Ciaran McKenna MCPara, reflects on the importance of staff engagement and partnership working to develop pathways and ultimately improve patient care.

The Northern Ireland Ambulance Service (NIAS) provides pre-hospital care for a population of 1.8 million over 5,450 square miles. A fleet of 60 A&E ambulances and 20 Rapid Response Vehicles (RRV’s) respond to an average of 500 emergency calls per day.

The NIAS, was until recently regarded as a “traditional ambulance service” in that the majority of calls they responded to resulted in the patient being transported to the Emergency Department. Within the last two years, NIAS have introduced a number of Appropriate Care Pathways (ACP’s) which offer patients alternatives to the ED which are more appropriate to their needs.

There were a number of factors which prompted the introduction of the Appropriate Care Pathways, however the key strategic drivers were the Donaldson report and the Transforming Your Care (TYC) review. Donaldson advocated expanding the role of paramedics while the TYC report encouraged care closer to home rather than in hospital. Before NIAS introduced the new ACPs, a rigours engagement process took place which included engagement with:

• Ambulance staff
• Patients and service users
• The general public
• Commissioners

Our staff engagement involved meeting both operational staff and management representatives. Our operational staff helped shape some of the pathways e.g. the introduction of a district nursing pathway to help manage calls to patients with blocked catheters. The meetings which were held across Northern Ireland also helped address some of the fears raised by our staff such as “what happens if it goes wrong?”

As a result of these meetings we were also able to change some operational practice following feedback from our staff. The Rapid Response Vehicle (RRV) referral pathway was developed which has enabled RRV paramedics to refer appropriate patients to the Patient Care Service (PCS). The paramedic no longer has to wait on scene for the PCS ambulance to arrive.

Service user feedback was key in developing the pathways and ensuring the service we are providing meets the needs of our community. In addition to articles in the patient client council newsletter, there were also a number of meetings held with a range of service user groups across NI. Two general service user meetings were followed with some pathway specific meetings including Diabetes UK; Epilepsy NI; Age NI and the Northern Ireland Human Rights Commission. The service users were able to question and challenge the proposed pathways and ensure that they would meet their needs. Diabetes UK and Epilepsy NI also provided telephone numbers for advice lines should our paramedics need any advice while on scene. Service user feedback was also important and so patient satisfaction surveys were issued following the implementation of the pathways.

It was clear from the outset that informing the general public would be important in the success of the new pathways. While there is still work to do, a number of initiatives are underway including:

• Ambulance information stands at prominent shopping centres
• School education visits
• Production of a series of short “patient stories” DVDs highlighting the new way of working
• Interviews on local radio stations
• Development of NIAS patient information leaflets
• Enhanced use of social media

The commissioners were involved in the development of all the pathways. We were able to demonstrate how the new pathways would enhance patient care and ultimately result in a better patient experience but we were also able to prove how utilisation of the pathways would benefit the wider health economy in Northern Ireland.

There are now 10 appropriate care pathways across NI which either mean our paramedics can treat the patient at home and refer to a specialist or transport the patient to a facility more appropriate for their clinical needs.

Examples of alternative destinations include:

• Cardiac Cath labs
• Frail / Elderly units
• Minor injury units
• Alcohol recovery centre

Examples of referral pathways include:

• Palliative care referral pathway
• District nursing referral pathway
• Falls referral pathway
• Frail / Elderly acute care at home pathway
• Diabetes referral pathway

To watch Ciaran's presentation from the 2016 National Conference, please click here.

Author: Ciaran McKenna McPara (Clinical Service Improvement Lead, Northern Ireland Ambulance Service)