interviews

Infomation-rich improvement

Pauline Howie, chief executive of the Scottish Ambulance Service, describes the positive results of a whole-system improvement strategy for both fleet management and patient care.

A clear strategy, streamlined information and strengthened leadership have led to significant improvements for the Scottish Ambulance Service.

Response times to life-threatening emergencies has been reduced in the past year, down from 6.9 minutes to 6.7 minutes, the annual review showed. Survival rates for cardiac arrest patients and response to hyper-acute stroke patients were also improved.

Chief executive of the service, Pauline Howie, told NHE the improvements had been achieved through a clear vision for the new strategy, ‘Working together for better patient care’, to develop a service that meets patient needs on a local basis, 24/7.

Whole system approach

She said: “It’s been a whole system-wide approach. Fundamentally, we’ve strengthened leadership and management development within the service, we have a clear focus on what’s important to patients and we’ve really prioritised our actions around meeting their needs.”

Working with five local operating divisions, improvement plans were developed to realise that vision through process improvements and technology enhancements across the fleet.

“Significant” investment went into information and data quality systems, to provide more timely and robust data from a single source.

“We were very data-rich and informationpoor,” Howie explained, “but we’ve really done a lot of work around focusing on what the most important information is.”

The system was developed internally through a command and control system provided by MIS and a patient report system developed in partnership with Terrafix. This allows the service to report clinical performance at an individual staff member level, at team level, and area, divisional and national level.

At the scene

Paramedics are now treating more patients at the scene, rather than transporting them to A&E, Howie said. Currently 12% treat and then leave, referring patients on to another part of the healthcare system, where treatment can be followed up locally.

Howie explained: “Hospital is not the best place for many different types of patient. One common reason people phone an ambulance is asthmatic attacks, or diabetes, and it’s often just a case of medicines needing to be recalibrated.”

Professional to professional support has been put in place to let paramedics consult with a patient’s GP before reaching a decision.

“It’s a three-way conversation that is being carried out, about the initial diagnosis and what the best care pathway is next for that patient – often it’s not taking them to hospital.”

The service also undertakes 1.3 million patient transport journeys every year to and from hospital appointments, discharges between hospitals or care homes and nursing homes. The closest available non-emergency resource can now be dispatched to meet patients.

Howie said: “We’ve significantly invested in mobile technology in the patient transport service, so we can dynamically deploy those resources in the same way as we do for emergency ambulances. It’s a much more dynamic and flexible service, able to meet patients’ needs.”

On target

The investment has paid off, as the service is on target, responding to 75% of life-threatening calls within eight minutes, as well as creating further outcome targets for cardiac care, stroke patients, major trauma and elderly falls – the most common reason for people contacting the ambulance service.

Howie described how the service was improved for this key demographic: “We worked with local authorities and health boards across Scotland to identify what service provision was there, what the gaps were, and to agree our referral protocol.

“Often the ambulance service is being called out for people who haven’t been injured, but require being put back to bed. We wanted to make sure they were safe, and there was follow-up care in place for those people and that they could have a formalised risk assessment process put in place, and if there were any particular needs that they had to prevent future falls, then the relevant agencies could follow those up.”

Looking to the future, Howie said that development of care pathways and links with other parts of the health and care system to enable referrals was top of the list. The service is also looking into the most common reasons why people phone for an ambulance to ensure there are appropriate alternatives in place.

The team is also working with NHS 24 to develop a common triage system between both organisations, in partnership with Capgemini, so that “no matter who you phone for help, then you’ll go through a standardised assessment process”.

The service is also piloting a new electric ambulance, with zero emissions, which takes around five hours to charge and can run for 100 miles.

Due to the huge areas the fleet covers in Scotland, this limits its use to more urban centres, but the team is working closely with The Carbon Trust to consider wider application within the fleet.

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