Read our 'Clinical Strategy' - Scottish Ambulance Service

32 Pages·2011·1.2 MB·English

Scotland
CliniCal
Strategy

2011 - 2015
Scotland
CliniCal
Strategy

2011 - 2015
CONTENTS

Preface
1. Introduction 3
2. Our Vision for the Future 6
3. Quality and Patient Safety 10
4. Developing our Clinical Workforce 16
5. Clinical Standards and governance 21
6. technology to Support Clinical Decision Making 24
7. Our Commitments 27
Scottish Ambulance Service Clinical Strategy 2011 - 2015
PREFACE
the role of the Scottish ambulance Service is changing. Our
Strategic Framework “Working together for Better Patient Care
2010 - 2015” was published in January 2010. Our strategic
direction takes into account extensive consultation and
engagement with patients and their carers, the public and key
stakeholders across the NHS, charities and the voluntary sector,
as well as other emergency services. the Strategic Framework
sets out a range of commitments for continuous development of
our services, which are both aspirational and ambitious.
Our aim is to develop world class clinically-focused ambulance
services which will:
• provide a national specialised unscheduled care service 24/7
• enhance our provision of pre-hospital care and treatment
• support patients and the wider NHS by treating more
above all else, the Scottish patients in their homes, better meeting those patients’
needs and preventing unnecessary trips to hospital
ambulance Service will strive
• focus ambulance patient transport resources on patients
with a clinical or medical requirement to get to and from
to deliver consistent, high
hospital appointments/discharges/transfers.
quality evidence based
above all else, the Scottish ambulance Service will continue
care to our patients.
to build its capability for the consistent delivery of high quality
evidence based care to our patients. this will be underpinned
by robust clinical governance and an improved educational
infrastructure which is embedding professionalism. this
document describes the strategic clinical framework within
which these ambitions and aspirations will be delivered.
thank you to everyone who contributed to the development
of this clinical strategy. I am confident that this will enable the
Service to realise its vision to deliver the best care for people
in Scotland, when they need us, where they need us.
george Crooks
Medical Director
2
1
INTRODUCTION
STRATEGIC CONTEXT
Scotland is changing: many people are living longer healthier lives; while at the
same time Scotland also has an increasingly elderly population, presenting a
significant challenge for the NHS. Scotland’s population is projected to rise from
5.1 million in 2006 to a high of around 5.4 million in 2031.
the number of younger people in Scotland In January 2010 the Scottish ambulance
is projected to decline, whilst the number Service published “Working together for
of older people is projected to rise by Better Patient Care”2 our five year Strategic
around 30% over the same time period. as Framework, setting out our strategy to
a result of the increasing number of older deliver the best care for people in Scotland,
people, demand on our Health Service is when they need us, where they need us and
changing with a much higher incidence of with three main goals to:
chronic disease and long term conditions.
at the same time, health technology and • improve patient access and referral to
clinical practice is advancing enabling more the most appropriate care
patients to be treated faster and better and • deliver the best services for patients
closer to home rather than in a hospital • engage with all our partners and
environment. the field of pre-hospital care communities to deliver improved
is also growing, with the development healthcare.
of treatments and equipment tailored to
the out of hospital environment, further this clinical strategy sets out the clinical
improving the quality and effectiveness of framework within which we will develop
care for critically ill or injured patients. and deliver clinical excellence across all
of our services. the strategy also aims
In 2007, Scottish government published its to define the key purpose, vision and
“Better Health, Better Care: action Plan”1 ambition of Scottish ambulance Service to
which articulated the vision for a Healthier be the provider of choice in the provision
Scotland, enabled by a programme of of emergency and urgent care services
comprehensive and targeted action to within the pre-hospital environment. Our
accelerate progress on health improvement, aspirations are to deliver 24/7 mobile
reducing health inequalities and improving healthcare services to people in Scotland,
the quality of healthcare. “Better Health, and in doing so ensure that we:
Better Care” set the policy direction and a
range of measures to improve the quality of • are clinically focussed and responsive
our health service, and placed much greater to patient need
The field of pre-hospital care is
growing with the development of emphasis on shifting the balance of care, • achieve improvement in both patient
treatments and equipment tailored extending anticipatory care approaches, outcomes and patient satisfaction
