Posts in A&E

NHS needs more advanced paramedics to ease A & E pressure, says NICE

04 July 17

Paramedics with advanced training can reduce the number of patients admitted to hospital unnecessarily, says NICE.

Single paramedic responder

NICE is recommending the NHS provides more advanced paramedic practitioners (APPs) to relieve pressure on emergency departments, in new draft guidance.

Evidence reviewed by NICE shows that using APPs can reduce hospital admissions by 13% compared with standard paramedics.

APPs are able to treat patients in the community, refer them to a GP or decide if they should go to hospital. They can administer stronger pain relief compared with standard paramedics and are able to assess if a wound need stitches.

A previous British Medical Journal study suggests that for each APP, the NHS can save up to £72,000 a year. They can be used on the ground or by sharing their expertise over the phone.

Professor Julian Bion, consultant in intensive care medicine at Queen Elizabeth Hospital and chair of the NICE guideline committee, said: “It is essential we spend what money we have wisely, investing in areas where we’ll see a real improvement in care for everyone.

“Increasing the number of advanced paramedics we have working across the country is one way we can achieve this. Their skills and expertise can help to ease pressure on emergency departments and ensure patients are cared for in the most appropriate location.”

The draft guidance also makes wider recommendations about emergency and acute medical services to standardise care across the NHS. It supports NHS England’s Five Year Forward View for the future of emergency medical services.

These include providing nurse-led support within the community for people who are at risk of hospital admission, for example, if they have recently suffered a stroke or been diagnosed with heart failure. 

Hospitals should consider daily consultant review of patients admitted with a medical emergency including weekends and bank holidays, the draft guidance says.

These patients should also get automatic, seven-day access to physiotherapy and occupational therapy if they need it, the document says.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “This draft guidance features recommendations that seek to standardise best practice across our emergency and acute medical services. It also highlights where we need more evidence to properly assess what should be done to get the most from the limited resources we have.” 

In total, there are 23 practice recommendations and 17 recommendations for more research, such as whether having GPs working in or near emergency departments can help reduce hospital admissions. 

NICE will be consulting on the draft guidance until 14 August.


Original post: 04/07/2017

Community Paramedics Delivering New Model of Care

30 May 17

A new model of care being introduced in East Kent is seeing a reduction in the number of patients being taken to hospital.

South East Coast Ambulance Service NHS Foundation Trust’s, check (SECAmb) new Community Paramedic Programme which went live this month in Whitstable, Canterbury, Faversham and Deal is helping to keep, on average, 15 patients per day out of hospital and treated closer to home.

The reduction in the number of patients being taken to hospital is being achieved through closer working with GP surgeries in the area.

The programme sees teams of paramedics and paramedic practitioners (PPs) undertaking some of the GP home visits on behalf of surgeries while also being responsible for most of the 999 emergency calls in the area.

The GPs will determine which patients are suitable for a paramedic visit, allowing the patient to receive a quicker response and GPs to focus on seeing patients in their surgeries.

If seen at home by a paramedic or a PP, patients will also have access to additional clinical investigations, including 12-lead ECGs, which would not be available with a GP home visit.

Whitstable Paramedic Practitioner Steve Hulks, who has been involved with the programme since its inception said: “Working alongside our GP and community service teams in this way, you feel part of a whole team working together for the benefit of the patient.

“A really good example of this approach working well was when we received a 999 call involving an elderly man who had suffered a fall. As I had already seen him previously on a GP home visit, I was fully aware of the patient’s previous medical history, which we have access to, and was then able to make an informed decision. This meant the patient could be kept at home and referred back to the GP the following day.”


Related article: - Pioneering Service Treats 100 Patients A Week At Home


The Community Paramedic teams will also respond to almost all 999 calls from their communities. Being locally-based, will allow the teams to build closer relationships with patients, local community teams and GP practices, as well as providing a more responsive and effective service.

This new model builds on a pilot which took place in Whitstable, one of the NHS Vanguard sites which received central funding.

Whitstable Medical Practice at Estuary Park was one of the practices involved in the Vanguard programme.

Senior partner Dr John Ribchester said it was a very important step and fully in tune with its model of care under the Vanguard scheme which aims to transform how care is delivered locally.

“The figures have been impressive and we expect it will prove very successful,” he said.

“In our first week we referred 32 patients to be assessed and 20 of them were dealt with by the SECAmb paramedic practitioners, 10 were dealt with at home in liaison with the doctor and only two needed to be referred on for admission.”

“The team also dealt with the referred 999 calls in the area and the transfer to A&E was also down so it has been an excellent start.”

Regional Operations Manager Chris Stamp added: “We’re really pleased with the early stages of this new way of working which ensures better levels of care for our patients and means that where possible more patients are treated in their own homes without the need for hospital treatment.

“We’re looking forward to the further roll out of the scheme across our region as SECAmb is committed to innovation to improve care and experience for our patients and to increase local ties with GPs and other local community services.”

Similar models are already being trialled in other areas of Kent. Plans are being developed to roll these out across the whole region from later this year.

Pioneering service treats 100 patients a week at home

26 May 17

A new service is helping patients stay out of hospital by treating them at home through a community paramedic scheme. 

The service was developed by Encompass in partnership with South East Coast Ambulance Service and means GPs will have more time to proactively manage patients with complex or long-term conditions.

Launched in Whitstable last spring, the service was rolled out in Faversham, Canterbury, Ash and Sandwich in November 2015. 

The programme sees teams of community paramedics undertaking some of the urgent GP home visits on behalf of surgeries. And, on average, they are visiting more than 100 patients per week.

GPs determine which patients are suitable for a paramedic visit, allowing the patient to receive a quicker response and GPs to focus on seeing patients in their surgeries.

The job of the community paramedic is to help an ageing population stay out of hospital and remain independent, thinking about patients’ mental wellbeing as well as their physical health and working closely with GPs and other primary care providers to create a more joined-up service.

Dr Jacky Buchanan, from Whitstable Medical Practice, said that community paramedics can often see patients quicker during the day, in the morning when a GP would not normally visit until the afternoon, which frees up GP time to see more patients with complex or long-term conditions. 

She said: “The paramedics are able to quickly asses and treat patients who have more straightforward conditions, such as those who have had a minor fall or chest infection. 

“This means that GPs can become more proactive by visiting patients with long-term conditions and making sure they have what they need before they request a visit.


“The scheme will change the way a GP service works, from being less reactive to more proactive. Hopefully by doing this we can try and prevent problems from becoming a serious issue or a crisis, avoid the patient having to go to hospital, and giving patients better overall care without unnecessary stress or discomfort.”

Whitstable community paramedic Steve Hulks said: “Working alongside our GP and community service teams in this way, you feel part of a whole team working together for the benefit of the patient.”

Dr John Ribchester, Encompass Chair and Clinical Lead, said the scheme was a good example of transforming care locally. He said: “The figures have been impressive and we expect it will prove very successful.

 “Since the programme was rolled out, the community paramedics have been seeing between 100 and 130 patients per week. Patient and staff feedback has been incredibly positive and early indications show a reduction in the number of patients being taken to hospital. 

“In a survey, 100 per cent of patients asked said they would be completely happy to see that paramedic again. More than 80 per cent of paramedics feel integrating with GPs has increased their primary care confidence, and 75 per cent feel they have been able to provide a better service to the community and patients. 

“The team also dealt with the referred 999 calls in the area and the transfer to A&E was also down, so it has been an excellent start.”

 This new way of working will mean that patients can receive more of their care from their local surgery, without the need to travel to hospital.

Original post by Canterbury NHS 


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