Ambulance Response Programme

Transcription

1 Ambulance Response Programme Phase 2.3 Version 1.8

2 NWAS Values

3

4 Story so far Implementation of phase one (pre-alert questions) 4 th October 2016 However: Due to latency problems with the CAD, this was removed on 28 th November MIS built new servers, commissioned and installed on 15 th December Pre-Alert questions reintroduced on 24 th January Nature of Call (NoC) list introduced on 21 st February

5 ARP 2.3 Go Live: 7 August 2017

6 Aims of ARP Achieving faster dispatch to the most critical calls through the use of pre-alert and nature of call questioning. Having more resources available (through less multiple allocations) to respond to life threatening immediate calls. Utilising Dispatch on Disposition to allocate the most clinically appropriate response to patients by taking a little more time to triage the call.

7 Has it made a difference? YAS, SWAST, WMAS currently on the trial. Ourselves & EMAS are joining them. YAS have: Achieved better allocation times Reduced stand down figures Vehicle ratio to calls has lowered Positive feedback from Dispatchers ARP has improved our patient care

8 Why ARP? Increased demand on the Ambulance Service Little or no increase in front line services Timeframes overruling patient care High diverting figures with crews on blue lights Patients not being conveyed for longer periods whilst RRVs were considered to be giving care The journey to improving patient care begins

9 ARP Principles What does the patient need? The right vehicle What does NWAS need? Less on scene time for RRVs The right skill Less diverts The right time Less multivehicle deployments

10 ARP Objectives Timely response to patients with life threatening conditions Right clinical resources to meet the needs of patients Reducing multiple allocations Reducing the diversion of resources Increasing hear and treat Increasing see and treat Conveying (transporting) resource availability

11 Current Response Targets Red 1 = 8 minutes Red 2 = 8 minutes Green 1 = 20 minutes Green 2 = 30 minutes Green 3 = 60 minute callback/180 minute target Green 4 = 60 minute callback/240 minute target

12 What is the mean? NWAS performance will be based upon the (mean) average time for all incidents.

13 What is the 90 th Percentile? NWAS performance will be based upon meeting the standard 9 out of 10 times.

14 ARP 2.3 Response Standards Category Mean 90 th Percentile Life threatening Category 1 Emergency Category 2 Urgent Category 3 Less Urgent Category 4 7 minutes 18 minutes minutes 40 minutes 120 minutes 180 minutes

15 When does the clock start? (for all except Category 1 calls) The project is called Dispatch on Disposition and the clock starts at: MPDS Code Allocation of Resource 240 seconds Approximately 90.7% of emergency calls have a clock start at the MPDS code, 2.3% at allocation and 6% at 240 seconds

16 Category 1 Identifier Clock Start Response Measure Category 1 Definition Problem identified Allocation 30 seconds Mean 90 th Percentile Time critical life-threatening event needing immediate intervention and/or resuscitation. Example Cardiac or respiratory arrest; airway obstruction; ineffective breathing; unconscious with abnormal or noisy breathing; hanging. Mortality rates high, a difference of one minute in response time is likely to affect outcome and there is evidence to support the fastest response. Sub-category of C1T (transport) will be monitored with a view to a future standard regarding transport.

17 Category 2 Identifier Clock Start Response Measure Category 2 Definition Allocation MPDS Code 240 seconds Mean 90 th Percentile Potentially serious conditions (ABCD problem) that may require rapid assessment, urgent on-scene intervention and/or urgent transport. Example Probable MI, serious injury, stroke, sepsis, major burns, fits, unconscious with normal breathing. Mortality rates are lower; there is evidence to support early dispatch.

18 Category 3 Identifier Clock Start Response Measure Category 3 Definition Allocation MPDS Code 240 seconds 90 th Percentile Urgent problem (not immediately life-threatening) that needs treatment to relieve suffering (e.g. pain control) and transport or assessment and management at scene with referral where needed within a clinically appropriate timeframe. Example serious injury modalities without systemic compromise; burns (not major); non-emergency late pregnancy/childbirth problems; uncomplicated diabetic hyper/hypoglycaemia; not immediately at risk drug overdoses; non-emergency injuries; abdominal pain. Mortality rates are very low or zero; there is evidence to support alternative pathways of care.

19 Category 4 Identifier Clock Start Response Measure Category 4T (Transport) Category 4H (Hear & Treat) Definitions Allocation MPDS Code 240 seconds 90 th Percentile Problems that are not urgent but need assessment (face to face or telephone) and possibly transport within a clinically appropriate timeframe. C4T 999 or 111 calls that may require a face to face ambulance clinician assessment, or requests for transport by health care professionals. C4H Calls that do not require an ambulance response but do require onward referral or attendance of non-ambulance provider in line with locally agreed plans or dispositions, or can be closed with advice (hear and treat).

