Hospital Delays Ambulance Delays What s the Big Issue?

Transcription

1 Hospital Delays Ambulance Delays What s the Big Issue? Mark Begley Head of Operations Andrew Battye Head of Operations

2 Question: How many Ambulances and cars were on duty in the Thames Valley area at mid-day yesterday, and how many were available to attend the next 999 call? Answers at the end

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4 We Are A Single Fully Integrated (Growing) Organisation 3,600 staff 1,300 CFRs and Co-Responders 105 sites 608 vehicles Population 7 million 7 RAF bases 2 Naval bases 7 prisons Atomic Weapons Establishment 1 secure hospital VIPs: HM Queen Theresa May Sonning and Maidenhead Chequers

5 We Operate In A Complex Setting 22 Acute sites 2 Major Trauma Centres 7 Specialist sites 6 Mental health trusts 1,216 GP surgeries 41 Local Authorities 568 Dental practices 380 Optician branches 791 Pharmacies 34 CCGs 66 MPs 7 Major Motorways 2 Major ports 1 Major fuel refinery

6 1,400,000 1,200,000 1,000, , ,000 We are all facing some serious challenges 1,127,756 40,113 36,087 29,843 29, , ,334 SCAS Demand 1,228,752 1,244,956 38, /18 Year To Date (SCAS) 15/09/17 562, Incidents 111 Calls Answered Linear (999 Incidents) Linear (111 Calls Answered) 400, , ,867 37, ,895 Excluding OOA

7 Triage Calls Emergency Response Refer to Alternative Pathways Health Care advice (CSD) Midwifery service Mental Health Professional NHS 111 Integrated Urgent Care What do we do? Respond to emergency (999) calls Community/Co-responders Rapid Response Vehicles (RRV) Ambulance Helicopter

8 Respond to specialist calls Specialist Paramedics HART Major Incidents What do we do?

9 Manage non-emergency (111) calls New Integrated Urgent Care Service Provide non-emergency patient transport services Commercial training (HSE First Aid, FPOS, etc.) First Responders Volunteers Military Fire Service Public Access Defibrillators What do we do?

10 Demand Management High Intensity Users Media Messaging (Nationally) What do we do?

11 Understanding our skill grades Emergency Care Technician Paramedic/ ECP/SP Assistant (Band 4) Ambulance (Band 6) (Band 3) (Emergency Care Assistant) Basic life support AED Intermediate airway management (LMA) Nurse (Band 5/6) Advanced Life Support including Intubation Emergency Care Practitioner / Specialist Practitioner Skills as per Paramedic Primary & secondary survey Oxygen therapy Entonox Dextrose 40% gel Aspirin Recognition of deteriorating patient Manual defibrillation & ECG recognition Medicines for life threatening conditions Patient assessment & treatment See & Treat Cannulation IM/IV medicines Patient assessment & treatment See & Treat Additional skills to treat: Chronic conditions Minor Injuries Minor Illness Targeted focus on see and treat

12 Whose In An Ambulance/RRV? Does an Ambulance Always have a Paramedic? Dual ECA (DECA) Technician/ECA Paramedic/Technician Paramedic/ECA Technician/Technician Paramedic/Paramedic Para/Tech/Student Para/ECA/Student

13 Whose In An Ambulance/RRV? Rapid Response Vehicle (RRV) Paramedic Specialist Paramedic Technician Team Leader Clinical Mentor HART

14 Pivotal role in urgent and emergency care systems

15 Air Ambulance 2016/17: Over 1000 missions flown 2 x new aircraft purchased Night flying capability 2 x ECRU cars

16 Air Ambulance

17 Hospital Transfers Time Critical Transfer We will respond with the next available Ambulance (over & above a cardiac arrest in community) Patient MUST be ready at time of call, including escort available Emergency Transfer We will send the next available Ambulance (only divert to priority 1 call) Urgent Transfer We will aim to be with you within the agreed time Turning Ambulance away with Trauma How many Ambulances were committed to that incident? Whose Bypass tool are you using? It must be the Thames Valley Trauma Network one Remember: You may be required to send an escort

18 Lost Hours - Impact 16,182 Hours lost (SCAS) = Equals Losing 1,618 Ambulances for 10 hours each year

19 Impact? What would the impact be for your Emergency Department? If you lost 3,236 staff hours per year As each Ambulance has 2 x members of staff on it

20 Impact on Management support to staff Clinical Risk to patients in community Impact on performance Increased waiting time for RRV/HCP Poor patient experience Financial impact Hospital & Ambulance staff anxiety Unable to provide 999 service Impact on resilience

21 Benefits of Joint Working to Reduce Delays Community Response Ability to keep lower acuity patients at home, frail & elderly decondition quickly, therefore a speedier response may avoid transport to the ED Ambulance Tsunami Avoids clumping, free up 5 Ambulances 6 come back! Manage Stress Yours & Ours! Reduction in bad experiences for all, including the patient Greater patient experience and perception Reduce impact on patient & reputational risk

22 Benefits of Joint Working to Reduce Delays Perception What do you see? What do others see?

23 Impact of Delays Team Leader How HALO Many How Many Ambulances Ambulances Operational Commander For this car? For this car? Staff management Response Car Back up from Ambulance Ability to respond to next call Patient Minor conditions Long Wait = conveyance Provision of Care Life threatening conditions R I S K How Many Ambulances For this car?

24 Question: How many Ambulances and cars were on duty in the Thames Valley area at midday yesterday, and how many were available to attend the next 999 call? Any ideas?

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