Abstract
Introduction:
It is recognised that there are pressures on the NHS particularly the emergency services. Therefore, a focus of the 21/22 Priorities and Operational Guidance was to develop community services to prevent emergency department (ED) attendance and avoidable hospital admissions. This informed the funding of urgent community response services (UCR). An urgent response is defined as a presentation that would likely result in hospital admission if a response were not made within 2 hours. Quality Improvement methodology was applied to evaluate the potential impact an advance clinical practitioner (ACP) could have in providing alternatives to hospital conveyance by redirecting appropriate calls to the UCR.
Method:
Small scale tests of change with iterations of Plan Do Study Act cycles were conducted to enable comparison and recommendation for the use of the funding. PDSA 1. ACP based in an ambulance station. PDSA 2 and 4 ACP based in 2 different hospital EDs at the point of triage. PDSA 3. ACP based in the clinical hub where 111 calls are triaged.
Results:
These PDSA cycles enabled process mapping of the patient journey to be made and a gap analysis showed the possible interventions an ACP to make to prevent an inappropriate admission. It was apparent that a call stack pull model where the ACP can directly respond to calls from the ambulance list, and often redirect to the UCR service, was the most effective method. Cross organisational information governance issues were found to be a barrier to implementation.
Conclusion:
Small-scale tests of change were implemented to seek the most effective use of an ACP to support alternatives to hospital admission. To introduce this pathway, a whole systems approach is needed to collaboratively provide a seamless service and an overall better experience for all.