New Clinical Response Model Q&A Q1. What is the Scottish Ambulance Service changing? In 2015 we launched our strategy Towards 2020: Taking Care to the Patient. This strategy is about providing patients with the right care first time. As part of this work, we are introducing a new clinical response model as a 12 month pilot which will save more lives and improve patient outcomes. Patients with immediately life-threatening conditions, such as cardiac arrest, or who have been involved in serious road traffic incidents, will be prioritised and receive the fastest response. In less urgent cases, our call handlers may spend more time with patients to better understand their needs and will send the most appropriate resource for their condition, which will improve outcomes. The new response model has been developed following the most extensive clinicallyevidenced review of its kind ever undertaken in the UK, with nearly 500,000 calls examined. The clinical data more accurately identifies immediately life-threatening conditions and the responses all patients need. This follows similar changes in Wales and parts of England which have proven highly successful, leading to faster response times for critically-ill patients. Q2. What will the new model look like? The new model will have three response types: Immediately life-threatening calls, such as cardiac arrest, where someone is in imminent danger of death. Clinical evidence shows that an immediate response has the potential to significantly improve the patient s outcome. The existing target to respond to 75% of immediately life-threatening calls within eight minutes will remain. Calls where a patient needs a fast response to be treated at the scene and/or transferred to a healthcare facility. These calls will be prioritised on the basis of clinical need and will receive a blue light response but there will be no time target. A range of clinical outcome measures will be introduced to evaluate the quality, safety and timeliness of care delivered. Calls which can be managed safely at home or by referral to the most appropriate care, such as GPs, NHS 24 or social care services.
Q3. Why is this new model being introduced? Our current response model is used across the world and measures performance on a time-based standard which dates back to 1974. This model does not measure patient care or outcomes. We can send patients a variety of responses, including paramedics in cars, on bikes and motorbikes, double-crewed ambulances and non-blue light ambulances. The 1974 model requires ambulance services to send all emergency calls the nearest available resource and not necessarily the resource the patient needs. For example, a patient with an immediately life-threatening condition, such as cardiac arrest, needs the fastest possible response, while a patient whose life is not in immediate danger who needs to be taken to hospital for treatment requires an ambulance. The evidence-based model being introduced will more closely match the help we send patients with their clinical conditions. This will save more lives and improve patient outcomes. Q4. How will we know we are saving more lives? The new response model has been developed following the most extensive clinicallyevidenced review of its kind ever undertaken in the UK, with nearly 500,000 calls examined. We will monitor the success of the pilot using a range of clinical measures, including the number of patients we are able to resuscitate from cardiac arrest at scene and take to hospital for definitive care. Our clinical review will help us more accurately identify patients with immediately lifethreatening conditions and send the fastest response to save lives We are aiming to reach more of these patients within our eight minute target and will report on the pilot s success in doing so. We will also continue to evaluate staff and patient feedback and experiences. Q5. How many more lives do we expect to save? The 12 month pilot will be independently evaluated, which will help us measure the improvements to patient outcomes. Similar models have been introduced in Wales and parts of England which have proven highly successful, leading to faster response times for critically-ill patients. In the meantime, the Scottish Ambulance Service is playing a significant role in saving 1,000 more lives as part of the Scottish Government s cardiac arrest strategy.
Q6. Will this result in delays for any patients? We aim to send the right response to more patients. Patients with immediately life-threatening conditions, such as cardiac arrest, will continue to be sent the nearest available help. We are aiming to reach more of these patients within our eight minute target, saving more lives. In less urgent cases, our call handlers may spend more time with patients to better understand their health needs and will send the most appropriate resource for their condition. We anticipate our dispatchers may on average spend approximately 120 additional seconds to ensure we send patients whose lives are not in immediate danger the help they need first time. Understanding that an ambulance is required for a patient who needs to be taken to hospital and not a paramedic in a car will mean many of these patients reach hospital quicker than at present. Q7. Can you give examples immediately life-threatening calls which need the fastest response? (The average response time to these calls in 2015/16 was 7.4 minutes) Patients who may be in cardiac arrest Patients involved in serious road traffic collisions Patients suffering acute anaphylactic shock Patients who are unconscious and not breathing Vulnerable patients, including pregnant women and young children Q8. Can you give examples of conditions which are not immediately lifethreatening and will still receive an emergency blue light response? (The average response time to these calls in 2015/16 was 11.2 minutes) Patients experiencing chest pain or possible heart attack symptoms Patients who are experiencing breathing problems Patients experiencing symptoms of stroke Patients with suspected serious fracture
