GHP August 2015

ghp August 2015 | 15 industry insight The Trust is an integral part of NHS Wales, providing both emergency and non-emergency ambulance services in addition to responding to around 430,000 calls a year, which come from almost 100 ambulance stations also operated by the Trust. The non-emer- gency service undertook one million journeys last year and the Trust has 2,500 operational staff that crew ambulances or manage calls within its three Clinical Contact Centres. Since 2013, the Trust, which has been operating since 1998, has been going through a process of modern- isation in order to ensure all patients receive a high standard of care and to update outmoded practises. One of the key elements of this modernisation strategy is a one-year pilot of a revised clinical model for the Trust, which has been approved by the Welsh Government and is due to be implemented in Octo- ber of this year. This new model will see a clinically led revision of the categorisation of calls and the standards used to measure the Trust’s response. The current perfor- mance reporting standards were introduced when the ambulance service became part of the NHS in 1974, and despite minor technical revisions in 2005 and 2011, they only look at the time taken for an ambulance to arrive at the scene of a call. There is currently no assessment of the clinical care provided or the outcome for the patient. However, this situation is set to change with the new model using response time and a series of clinical indicators to measure the ambulance service’s performance in responding to the most serious calls, such as cardiac arrests or strokes. For these calls not only is a fast response vital, but also the quality of the care provided will shape the eventual outcome. Measures such as the number of patients surviving cardiac arrest will be used to understand how the Trust is performing, with the new model measuring the service against the treatment provided and the outcome for the patient rather than purely time taken to arrive on scene. These new performance measures are particularly important because the role of the ambulance service has changed. Previously, ambulance crews took patients to the nearest hospital, however stroke and heart attack patients are now increasingly assessed by an ambulance crew and then taken to a specialist unit for treatment, which may not be the local hospi- tal. This means time is not such an important factor, with more emphasis placed upon the quality of the service, the decision-making of the ambulance crew, the treatment provided en route to a specialist unit and how all that impacts on a patient’s recovery. Since 2013, the Welsh Ambulance Service has embarked on a £7m modernisation programme, equipping crews with the latest life-saving technology to provide the best possible treatment for patients. Another key part of the Trust’s modernisation pro- gramme is the purchasing of new equipment. The Trust has invested £7 in a host of new devices, including new drug boxes, which contain a wider range of medication, colour metric capnographs and emergency lifting cushions, which are being fitted to all of the Trust’s Honda CRV Rapid Re- sponse Vehicles. An exciting new product currently being rolled out by the Trust is the Anoto digital pen, designed to save time and increase efficiency by enabling ambulance crews to write notes which are then immediately translated into digital form, improving clinical audit information, saving a significant amount of time and reducing errors. Richard Lee, Interim Assistant Director of Operations at the Trust, commented on how the pens were going impact on the ambulance service. “We are currently finalising the roll out of a digital pen to all emergency service staff. Our clinical records are vital in ensuring that details of the treatment provided to a patient is passed to the receiving hospital unit or their GP or other healthcare professional if the patient is treated at the scene and not conveyed to hospital. “Currently, the Trust has to manage over 450,000 patient clinical records and other associated clinical forms per annum. The move to digital recording of this information in September 2015 will improve our record keeping but more importantly our ability to audit and evaluate the quality of the care we provide. We will also be able to link our data with other parts of NHS Wales to track patient outcomes from the original 999 call through to discharge from hospital. This will allow whole system evaluation and measure- ment of clinical outcomes.” He added that the modernisation programme was vital as the ambulance servicebecomes more central in Wales’ unscheduled care system. “The ambulance service continues to modernise and become a more integrated part of the wider NHS unscheduled and emergency care system. Invest- ment in equipment and technology are central to this transformation but at the heart of all excellent care are our staff who day in, day out, at night, at weekends, in the rain continue to deliver care to our patients. A lot has changed in the ambulance service since 1974 but the care we provide to our patients at their most frightening moments remains at the core of what we do.”