Safely Reducing Avoidable Conveyance Programme

Mental Health Practitioners in the Clinical Hub (Proof of Concept)

Brief Description of Initiative

A Pilot was undertaken placing a Mental Health Nurse from Avon & Wiltshire Partnership NHS Trust (AWP) working in the Bristol Clinical Hub.

Cover was provided between the hours of 1600-0000, initially Thursdays – Sundays inclusive, and then 7 days a week as of 25th February 2021.

The nurses receive referrals of appropriate 999 calls (from within the BNSSG area only) from 3 routes:

  1. Emergency Medical Dispatchers (EMDs) prompted via the C3 CAD to electronically transfer Category 3, 4 or 5 Psychiatric Protocol incidents (as approved by the Executive Medical Director).
  2. Hub Clinicians transferred incidents after ruling out of addressing other medical concerns.
  3. Operational Crews transferred incidents following on-scene assessment, for advice and assessment with appropriate care pathways.

All referrals were subject to the agreed exclusion criteria.

The C3 Specialist Desk Module was initially funded on a trial basis for three months to support the Pilot, and subsequently purchased by the Trust as a product of wider value to the Clinical Hub function.

Date Initiative was introduced in Trust

Pilot undertaken between 15 October 2018 and 14 April 2019.

Date of upload or review

Uploaded to Repository 16 April 2021.

Background Context

In recognition of the growing complexity and frequency of patients calling with mental health related presentations, and the impact that this is having on our staff and resources, placing expert advice within the Clinical Hub was felt to be valuable.

Which specific patient group or presenting need is this response targeted at?

Mental Health presentations.

Geographical area or location covered by this response model

Bristol, North Somerset and South Gloucestershire.

Key Aims

To better support our clinicians to effectively, both confidently and competently treat and refer patients presenting with a MH crisis. This would provide better experiences for staff and patients and would potentially support efficiencies within our front line and Hub resources.

Benefits for Patients
  • Consistent response
  • Patient centred care (physical and mental)
  • Familiarity of terminology
  • Care, support and advice specific to each patient
Benefits for Trust or System

The Trust

  • Learning and knowledge exchange
  • Timely advice and assistance to our front line clinicians
  • Increased appropriate hear and treat

Mental Health Providers

  • Single point of access for emergency personnel for crisis advice
  • Cross service learning
  • More appealing rotational job role

The System

  • Collaboration and sharing of knowledge
  • Reduced impact on emergency departments
  • Reduced ambulance attendance rate
Implementation

1. How long has this initiative been operational?

6 months.

2. Days / Hours of operation:

7 days a week.

3. Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

3 WTE

4. Which other partners are involved in providing the response?

N/A.

5. What other key resources are needed for this response to work? (vehicles, specific equipment etc)

N/A.

6. How is the initiative funded? (level of engagement/support from CCGs / COVID funding etc)

The funding was a lump sum of £65000 agreed in March 2018 for Ambulance Resilience Winter Pressures.

7. What were the main facilitators / blockers / interdependencies when introducing this response?

It has been challenging recruiting staff to populate the rota.

Evaluation & Monitoring

1. What are the key success measures?

Positive feedback from stakeholders (Clinical hub, Operations and the Mental Health Partnership Trust).

2. How are these being measured / collated / monitored? (frequency / who reported to etc)

Incidents whereby the initiative interacted were documented on the dispatch system and then reviews by a clinical manager.

3. Has a formal evaluation process been undertaken (independent / inhouse)?

Yes (in brief)

4. What are the current findings in terms of the success measures?

 

Sustainability

(We are currently running another pilot in the same vain to test this as the initial ‘proof of concept’ was relatively small scale).

Additional Information

Final Report – Mental Health Nurse in the Clinical Hub (Pilot)

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Please note, this enquiry facility is for the use of NHS colleagues to find out about the set up of this initiative. Patient enquiries about a case or care experience need to go direct to the relevant ambulance NHS trust.

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