Integrating services to provide community-based care for 999 calls
Annette Davies, Community Resource Team Integrated Manager
Jeff Morris, WAST Operations Manager, ABMUHB area
Louise Thomas, Interim Acute Clinical Team Lead Nurse Practitioner
Dr Firdaus Adenwalla, Consultant Physician
Abertawe Bro Morgannwg University Health Board (ABMUHB) and Welsh Ambulance Services NHS Trust (WAST)
This Bevan Exemplar project gave a local Acute Clinical Team access to 999 calls, enabling them to provide community-based care instead of sending patients to A&E.
Requests for an emergency ambulance to Welsh Ambulance Services NHS Trust (WAST) are triaged through a robust system and are given a call status of either Red, Amber or Green. All calls are registered in a ‘Live Stack’ system, which are responded to in order of priority.
Although 999 calls are made by people as an emergency, evidence shows that only 4% of these calls are actually of Red status and do need a critical response.
The Acute Clinical Team (ACT) have been providing enhanced care in the community to residents of Neath Port Talbot since 2005, offering a safe alternative to unnecessary hospital admission.
Working collaboratively with WAST they created an innovative model to allow the ACT to access the ‘Live Stack’, ensuring governance and permissions were adhered to.
This model has allowed WAST to redirect 999 calls where patient management would be better suited to receiving community-based care from the ACT.
This was done via a two stage process where initially WAST control clinical desk contacted the ACT with suitable calls, which progressed to the ACT monitoring the ‘Live Stack’ and contacting WAST when they could see suitable calls that could effectively manage in the community.
Option 1 of the pilot was for the clinical desk to monitor the ‘Stack’ and identify suitable calls for ACT, but this was difficult due to the clinical desk capacity issues and the need to monitor the Trust wide ‘stack’.
To overcome this, the team moved to option 2 of the project which meant giving ACT access to the Live Stack so that they could identify suitable calls. The main challenge of option 2 was addressing the information governance arrangements between the two organisations.
The pilot project was undertaken with no extra resources for ACT, which resulted in the Stack not being viewed as often as hoped.
The pilot ran for a five-month period (October 2017 to March 2018). During that time 40 patient calls were taken off the stack by ACT.
Admission to an acute hospital was avoided in 92% (37/40) of the cases taken up by the ACT. None of these were admitted in the 28 days following discharge from the care of ACT.
Collaborative working between two organisations has resulted in trust and respect, enabling the implementation of truly prudent healthcare.
There was a significant cost and time saving to WAST by not transporting these 37 patients and needing to wait outside A&E.
Patient and carer satisfaction was high.
- Complete the evaluation process.
2. Learn from the development process.
3. Continue with the collaborative relationships.
4. Present the evaluation internally to both organisations.
5. Showcase the pilot across Wales and beyond.
6. Lobby strategic bodies for further resources.
Did you know?
Staff reported that the whole experience enabled them to work dynamically and differently. They felt that they were able to offer the patient a choice: whether they were happy to be treated at home as a safe alternative to current practice.
Part of cohort Bevan Exemplar Projects 2017-18