to the out of hospital environment. developing early intervention programmes • are innovative and drive continuous
and in particular it committed to providing quality improvement by introducing
local care wherever possible, embedded in new evidence based models of care
communities and tailored to individual need. supported by the application of new
technology
• demonstrate high performance, attaining
and exceeding international standards
of excellence evidenced through
benchmarking our service against world
leaders in pre-hospital care.
1 Better Health, Better Care 2007
2 Working together for Better Patient Care 2010-2015
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
In developing our strategic framework, we have ensured that Our air wing provides an emergency response or essential
our aspirations and ambitions are aligned with the vision hospital transfer service for the islands and remote and
and policy set out in “Better Health, Better Care” and the rural areas. the air ambulance deals with more than 4,000
subsequent Healthcare Quality Strategy for NHS Scotland3 incidents per year and we transport over 90,000 patients
published in May 2010. between hospitals by road and air annually.
Our Services We have three emergency Medical Dispatch Centres based in
glasgow, edinburgh and Inverness, which handle in excess of
the Scottish ambulance Service is a Special Health Board. 800,000 calls for help each year, ranging from life threatening
We provide services from 179 locations across Scotland which emergencies to planned care for patients with chronic long
are currently delivered through five geographically based term conditions.
operational divisions. We cover the largest geographical area
in the UK, responding to life threatening emergency calls, Our National risk and resilience Department (NrrD)
increasingly preventing unnecessary hospital attendances or provides an integrated system of management and
admissions by treating or referring people at the scene and governance for resilience, encompassing the disciplines
by taking people who have a clinical requirement to and from of corporate risk management: including adverse incident
hospital as part of a planned episode of care. We respond reporting, business continuity management, emergency
to 600,000 emergency and urgent calls per annum, we preparedness and also aspects of security. the Special
undertake 1.5 million journeys supporting patients in need Operations response teams provide a trained response to
of ongoing scheduled care. major incidents in addition to responding to over 8,000
calls each year.
3 Healthcare Quality Strategy for NHS Scotland
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
Our Clinical Strategy Our clinical strategy also aims to support our corporate vision
to put patients and the public firmly at the heart of everything
Our Clinical Strategy aims to set out our aspirations for the we do and to ensure our models of care are leading edge,
clinical development of our service and our staff to meet innovative and integrated within the wider NHS.
the changing demands and expectations of both clinicians
delivering care and patients as the recipients of that care. Putting patients at the heart of everything we do
Our aspirations to enhance clinical skills and practice
within the pre-hospital care environment are founded upon Delivering a world class ambulance service requires a
the principle that the care we provide to patients will be concerted and coordinated effort across all aspects of
evidence based and supported by the continued professional the organisation, taking account of evidence based good
development of our workforce within an organisational culture practice guidelines, through the application of clinical quality
geared to support clinical excellence. improvement methods, by increasing our research and
development capability, and by enhancing opportunities
this document aims to articulate: for continued professional development and learning within
a robust clinical governance framework.
• our vision for the future clinical development of our service
• our priorities around patient safety, minimising clinical risk the Clinical Strategy does not sit in isolation: it is supported
and improving clinical effectiveness and enabled by an organisational infrastructure designed
• our commitment to continuous quality improvement to ensure an integrated approach to service development
• our aspirations for ongoing clinical development within and improvement. Diagram 1 below demonstrates the
our workforce infrastructure and key relationships within which this
• the clinical standards and governance arrangements framework for clinical development sits, and the various
within which we operate elements of the integrated organisational infrastructure
• our plans to enhance and support clinical decision essential to deliver and achieve our ambitions.
making through better use of e-health and technology
• our priorities and commitments over the next three
to five years.
WORKING TOGETHER
Diagram 1 Service
Delivery Plans
Our performance
Learning and and response HR and
Development
Organisational
Strategy
Development Strategy
Our Career Framework
Our values

