Best Practice at South Western Ambulance Service NHS Foundation Trust
The Community First Responder Lifting Scheme
South Western Ambulance Service’s volunteer Community First Responders already responded to critically unwell patients in their local community with paramedic back-up. The Community First Responder Lifting Scheme set out to test whether Community First Responders (CFRs) could be equipped and trained to assess and lift patients, if provided with clinical support over the telephone.
Non-injurious falls are predominantly assigned the lowest level of response priority (category 4). Whilst clinically appropriate, at times of high demand, patients may experience unacceptably long waits, as ambulances are diverted to critically ill patients.
A clinical review of non-injury fall incidents was conducted and established that the average patient age was 81years and response times ranged from 3-545 minutes.
The CFR Lifting Scheme project was launched following a positive feasibility study in April 2017. The project team engaged with key frontline staff and volunteers at the outset in order to develop an effective operating model. CFRs had not regularly been dispatched to incidents where the patient was not likely to require conveyance to hospital.
This was the first time that CFRs had been empowered to:
- assess fallen patients using a decision support tool
- lift, where appropriate, using mechanical lifting aids
- enable clinicians in the clinical hub to validate the CFR assessment and discharge on scene.
Seventeen CFR groups were selected across the Trust, with training being delivered by local Community Responder Officers before lifting equipment was issued.
Work was also required in the clinical hub to develop a method of identifying and dispatching CFRs to appropriate incidents. Robust governance processes, with detailed evaluation and clear stop criteria, were developed to ensure patient safety.
CFRs and clinical hub staff were engaged at the outset. The Trust’s Right Care project had already embedded a culture of encouraging feedback from staff, with around 2,800 items of feedback received per annum. In addition to normal feedback routes, including Datix, a survey was created specifically for the project, with 78 responses being received from staff and volunteers.
Volunteers were also supported by regular face-to-face meetings. A feedback log was maintained and suggestions have informed changes to practice and guided plans for phase two. Improvements have included a change to the lifting equipment used, adjustments to the patient clinical record and enhanced access to remote clinician support.
CFRs are volunteers and so no additional staff costs were incurred. The total cost of lifting equipment used for the project was £23,659.75 exc. VAT. As a result, in eight weeks, 88 ambulance responses were not required, as these incidents were managed by CFRs with remote clinical support.
Based on the Trust’s published reference costs, each incident resulted in an efficiency saving of £123.81, equating to an overall saving of £10,895.28.
Over the first 8 week period the most significant results included:
- 5% decrease in response times
- 77% of incidents were managed by CFRs using the decision support tool and remote clinical support, without the need for an ambulance response.
- 148 hours operational time saved- time reinvested to attend time critical patients.
- £10,895.28 efficiency saving.
- 4% increase in availability of participating CFRs
- 0 adverse incidents or SIs
- 98% of survey respondents felt that the pilot was important/very important to patient care.
- 92% quality compliance for clinical records.
- 4% increase in allocations to participating CFRs
- 100% of survey responses supported expansion of the project
SWASFT’s Senior Leadership Team has supported the adoption of this pilot, which has now become embedded as normal practice. A decision has been made to expand the project to further groups. There is significant scope to scale up the lifting scheme with an additional 441 CFR groups eligible within the SWASFT area. The Trust plans to use charitable funds to purchase lifting equipment in order to increase the rate of expansion.
With around 40,000 CFRs supporting ambulance services across the UK, there is considerable scope to expand the concept nationally in order to benefit many thousands of older patients.