The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic

2021 ◽  
Vol 6 (2) ◽  
pp. 49-58
Author(s):  
Fiona Bell ◽  
Richard Pilbery ◽  
Rob Connell ◽  
Dean Fletcher ◽  
Tracy Leatherland ◽  
...  
Keyword(s):  
Decision Making ◽  
Healthcare Delivery ◽  
Pilot Project ◽  
Service Evaluation ◽  
Ambulance Service ◽  
Telephone Triage ◽  
Video Technology ◽  
Clinician Satisfaction ◽  
Technical Issues

Introduction: In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process.Methods: This service evaluation utilised a mixture of routine and bespoke data collection. We sent postal surveys to patients who were recipients of a video triage, and clinicians who were involved in the video triage pilot logged calls they attempted and undertook.Results: Between 27 March and 25 August 2020, clinicians documented 1073 triage calls. A successful video triage call was achieved in 641 (59.7%) cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) were also satisfied with the technology and with the care they received. Callers receiving video triage that ended with a disposition of ‘hear and treat’ had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical hub telephone triage alone (16/212, 7.5% vs. 2508/14349, 17.5% respectively).Conclusion: In this single NHS Ambulance Trust evaluation, the use of video triage for low-acuity calls appeared to be safe, with low rates of re-contact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate for or acceptable to patients and technical issues were not uncommon.

PP35 The acceptability and safety of video triage for ambulance service patients and clinicians during the covid-19 pandemic: a service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A15.1-A15
Author(s):  
Fiona Bell ◽  
Richard Pilbery ◽  
Rob Connell ◽  
Dean Fletcher ◽  
Tracy Leatherland ◽  
...  
Keyword(s):  
Decision Making ◽  
Healthcare Delivery ◽  
Pilot Project ◽  
Service Evaluation ◽  
Ambulance Service ◽  
Telephone Triage ◽  
Emergency Operations ◽  
Clinical Support ◽  
Clinician Satisfaction ◽  
Technical Issues

IntroductionIn response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust (YAS) introduced video call technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the Emergency Operations Centre (EOC). We aimed to investigate patient and staff acceptability of video triage, and the safety of the decision-making process.MethodsThis service evaluation utilised a mixture of routine 999 call and bespoke data collection from participating clinicians who logged calls they both attempted and undertook. We sent postal surveys to a group of patients who were recipients of a video triage.ResultsBetween 27th March 2020 and 25th August 2020 clinicians documented 1073 video triage calls. A successful video triage call was achieved in 641 (59.7%) of cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) viewed the technology, the ambulance staff and the care planning favourably.Callers receiving video triage that ended with a disposition of ‘hear and treat’, had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical support desk telephone triage alone (16/212, 7.5% vs 2508/14349, 17.5% respectively.)ConclusionIn this single NHS Ambulance Trust evaluation, the use of video triage for low acuity calls appeared to be safe, with low rates of recontact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate or acceptable to patients and technical issues were not uncommon.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

scholarly journals Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Shared Decision Making ◽  
Vital Signs ◽  
Ambulance Service ◽  
Guidance Document ◽  
Shared Decision ◽  
Clinical Guidance ◽  
Decision Making Model

<p><strong>Introduction</strong></p><p>Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.</p><p><strong>Results</strong></p><p>31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.</p><p><strong>Conclusion</strong></p><p>Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.</p>

PP34 The experiences and attitudes of ambulance staff towards the counter-terrorism ‘PREVENT’ training: a survey-based service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A14.2-A14
Author(s):  
Tessa Mochrie ◽  
Theresa Foster ◽  
Larissa Prothero ◽  
Nigel South
Keyword(s):  
Service Evaluation ◽  
Ambulance Service ◽  
Future Research ◽  
Duty Of Care ◽  
Training Module ◽  
Counter Terrorism ◽  
Service Setting ◽  
Emergency Ambulance ◽  
Question Survey ◽  
Do So

BackgroundUnderstanding the views and opinions of ambulance clinicians about counter-terrorism is limited, as are the roles they have in identifying individuals vulnerable to radicalisation. The aim of this survey was to investigate ambulance clinician views and preparedness to identify individuals at risk of radicalisation and whether the current national PREVENT training offered is suitable for this clinical setting.MethodsA purpose-designed, 18-question survey, was developed to understand staff attitudes and content knowledge of the national PREVENT training module. The survey was opened to all emergency ambulance clinicians in one UK ambulance service during August 2020, resulting in a sample of 123 responses which were analysed using descriptive and thematic approaches.ResultsMost respondents (87%; n=107) were aware of the PREVENT strategy, with almost three-quarters (73%; n=90) receiving training within the previous three years. Respondents were asked to score training received: the majority (89%; n=110) reported 5/10 or less. Whilst most (79%; n=97) identified the correct way to refer an individual, few had completed a PREVENT referral (9%; n=11). ‘Gut instinct’ was utilised by respondents to support their knowledge obtained via PREVENT training (70%, n=86). Respondents felt the national PREVENT training lacked relevance to their role and recommended ambulance-specific training packages be made available. They recognised their responsibility of identifying radicalisation and the opportunities their unique position offered to do so. Having a ‘duty of care’ and ‘moral responsibilities’ to make PREVENT referrals, and the importance of treating individuals as patients (not criminals), was also highlighted.ConclusionsAmbulance staff have highlighted the importance of a clear and robust referral pathway for individuals vulnerable to radicalisation. Current training lacks specificity and effectiveness for the ambulance service setting. As this survey was limited to one ambulance service, future research is warranted to ensure PREVENT training is appropriate for all ambulance staff.

