstrated both the paramedics and GPs' commitment to and belief in the scheme, and that Paramedic Pathfinder can successfully stream patients away from the ED. [11,12] Although much evidence suggests early success [3,[10][11][12], there has been no formal enquiry to explore the efficacy or effectiveness of such referrals. A lack of follow-up evidence has resulted in a knowledge gap regarding the safety and health outcomes of patients referred to the scheme [3].…”