Safely Reducing Avoidable Conveyance Programme

Falls Pathway

Brief Description of Initiative

The Non Injury Fallers Pathway is a process by which patients who have accessed the 999 system as a result of a fall, can be assessed by a WAST clinician, and where clinically safe and appropriate, be left at home and avoid admission to A&E.

The process also enables the clinician to make a referral to local services to ensure that the patient received follow up contact, and where appropriate, additional support to enable patients to live safely and independently.

Date Initiative was introduced in Trust

Initial trial in the Swansea area commenced September 2012. Spread and scaled across whole of Wales in the following months.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

The Welsh Ambulance Services NHS Trust (WAST) receives over 460,000 emergency 999 calls each year. Nearly 50,000 of these calls are as a result of falls.

A large majority of these calls fall within WASTs GREEN category of call, which is neither urgent or life threatening. This provides a very large cohort of patients that can be potentially left at home, following a clinical assessment by a WAST clinician. Where clinically safe and appropriate to do so, patients can be referred to alternative pathways of care / follow up without the need for admission to A&E.

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

Falls.

Geographical area or location covered by this response model

Pan Wales.

Key Aims
  • Reduce the number of patients admitted to A&E following a fall
  • Increase the number of patients managed in their own homes where clinically appropriate
  • Utilise local services available to patients.
Benefits for Patients
  • The most appropriate care for the patient, by the most appropriate clinician at the most appropriate time.
  • Care at home with assistance to live independently if required.
  • Avoid unnecessary admissions to hospitals and the risks associated with it.
Benefits for Trust or System
  • More efficient use of resources
  • Reduced number of journeys to A&E
  • Increased availability of resources to respond to 999 calls.
Implementation

1.     How long has this initiative been operational?

7 years.

2.     Days / Hours of Operation?

24 hours / 7 days.

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

Existing staff utilise the pathways, so no extra staff recruitment required.

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

  • WAST Health Information team
  • WAST Informatics team
  • Local Health Boards
  • Local Response Teams
  • WAST Operational Staff

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

  • Paramedic field guide
  • Dedicated telephone number (pan Wales)
  • Robust feedback process
  • Information Leaflets for Patients~
  • Referral Database
  • Automated data collection and reporting

6.     How is the initiative funded? (level of engagement / support from CCGs etc)
The initiative is funded internally with agreed collaborative working with Local Health Boards and response teams across Wales. Engagement with Local Health Boards helped maintain collaborative working practices and safe governance for referrals.

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

The clinical rationale and governance behind the implementation of this pathway was in line with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines. These are the national clinical guidelines used by most UK Ambulance Services. Within these guidelines, non-injury falls patients are recognised as one category of patient that can be managed within the community, following a clinical assessment and provided the patient meets the relevant criteria.

Some challenges were faced when trying to introduce a one stop service across Wales for WAST clinicians, as each different Health Board would receive and manage their calls in different ways. It was important that the front facing part of the process looked the same to all clinicians, but for the appropriate referral process to be followed for each of the Health Boards across Wales. This was reliant on the work of the Health Information team who collate the referrals and pass them on to the Health Boards in the required manner.

Evaluation & Monitoring

1.     What are the key success measures?

    • Number of referrals made
    • Number of A&E avoidances
    • Increased availability of 999 resources
    • Patient safety / risk monitoring
    • Updated when required in response to changes in JRCALC guidance.

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

There is an automated data reporting suite that is updated daily. This can be viewed on our internal data reporting portal.The Health Information team monitor the referrals for any potential issues (for example, repeat referrals from the same patient).

3.     Has a formal evaluation process been undertaken (independent / in-house)?

Yes – in-house.

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

To date, nearly 26,000 patients have been referred via our patient pathways process.

Sustainability

1.     Does the trust intend to continue with this response for the foreseeable future?

Yes. The pathway has been in place for 7 years.Scale and spread has been Pan Wales and continues to operate alongside other pathway initiatives.

2.     What long-term resourcing requirements are there?

Requirement for a 24/7 telephone referral system..

3.     What risks have been identified (for patients / trust / system) in providing this service and how have these been mitigated?

The Health Information team do not work 24/7, so this created an issue with Paramedics’ calls being answered and the referral being made. To mitigate this, currently, our Clinical Contact Centre enter the referrals out of hours, the referral is then held in the system for the Health Information team to complete the referral the next day.

4.     Is there potential to expand this response model?

The model has been expanded to the whole of Wales.

Sharing & Learning

1.     What has the Trust learnt most from introducing this process?

That the referral process needs to be as easy as it is to take the patient to hospital. Therefore, the process needs to be consistent across the whole of Wales for all clinicians.

Additional Information

Download the following for more information on this Initiative.

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