Delivering
Clinical Excellence
Continuous
Quality Improvement Patients at the heart Governance

Our clinical standards
Our quality ambitions

Research and
e-Health &
Development
Technology Strategy
Framework
Enabling innovation
Our evidence base

the role of the Medical Directorate is key to the delivery of clinical excellence, in providing clinical leadership, focus and
direction to clinical staff, constantly seeking out opportunities to improve patient safety and the clinical quality of services to
patients and service users.
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
2
OUR VISION FOR
THE FUTURE
“Working together for Better Patient Care” established our vision to deliver the
best patient care for people in Scotland, when they need us, where they need
us; and with these main goals:
• to improve patient access and referral to the Our Clinical Strategy is intrinsically linked to the delivery of our
most appropriate care Strategic Framework. We aim to optimise our unique position
to be able to work across boundaries in primary, secondary
• to deliver the best service for patients
and tertiary care through a range of national clinical networks.
• to engage with all our partners and this will be increasingly important in the current financial
communities to deliver improved healthcare. climate as we support our wider NHS partners to maintain
high quality and cost effective care. emerging technologies
and their adoption across the service will better allow us
to assess, monitor and manage patients in the community
without the necessity of hospital attendance. advances in
monitoring, decision support and other enabling technology
solutions will better support our clinical workforce to manage
patients with the aim of maximising clinical effectiveness,
supporting improved patient safety and improving outcomes.
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
Our Aspirations for Clinical Excellence
the delivery of excellent patient care is central to our core Our Clinical Strategy embraces these values and aims to
values and to achieve this we are reliant on our greatest strengthen the delivery of clinical care by promoting these
asset: our staff. We recognise that their ongoing commitment, through strong visible clinical leadership that ensures
dedication and passion are vital ingredients in the delivery of respect, integrity, clinical competence, equal contribution
our objectives. and teamwork are central to the way in which we deliver
care to patients.
Our core values were developed in partnership with our
staff and partners, following extensive consultation and One Service
engagement as follows:
Our vision for the future is for One ambulance Service,
• putting the patient at the heart of everything we do providing scheduled and unscheduled care, (Diagram 2)
• acting with integrity, openness and honesty capable of providing the right response at the right time,
• treating each and everyone with respect first time, every time.
• encouraging learning, creativity, innovation and
new ways of working Developing the model for the future will ensure greater
• challenging abuse, discrimination or harassment. integration with the wider NHS, closer collaboration with
unscheduled care providers and primary care to improve
clinical triage and offer a range or alternative referral options to
ensure patients get access to the most appropriate treatment.
Diagram 2
999
Emergency Scheduled
Unscheduled Request
SAS
Triage Tool Referral
Triage
Dispatch
Book
Emergency or
Scheduled
Unscheduled
Specialist Enhanced First Other
A&E PTS IHT Discharge Skill
Retrieval Responders Providers
Paramedics
Service
Delivery
Skills Resources Engagement Quality Governance Manage Priorities
Expectations
Follow-up &
Review Process
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
Our Key Aims •
Over the next five years our key clinical aims are to • in conjunction with all providers, (primary and secondary
systematically enhance the provision of pre-hospital care and and social care) agree consistent care pathways for a
referral pathways. In terms of our clinical strategy our priorities range of long term conditions that can effectively deal
will be focussed on improving the patient journey and in with exacerbations of the patient’s condition, for example,
particular: breathlessness, heart failure, falls, frailty in older people,
drug and alcohol misuse and mental health
• ensuring that our care is safe, effective and patient centred
• enhancing specialist skills within our paramedic
• enhancing initial telephone triage and first clinical practitioner workforce to support:
assessment, supported by the introduction of the - the management of major trauma
Single Common triage tool - the delivery of more bespoke and specialist care
for paediatrics
• getting the right response to patients first time, every - the care of vulnerable adults
time, extending and enhancing the alternatives to hospital - greater awareness of developments and best practice
attendance, for example, “hear and treat”, providing self in child protection
care advice, referral to a member of the primary care team - the care and transfer of intensive care patients
i.e. pharmacy, district nursing, health visiting, community - the clinical skills required to improve the delivery of
psychiatric nursing teams etc specialist retrieval services
• working collaboratively with primary care to better manage • electronic transfer of our ePrF (electronic patient record
patients with long term conditions form) to gPs and hospital clinicians to ensure patient
follow up, continuity of care and better case management
• sharing information with primary care, having access and
input to anticipatory care plans to enable paramedic • optimising the use of e-health and tele-health technology
practitioners to effectively participate in the case to provide remote diagnostic and clinical assessment
management of high risk patients or frequent support to paramedics, particularly in remote and rural
users of emergency services communities where the transfer is often only undertaken
for a routine diagnostic procedure
• increasing the range of primary care we deliver in the
pre-hospital environment by extending our current scope • enhance diagnostic capability within the service,
of practice and increasing see and treat protocols for e.g. near patient testing, sonography etc.
minor illness and injuries in order to reduce avoidable
and unnecessary attendance at hospital Our Model of Care for the future is articulated in the following
section (table 1).
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Scottish Ambulance Service Clinical Strategy 2011 - 2015
Our Model of Care
Table 1
Now The future
Initial telephone triage Single common triage tool
• Ambulance specific • Integrated system wide context
• Protocol driven • Flexible
• Condition specific focus • Person centred
• Limited referral/response options • Response and referral options tailored
to patient needs
Face to face assessment Technology enabled
• Rapid response • Rapid response appropriate to clinical need
• Comprehensive assessment but limited • Comprehensive assessment which can be
diagnostic capability supported by tele-medicine and e-health
• Limited diagnostic equipment solutions enabling better diagnosis
• Access to patent information limited • Improved medical equipment particularly
• Limited referral options – largely referral to support diagnosis and assessment
to a&e • A menu of referral options and referral
• Limited range of see and treat protocols pathways and alternatives to hospital
Treatment Treatment
• Effective life saving interventions • Effective life saving interventions
• Increasing use of supporting technology • Additional medicines available for
• Limited medications available treatment on scene
• Limited opportunities for review • Ability to review patients left at home
• Limited communication with General • Transfer of all relevant pre-hospital records
Practice to a&e or alternative receiving unit
• Limited transfer of pre-hospital • All interventions communicated to
information to receiving a&e unit gP and primary and social care team
• Limited “See and Treat”
For our staff For our patients
• More chance to extend skills to advanced • Improved safety and quality
practitioner level and support diagnosis • A seamless service with consistency in
in pre-hospital environment terms of response from SaS or
• Better access to clinical decision support unscheduled care
through telephone, tele-health, mobile • More care delivered locally at home
technology to support care at home • Increased patient satisfaction
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