Practice example: East Midlands Ambulance Service (EMAS) in Lincolnshire.

Who?

EMAS provides emergency 999 care and telephone clinical assessment services for a population of 4.8m people. The service employs more than 3,920 staff and has over 70 facilities including ambulance stations, two emergency operations centres (Nottingham

and Lincoln), training and support team offices and fleet workshops. Lincolnshire is the largest of five EMAS divisions.

What

EMAS in Lincolnshire has been working with strategic partners, clinical commissioning groups (CCGs) and GP practices to develop different ways of working with the aim of reducing the number of journeys to emergency departments (EDs), while

still providing a service that meets people’s needs.

Why?

There is a particular need to reduce journeys to EDs because:

Lincolnshire is a large rural county with only two acute hospitals, meaning that ambulance journeys can be long and time-consuming

during 2017/2018, EMAS lost 72,132 hours to pre-hospital handover delays, equating to the loss of 6,011 12-hour vehicle shifts (an average of 16 shifts a day)
on average EMAS gets an emergency call every 34 seconds
there is over-demand on hospital capacity.

When?

The transformation of EMAS in Lincolnshire began in September 2018.

How?

Transformation priorities and initiatives include:

Active ambulance handover – local managers working with ED staff to support them at times of acute demand in the system.

Electronic patient records – ensuring efficiency in the system.
Home First – with a view to planning for the future, EMAS and partners carried out a one-week audit on all ambulance conveyances to Lincoln and Boston hospitals and looked at what other options and pathways in the community would have been available to patients.
Rotational paramedic service pilot – four specialist paramedics (SPs) work within GP practices focusing on patients who cannot get same-day home visit appointments and are potentially going to call 999 or 111 and need to be conveyed to hospital by ambulance. The paramedics work with GPs to provide a home visiting service with the aim of avoiding visits to EDs.
Care home visiting service – two specialist paramedics are working with a group of care homes in East Lincolnshire which have a particularly high rate of ambulance callout. The paramedics work with staff in the care homes on improving health and wellbeing for the people who live there, with the aim of supporting them to stay at home.

Challenges

Working collaboratively with other organisations. EMAS can and does play a major role in helping them to achieve their goals around transforming services.
Managing to get engagement with system partners as well as the daily EMAS objectives.

Impact

From April 2018 to February 2019 SPs discharged 495 patients on-scene because they could be assessed as not requiring hospital admission.
The rotating paramedic pilot team was the winner of the Lincolnshire Health Awards – Clinical Team of the Year.

Case study

Daisy is an 87-year-old woman living in a small rural village in Lincolnshire with her husband Jack. She has a number of health conditions and needs help with daily activities from her husband. Jack worries a lot about Daisy, but looks after her well.

When Daisy developed flu-like symptoms and didn’t seem her normal self, Jack became very concerned that his wife’s illness might be something serious. He knew that he wouldn’t be able to get a home visit from his GP that day, but remembered a friend had recently been visited at home by a paramedic who had been able to prescribe him an antibiotic for an infection. Jack called the GP practice and was told that a paramedic would be able to visit Daisy that morning. The paramedic examined Daisy and was able to reassure her and Jack that her vital signs were good and her illness was not serious. He also offered to visit them again if they had any further worries.

East Midlands Ambulance Service (EMAS) in Lincolnshire

Scheme