20 Analysis RED 1 & 2 Year Month Gov Priority Mean Response (hh:mm:ss) 90th Centile (hh:mm:ss) 2017 April RED1 00:07:35 00:12: April RED2 00:07:41 00:14: May RED1 00:08:07 00:12: May RED2 00:08:41 00:16: June RED1 00:08:23 00:13: June RED2 00:07:59 00:15:27 YTD RED1 00:07:59 00:12:38 RED2 00:08:09 00:15:23

21 Analysis Trial Categories Year Month New Category Mean Response (hh:mm:ss) 90th Centile (hh:mm:ss) 2017 April Category 1 00:09:25 00:16: April Category 2 00:16:58 00:40: April Category 3 01:09: April Category 4 02:04: May Category 1 00:10:31 00:18: May Category 2 00:19:33 00:47: May Category 3 01:21: May Category 4 02:20: June Category 1 00:10:39 00:18: June Category 2 00:18:21 00:46: June Category 3 01:18: June Category 4 02:15:23 YTD Category 1 00:10:08 00:18:00 Category 2 00:18:18 00:44:45 Category 3 01:16:23 Category 4 02:13:23

22 ARP Responses Standard % of Activity Ave Number of Responses per day (based on responses) Category 1 8% 241 Category 2 52% 1537 Category 3 28% 839 Category 4 12% 317 January 2016 June 2017

23 ARP Recommendations

24 Clock Stop C1 A fully equipped Trust Ambulance (Land or Air), with ambulance staff trained to deliver clinical care to patient(s) at the scene of an incident, arrives within a 200 metre geo-fence of the patient (if tracked); or such an ambulance confirms arrival at scene through an updated status message via the Mobile Data Terminal (MDT) in the vehicle, or a clinician confirming verbally to the EOC that they are on scene; A fully equipped Rapid Response Vehicle (RRV), motorbike or cycle, Blue Light Response Officer, or Critical Care BASIC Responder, arrives within a 200 metre geo-fence of the patient (if tracked); or the RRV confirms arrival at scene through an updated status message via the MDT in the vehicle, or a clinician confirming verbally to the EOC that they are on scene; An ambulance resource commissioned to work on behalf of the Trust, who is deployed by the Trust, working to the Trust Policies and Procedures, on a fully equipped ambulance with qualified staff on board (for example, Private Ambulance Service (PAS) or Voluntary Ambulance Service (VAS)) arrives within a 200 metre geo-fence of the patient (if tracked); or the clinician confirms arrival at scene through an updated status message via the MDT in the vehicle, or a clinician confirming verbally to the EOC that they are on scene; An approved First Responder deployed by the trust, equipped with a defibrillator, trained in basic airway management, and trained in the use of and the provision of emergency oxygen; arrives within a 200 metre geo-fence of the patient (if tracked); or the First Responder confirms arrival at scene through an updated status message via the MDT in the vehicle, or a First Responder confirming verbally to the EOC that they are on scene, or through technical methods that offer the same level of assurance; Examples of approved First Responder include, but are not limited to; Community First Responder (CFR); Co-Responder from other public services such as Fire Service, Mountain Rescue, Coastguard; and schemes established with private companies; An approved first responder such as a doctor or other HCP is with the patient, and is equipped with a defibrillator, where the question is confirmed by the EOC Call Assessor.

25 Clock Stop C2,C3,C4 A fully equipped Trust Ambulance (Land or Air), with ambulance staff trained to deliver clinical care to patient(s) at the scene of an incident, arrives within a 200 metre geo-fence of the patient (if tracked); or such an ambulance confirms arrival at scene through an updated status message via the Mobile Data Terminal (MDT) in the vehicle, or a clinician confirming verbally to the EOC that they are on scene; A fully equipped Rapid Response Vehicle (RRV), motorbike or cycle, Blue Light Response Officer, or Critical Care BASIC Responder, arrives within a 200 metre geo-fence of the patient (if tracked); or the RRV confirms arrival at scene through an updated status message via the MDT in the vehicle, or a clinician confirming verbally to the EOC that they are on scene; An ambulance resource commissioned to work on behalf of the Trust, who is deployed by the Trust, working to the Trust Policies and Procedures, on a fully equipped ambulance with qualified staff on board (for example, Private Ambulance Service (PAS) or Voluntary Ambulance Service (VAS)) arrives within a 200 metre geo-fence of the patient (if tracked); or the clinician confirms arrival at scene through an updated status message via the MDT in the vehicle, or a clinician confirming verbally to the EOC that they are on scene;