PP31 Patterns of use of ambulance senior support during the COVID-19 pandemic: a service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A13.2-A13
Author(s):  
Fiona Bell ◽  
Andrew Hodge ◽  
Richard Pilbery ◽  
Sarah Whiterod
Keyword(s):  
Patient Care ◽  
Service Evaluation ◽  
Urgent Care ◽  
Call Centre ◽  
Telephone Triage ◽  
Clinical Leadership ◽  
Additional Layer ◽  
Patterns Of Use ◽  
Clinical Support ◽  
Emergency Ambulance

BackgroundIn early March 2020, a senior clinical support cell (SCSC) was established within Yorkshire Ambulance Service NHS Trust (YAS). The SCSC aimed to provide an additional layer of clinical leadership within the Emergency Operations Centre to support call centre and decision support for on-scene ambulance staff working in challenging circumstances. It was staffed by advanced practitioners, doctors and other senior paramedics with range of diverse skills from critical to urgent care. We aimed to understand the patterns of use of a SCSC for emergency 999 calls during the COVID-19 pandemic.MethodsRoutinely collected call data was retrospectively analysed to understand the patterns of use in the first three months of the service. The reason for the call, patient demographic and any regional differences were described. An anonymous survey was distributed to frontline ambulance crews to understand the reasons for contacting the SCSC, or not, and the outcomes of that contact for patient care.Results7296 patient care episodes received either a telephone triage by SCSC for 999 calls or 111 calls transferred for an emergency ambulance response (3160) or had telephone support provided to crews on scene (4136). Telephone triage accounted for 3160 calls where 642 cases (20.3%) resulted in a hear-and-treat outcome, and the findings suggest a low re-contact rate within 24 hours at 2.4%.The primary reasons for crews seeking support/advice from the SCSC were discharge advice or permission (37%); support for pathways in their area (25%); or for cases where patients refused care or conveyance (11%).ConclusionsSCSC was developed in response to the COVID-19 pandemic, and lessons can be learned to prepare for any future significant service challenges as a result of the rapid implementation of the SCSC and the clinical leadership required to support the pace of change and emerging clinical knowledge and practice.

Innovating Healthcare through Remote Monitoring

2017 ◽  
pp. 247-268
Author(s):  
Faustina Acheampong ◽  
Vivian Vimarlund
Keyword(s):  
Decision Making ◽  
Business Model ◽  
Remote Monitoring ◽  
Clinical Decision Making ◽  
Healthcare Delivery ◽  
Work Processes ◽  
Home Based ◽  
Patient Health ◽  
The Government ◽  
Remote Patient

Information technology has been suggested to improve patient health outcomes and reduce healthcare cost. This study explored the business model and effects of collaborative innovation between caregivers and patients on healthcare delivery through remote patient monitoring by interviewing caregivers and surveying atrial fibrillation patients. Findings indicate that remote monitoring enhanced early detection of potential risks and quality of clinical decision-making with patients feeling more empowered and involved in their own care. The remote monitoring system which consisted of a home-based ECG and a web-based service and was offered free to patients, brought together caregivers, patients, service provider and the government as actors. The introduction of remote monitoring increased the workload of caregivers and facilitation of timely diagnostics and decision-making were not realized. IT is an enabler of innovation in healthcare, but it must be integrated into work processes with a viable business model to realize potential benefits and sustain it.

The Administrative Policy Quandary in Canada's Health Service Organizations

2018 ◽  
pp. 334-353
Author(s):  
Grace I. Paterson ◽  
Jacqueline M. MacDonald ◽  
Naomi Nonnekes Mensink
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Health Service ◽  
Policy Development ◽  
Healthcare Delivery ◽  
Service Organizations ◽  
Administrative Policy ◽  
Canadian Health ◽  
Integrated Policy ◽  
Health Service Organizations

This chapter examines the process for administrative health service policy development with respect to information sharing and decision-making as well as the relationship of policy to decision making. The challenges experienced by health service managers are identified. The administrative health policy experience in Nova Scotia is described. There is a need for integrated policy at multiple levels (public, clinical, and administrative). The quandary is that while working to share health information systems, most Canadian health service organizations continue to individually develop administrative health policy, expending more resources on policy writing than on translation/education, monitoring, or evaluation. By exploring the importance and nature of administrative policy as a foundation for quality improvement in healthcare delivery, a case is made for greater use of health informatics tools and processes.

Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working

2020 ◽  
pp. 146531252097367
Author(s):  
Emer Byrne ◽  
Simon Watkinson
Keyword(s):  
Teaching Hospital ◽  
Service Evaluation ◽  
Remote Consultation ◽  
Cross Sectional ◽  
Face To Face ◽  
Level Of Satisfaction ◽  
The Future ◽  
Clinician Satisfaction ◽  
High Level ◽  
Remote Consultations

Objective: To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. Design: Service evaluation involving descriptive cross-sectional questionnaire. Setting: Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. Participants: Patients and clinicians involved in video consultations. Methods: Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations. Results: A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future. Conclusion: The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.

Measurement for Management: Report of a Pilot Project to Quantify Ambulance Misuse for Managers of a Fife Hospital

1989 ◽  
Vol 2 (3) ◽  
pp. 213-216 ◽  
Author(s):  
Donald R. Coid
Keyword(s):  
Health Service ◽  
Simple Technique ◽  
Full Range ◽  
Pilot Project ◽  
Ambulance Service ◽  
Pilot Survey ◽  
Inappropriate Use ◽  
Available Information ◽  
Service Managers ◽  
Management Report

Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies ‘appropriate’ utilisation. A simple technique is suggested to measure ‘appropriateness’ of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the ‘appropriateness’ of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be ‘probably inappropriate’. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.

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