Q9. Are cardiac arrests and heart attacks the same thing? No. A heart attack is not the same as cardiac arrest. Heart attack A heart attack is a sudden interruption to part of the heart muscle. It is likely to cause chest pain and permanent damage to the heart but the heart is still sending blood around the body and the patient remains conscious and still breathing. In these cases a fast response is important but sending the most appropriate response under blue lights to assess the patient and transfer them immediately to coronary care is the help needed. Cardiac arrest A cardiac arrest is immediately life-threatening and occurs when the heart suddenly stops pumping blood around the body. Someone who is having a cardiac arrest will suddenly lose consciousness and will stop breathing, or stop breathing normally. Unless immediately treated with CPR, this always leads to death within minutes. Patients suffering cardiac arrest therefore need the fastest response possible. Q10. What is wrong with the current system? The new clinical response model is about improvement. Our current response model is used across the world and measures performance on a time-based standard which dates back to 1974. This model does not measure patient care or outcomes and takes no account of the advances made in clinical development of pre-hospital care. We can send patients a variety of responses, including paramedics in cars, on bikes and motorbikes, double-crewed ambulances and non-blue light ambulances. The 1974 model requires ambulance services to send all emergency calls the nearest available resource and not necessarily the resource the patient needs. For example, a patient with an immediately life-threatening condition, such as cardiac arrest, needs the fastest possible response, while a patient whose life is not in immediate danger who needs to be taken to hospital for treatment requires an ambulance. The evidence-based model being introduced will more closely match the help we send patients with their clinical conditions. This will save more lives and improve patient outcomes. Q11. Will this model work in urban and rural areas? Our new clinical response model has been developed following the most extensive clinically-evidenced review of its kind ever undertaken in the UK, with nearly 500,000 calls examined from across Scotland. The model will more closely match the help we send patients with their clinical conditions in urban, rural and remote communities in Scotland.
Q12. Why is the model being introduced now? We have been listening to and engaging with our staff, who along with our National Partnership are supportive of the new clinical response model and recognise the opportunity to save more lives and improve patient outcomes. We have also taken learning from patient experience. The new model will improve both safety and patient experience. The clinical evidence has been reviewed over several months and been subject to rigorous examination by expert clinicians and our governance procedures. Q13. What engagement has the Scottish Ambulance Service undertaken? The new clinical response model is supported by: The Chief Medical Officer Our workforce Trade unions (National Partnership) Our Clinical Advisory Group (senior emergency consultants, academics and GPs) The Scottish Government We will undertake a planned programme of workforce, public, patient, third sector, MSP and public body engagement prior to the model being introduced. Q14. What will the benefits be for staff? The evidence-based model being introduced will more closely match the help we send patients with their clinical conditions. This will enable paramedics and ambulance crews to be deployed more effectively based on patient need. A major benefit will be the ability of our call handlers, dispatchers and frontline staff to provide more patients with the care they need first time, which will save more lives and improve patient outcomes. We are confident this will be reflected in staff feedback and experiences. Q15. How will these changes be measured and reported? We will undertake robust evaluation of the new clinical response model throughout the 12 month pilot, with the findings reported regularly and made publicly available. A range of clinical outcome measures will be introduced to evaluate the quality, safety and timeliness of care delivered. The success of the new model will also be evaluated independently.
Q16. Is this about saving money? No. This is about saving more lives. In fact, the Scottish Government is increasing funding for the Scottish Ambulance Service to recruit and train an additional 1,000 paramedics by 2020. Q17. Is this about changing performance measures to meet targets? No. The 1974, time-based performance model does not measure patient outcomes and does not take account of the advances made in clinical development of prehospital care. The new clinical response model is about saving more lives and introducing a clinical response model which does measures patient outcomes. Q18. Is this about unblocking hospitals and A&E departments? No. This is about saving more lives and improving patient outcomes. Patients who need hospital treatment will continue to be taken there. The Scottish Ambulance Service is already making a major contribution to the Scottish Government s 2020 vision for healthcare, where everyone is able to live longer, healthier lives at home or in a homely setting. Last year, we treated over 86,000 people at home or in their communities. We are also working in partnerships to develop care pathways for patients, including frail and elderly patients who suffer falls, patients with diabetes and patients experiencing mental ill-health. Falls continue to be the largest single cause of ambulance callouts, with almost 69,000 cases responded to last year. The development of integrated community care pathways to safely treat patients who suffer falls has reduced the number of frail and elderly patients being taken to hospital by ambulance. Q19. What training and resources has the Scottish Ambulance Service put in place to make these changes? The new clinical response model requires relatively minor technical changes. We will provide comprehensive training for all relevant staff prior to the model being safely introduced. Q20. When will these changes take place? The model will be introduced from 23 November 2016 and piloted for 12 months. Q21. If I need further information, wish to provide input, share feedback or raise a concern or complaint, who can I contact? The Scottish Ambulance Service welcomes feedback. Members of the public who wish to find out further information or raise a concern can contact the Service on scotamb.clinicalmodel@nhs.net. Formal complaints will be dealt with through the Service s complaints process (telephone 0131 314 0000).