Quality successes throughout the year
Stroke video triage
In August 2022 we began a trial of a stroke video triage and currently have two pilot sites across the east of England, one is north Cambridgeshire and the other in west Essex. This pathway enables ambulance clinicians to connect via FaceTime on their iPads to stroke senior registrars and consultants whilst on scene with patients. Both clinicians will then agree the correct pathway for the patient which can be from determining a time critical stroke patient, booking a computerised tomography (CT) scan prior to arrival of the patient, and the patient being met by the stroke team at the front door of the Acute Stroke Centre (ACS) or Hyper Acute Stroke Unit (HASU) and taking the patient directly to the CT scanner, to determining that the patients presentation is unlikely to be a stroke for example functional neurological deficit or systemic infection, and as such diverting the patient away from the acute stroke centre to their nearest emergency department. In some cases, patients can be deemed to not require conveyance, and can be managed in the community or if required seen either the same day or the following day in a transient ischaemic attack (TIA) clinic.
To date, within north Cambridgeshire; 76 patients have been triaged; 35 diverted from ASC/HASU, 34 directed straight to a CT scanner and 7 patients not conveyed. Early results show a significant reduction in door-to-imaging times (22 minutes down to 2 minutes) and door-to-needle times (55 minutes down to 15 minutes). There has been very positive feedback from patients, ambulance crews, the emergency stroke team, radiologists and emergency department colleagues. A full evaluation will take place in August 2023.
An expression of interest is currently out to all east of England stroke centres to participate in this project, with a view to expanding the pilot more widely across the region.
Electronic Patient Care Record (ePCR)
EEAST began rolling out its new Electronic Patient Care Records (ePCR) iPad solution in April 2021 with all regions rolled out by October 2021. Following the roll out there was a transition period while staff got familiar with the devices and received training on how to use them.
In the past 12 months we have seen a steep increase in the usage of the new system within the Trust now seeing overall compliance of 92%. This is the highest usage of an ePCR system that the Trust has ever seen, and we are now looking to expand the availability of devices to our private providers who support our frontline operations.
The product continues to be developed to further improve its functionality; our imminent next release will include digital Recognition of Life Extinct (RoLE) forms further reducing the Trusts use of paper records.
Future plans also include completing safeguarding referrals on the device which will help to reduce on scene times.
Wound care
Following the development of a dedicated EEAST skin tear management pathway in collaboration with the dressings provider in 2020. This was peer reviewed by tissue viability nurses across the east of England. The aim of this was to eliminate clinical variation and to promote excellent practice across all clinical grades when dealing with this common wound type, this approach was unique among UK Ambulance Trusts and although face-to-face training was ceased due to the COVID-19 pandemic, this was quickly moved to a full and innovative use of Microsoft Teams.
In February 2023, the industry-leading work EEAST has put into assessing and managing patients with skin tears over the course of the last 3 years was recognised by the prestigious Journal of Wound Care, after being shortlisted for an award at its annual ceremony in London.
While missing out on first place for the award of 'Safe and Effective Wound Care in a Non-specialist Setting', EEAST picked up second place and the silver award.
Frontline staff continue to be able to undertake Biatain Silicone skin tear assessment and management training at any time via our online training tool, or by approaching a local specialist or advanced paramedic in urgent care.
Advanced Practice (Urgent Care)
Recognising that it is more appropriate to treat some people at home rather than convey them to hospital, EEAST launched dedicated teams of specialist and advanced paramedics in urgent care in Swaffham, Cromer, Waveney, Cambridge, Ipswich, Weeley, Basildon and Stevenage on 19th December 2022.
These were targeted to low acuity calls with the primary aim of providing safe and effective 'see, treat and discharge' services, meaning patients are managed closer to home.
This also assisted with system pressures in these areas with less patients being transported to acute Trusts and enabled more ambulances to be available to attend high acuity calls.
As well as the benefits to patients it enables a career progression pathway for EEAST staff in line with our Urgent and Emergency Care Strategy.
To date this team of staff has provided 1,700 responses with an average of 74% of these patients being seen, treated and discharged on scene.
In line with the strategy, this will be further developed in collaboration with the integrated care systems in our region.
Repose mattress topper
EEAST, like all other ambulance services, has seen many delays in handing patients over at hospital and staff will do as much as they can to help keep patients comfortable however the risk to patients of pressure ulcers is increased during this time.
Following on from his service improvement module within his paramedic course, a paramedic from west Norfolk had transported a 94-year old patient with pressure ulcers to hospital and was delayed outside for over two hours, and utilised a Repose mattress. He recognised that this improved the patients comfort as well as improved some of their observations, such as respiratory rate, heart rate, blood pressure and pain score.
In 2022, he was approached by our quality improvement team with a view to taking this further as a QI project.
Working with our hospital partners and management teams he has successfully implemented this in three hospitals within the Norfolk and Waveney area.
Part of his project included a survey of staff who had used the mattress. Some of the feedback to date has included ‘made my patient so happy and comfortable’ and ‘why can’t these be utilised at all hospitals across EEAST’.
He is currently in the process of launching it at hospitals in west Suffolk, Ipswich, Colchester and Harlow, with initial contact made with others.
'The feedback from the patients and the crews is amazing and continuously spurs me on to implement this idea across as many hospitals within the EEAST region as possible. During these difficult times of long delays and frustration, it may seem the smallest of things to be able to make someone comfortable, but the hidden benefits of reducing indirect harm, decreasing acute pressure ulcers, reducing pain scores, decreasing agitation and improving a patient’s observations, to me, is a success.’ - Paul Barnard, SRP West Norfolk.
Healthcare Professional (HCP) Portal
EEAST has worked collaboratively with one of its healthcare provider partners, IC24, to develop the HCP Portal. IC24 provide NHS111 services in Mid and South Essex and Norfolk and Waveney. The HCP Portal allows clinicians in both localities to electronically refer patients to NHS111 via their Trust issued iPad, and reduces the time taken for the patient to achieve their healthcare outcome.
Both patient and staff experience shall be improved by using this solution as well as finding operational efficiencies for both organisations.
Unmet Needs Facilitator Scheme
A family struggling to pay the bills and a man sleeping rough are among the patients that have been helped by a pioneering programme set up by EEAST to signpost patients to services able to help unmet needs.
The programme – which went live in mid-October 2022 after EEAST’s charity received a grant of £116,624 from NHS Charities – has now reached a significant milestone after helping over 500 patients with issues that have come to light following a 999 call and a conversation with EEAST staff.
The funding has seen the introduction of a dedicated team of navigators for patients with unmet needs who follow up referrals from EEAST and assess what community and social support is available in each case.
This new referral pathway has been embraced at EEAST by ambulance crews, community first responders and clinicians in control rooms as they often see patients who require additional help beyond what the ambulance and NHS can immediately offer.
The team of navigators link in with local authorities, social care partners, link workers and integrated care bodies and have also established contacts with other community and social pathways.
Collision Analysis and Support Team (CAST)
As part of ongoing work to improve professional standards at EEAST, including driving standards, the Trust has trained a team of five staff members to undertake analysis of collisions involving Trust vehicles.
By using specialist techniques in assessing the scene of the collision, including measurement and photography, and utilising the onboard vehicle telemetry, the team can identify themes and trends in vehicle and driving behaviour to reduce the chance of damage and harm. The team is also able to support staff involved in collisions to improve their wellbeing at what can be a distressing time.
Over the coming 12 months, additional work will be undertaken to utilise available technology further to automatically identify learning themes to improve driving standards across the region.
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