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.


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.

Ambulance rural

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.


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."

Stacey Ayre

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

New 111

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.

Original new amb

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.'

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