Technology and NEAS
With a fleet of over 500 vehicles, NEAS serves 2.6 million
people and responds to over 360,000 emergency calls and urgent
incidents every year. The A&E service and Patient Transport
Service are supported by the NEAS contact centres which receive
over 450,000 calls annually.
And as with most things these days, none of the above would be
possible without technology.
Problems
The North East region presents a number of challenges. Many
areas of Durham and Northumberland in particular are sparsely
populated, rural areas, making it difficult to know how to position
ambulances to provide a quick response. In addition to isolated
residents, the North East suffers high levels of disease
prevalence. It is therefore essential that NEAS can not only
provide a quick response, but that they ensure the response is
appropriate so valuable resources are not wasted.
Although unable to change the geography or demographics of the
region, our innovative use of electronic clinical systems allows us
deliver in these challenging circumstances. Previously, contact
centre staff had to use a large, paper folder to prompt triage
questions and then manually determine corresponding disposition
codes. A process that was time consuming with a
high potential for human error. Subsequent systems resulted in
ambulances attending cases that turned out not to be emergencies.
An ambulance response would be sent to nearly every call,
regardless of severity, placing unnecessary strain on the
service.
Pioneering technology - innovative
solutions
In 2006, NEAS became the first ambulance service to pilot NHS
Pathways (a system developed by Connecting for Health to identify
the best service to treat a patient, and how quickly they need to
be seen, based on their responses to set questions.) NHS Pathways
integrates with Cleric, the clinical system used at NEAS, so that
the information gathered in the triaging process can be forwarded
to the relevant care service. Now, contact centre staff are able to
perform a detailed, consistent triage using NHS Pathways, and there
is an on-site clinician in each centre to provide further support.
By asking more questions, in a structured, standardised flow, the
appropriate response can be implemented as soon as possible.
Another important development in the system was the ability to
easily stand an ambulance down if it was not needed. Previously an
ambulance response was sent to almost every emergency call. Now,
when a 999 call is received, the ambulance is dispatched after 60
seconds. The contact centre operative keeps the caller on the phone
and uses
NHS Pathways to perform the triage. They are then able to divert
the ambulance if the triage reveals it is not needed, and arrange
alternative, appropriate care. This is hugely important as it means
more ambulances are available for emergencies, and patients with
less severe conditions can be treated effectively without using
resources unnecessarily.
NEAS is also the first, and currently the only (as of 2013),
trust to offer electronic appointment booking in association with
their 111 service. Normally, if the result of a call is that the
patient needs to see a doctor, the patient would have to organise
this themselves. There is no guaranteed outcome as the contact
centre staff have no way of knowing whether the patient will follow
their advice. NEAS therefore use an integration between Cleric and
SystmOne, a clinical system that aims to join up healthcare through
the 'one patient, one record' model. At participating SystmOne PCCs
(Primary Care Centres), NEAS staff can instantly book an
appointment for the patient. We can also electronically send
information from the triage call that can be used in the patient's
appointment. Cleric can also integrate with clinical system Adastra
to provide the same service for Adastra PCCs. This functionality
makes the whole process more efficient, reduces error and
duplication of work, saves time, and improves the patient
experience.
Steven Pratt, IT Systems Manager said: "Integration is
essential to providing the best customer experience. The more this
is accepted by healthcare providers, the closer we can get to the
ultimate goal of delivering excellent patient care."
The streamlined flow of information is part of what makes the
system so efficient. All the information gained by the contact
centre and the ambulance crew can be made electronically available
to the relevant care provider, often before the patient even
arrives. Units can also update information on the Directory of
Services (DOS) to show how busy they are, so patients are not all
sent to a unit that has limited availability, even if it is a bit
closer. The integration of multiple systems means information is
available immediately so staff can make more informed decisions in
their delivery of patient care.
Benefits
Stacey Ayre, NHS 111 Supervisor commented "The
numerous benefits of this more streamlined system were immediately
apparent. Through integrated systems, NEAS can provide a complete
'end to end' service from a single point of contact. 111 has
allowed a wider variety of care options to be provided for
patients, and has received very positive
feedback."
NEAS have maintained an excellent response time for
111 patients, whilst freeing up more ambulances to attend to 999
emergencies. NHS Pathways triaging ensures there are very few
incorrect assessments and information is made immediately available
to staff who will treat the patient.
Further integration with SystmOne and Adastra means
GP and Out Of Hours appointments can be booked immediately to
ensure a guaranteed patient outcome.
Steven said "We see the
integrations and work we are doing as setting the standard of what
trusts need to
be doing, not just what they should
think about doing. Sharing patient
information is key to providing the best level of care. Now that we
have this functionality available, there is no reason it should not
be implemented everywhere."
Looking Forward
NEAS is proud of the work we have achieved so far, but
continue to develop processes in order to provide an even better
service. Working with NHS Pathways, we often make suggestions
to help improve the triaging prompts, ensuring staff can record all
the relevant information
For example, previously a patient experiencing breathing
problems had either an 8 min or 24 hour response time, nothing in
between, but now NHS Pathways have added more questions to help
gauge the severity and consider other possible care responses. We
also investigate 'near misses' and trace back the cause to
determine any ways to improve their service in future.
NEAS is looking at a development with OOH provider
Northern Doctors Urgent Care to assist End of Life Care. Currently,
Northern Doctors send over a weekly spreadsheet of any patients
added to the End of Life Care list. NEAS are now working to find
ways this information can automatically populate fields on Cleric
so records are kept up to date.
All 111 services have a national obligation that 5% of the calls
they take are out of area. To facilitate this, NEAS are working
with South Central Ambulance service and Yorkshire Ambulance
Service to pilot further integration between 999 and 111 services.
NEAS' 111 contact centre can take an out of area call, such as via
a mobile, and realise it is a 999 emergency. We then use the
DoS to profile ambulance services near the patient. Once we
have found the most appropriate ambulance provider we can
instantly send the information over to them as a 999 call which
will flash up on their screen and they can then respond to in the
usual manner.
Looking to the future, NEAS has high hopes of how they we
continue to use IT to improve healthcare. NEAS believe there are
tremendous benefits to the patient experience through booking
appointments electronically and want this functionality to be made
available for more services. With participating PCCs using SystmOne
or Adastra, it is already possible for NEAS staff to immediately
book an OOH appointment for a patient electronically. We are hoping
GP units will also allow NEAS to book appointments directly into
their system, and it is hoped that NEAS will work with SystmOne
provider TPP to develop this further.
Steven said: "Both NEAS and TPP immediately recognized the
benefits of electronic bookings and have been working together to
make this a reality. Electronic bookings save time and
ensure patients in need of care are booked into appointments
straight away. Overall, this makes a huge difference in the patient
experience, knowing they won't be put on hold and passed around
between different units, but that someone has given their call
serious consideration and provided the most appropriate resolution.
Making electronic bookings available through GPs, as
well as PCCs, could really improve the service we are able to offer
patients."
With more opportunities to instantly send electronic
information, in the future it may be possible to look at ways that
patients or staff could send images to help with triaging.
Many other ambulance services are now looking to adopt the
systems and processes pioneered by NEAS. Steven
said: "Encouraging further system integration is not just about
promoting a good solution, it's about promoting good thought. It is
important that healthcare services are thinking about patient care
in the right way, and integration is really at the heart of what
patient care is about; being able to deliver a quick, appropriate,
well-informed response." An innovative use of IT has
helped NEAS to dramatically improve a vital medical service, and IT
will continue to play an important role in NEAS' ongoing efforts to
realise their vision of 'right care, right place, right
time.'