26 ARP Standards Category 1 Identifier Clock Start Response Measure Category 1 Problem identified Allocation 30 seconds Mean 90 th Percentile Response standard = 7 minutes (mean) / 15 minutes (90 th percentile) Clock Stop: RRV, Amb (inc VAS), CFR or HCP with AED Definition = Time-critical, life threatening event requiring immediate clinical intervention

27 Potential ARP Standards Category 1T Identifier Clock Start Response Measure Category 1 Problem identified Allocation 30 seconds Mean 90 th Percentile Clock Start = Problem identified, Allocation or 30 seconds from call connect Clock Stop: Conveying vehicle type Definition = Time-critical, life threatening event requiring immediate clinical intervention

28 ARP Standards Category 2 Identifier Clock Start Response Measure Category 2 Allocation MPDS Code 240 seconds Mean 90 th Percentile Response standard = 18 minutes (mean) / 40 minutes (90 th percentile) Clock Stop: Conveying vehicle type RRV can stop the clock if patient treated on scene Where an RRV is allocated and the patient is conveyed, the mean 18 minute/ 90 th percentile 40 minute is the conveying resource type Definition = Emergency/serious condition

29 ARP Standards Category 3 Identifier Clock Start Response Measure Category 3 Allocation MPDS Code 240 seconds 90 th Percentile Response standard = 120 minutes (90 th percentile) Clock Stop: Conveying vehicle type RRV can stop the clock if patient treated on scene Where an RRV is allocated and the patient is conveyed, the 120 minute (90 th percentile) is by the conveying resource type Definition = Emergency/not immediately life threatening/urgent condition

30 ARP Standards Category 4 Identifier Clock Start Response Measure Category 4T (Transport) Category 4H (Hear & Treat) Allocation MPDS Code 240 seconds 90 th Percentile C4T Response standard = 180 minutes (90 th percentile) Clock Stop: Conveying vehicle type Definition = Urgent problem requiring transport to appropriate facility C4H Secondary telephone triage within 60 minutes (NWAS) Definition = Urgent problem requiring further telephone assessment

31 C3

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33 MDT

34 A problem that YAS had Remember that Amber (Category 2) are emergencies and do need a response. The new standard has been devised to make sure that they receive an appropriate response not because they don t require a response!

35 Skills Matrix

36 Divert Matrix Back up to a CFR should not be diverted on a Category 1 call All other diverting rules still apply Category 1 Divert From All other codes P1 Back Up Category 2, 3, 4 P2, 3 Divert To Uncovered Category 1 Category 2 Category 3, 4 Category 1 P2 Back Up P3, P4 P1 Category 3 Category 4 Category 1, 2 P3 Back Up P4 P1, 2 Category 4 Category 1, 2, 3 P4 Back Up P1, 2, 3

37 Meal Breaks

38 End of Shift

39 Operational Research in Health ORH has been jointly commissioned in conjunction with our commissioners to conduct a demand and capacity review. ORH will look at what is required for NWAS to achieve the new ARP measures and current. ORH will identify areas that require changes to resource levels in EOC, Operations and UCD ORH will look at our abstraction levels On completion ORH will make recommendation on any changes required.

40 ARP Development Group AQIs HCP calls CFRs (falls) Stop codes Refer to GP Refer to A&E Refer to MIU/WIC Refer to HCP Refer to Specific service Refer to 111/OOH

41 Trust Reporting Considerations ARP will involve a complete rationalisation of Trust Informatics reporting to support the Emergency Service and Emergency Operations Control. Guidance for reporting continues to change. Reporting will not be available directly from the CAD. Limited reporting will be available from Informatics initially by wallboard in control from the 7 th August. Legacy reporting will be disabled. ARP report will be available daily thereafter detailing the same wallboard information and weekly will follow this. ARP reporting timelines for NHS England will be catered for and shared internally. A period of grace has been agreed with NHSE and Commissioners for commissioning reporting that will require rebasing and agreement with stakeholders (Reporting in November for October) Specifications for reporting will be gathered for EOC reporting to support delivery of the new standards against the new categories. Adhoc reporting requests other than mandatory requests will cease during this development period and all requests will go to Commissioners as per the agreed process Agreed NWAS will produce slide briefing pack to share with Commissioners to support management of key messages by the end of the week.

42 REMEMBER! Go Live: 7 August 2017

43 Work in Progress

44 Any questions?