esr good practice guide for ambulance services and their commissioners

8/12/2019 ESR Good Practice Guide for Ambulance Services and Their Commissioners

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EMERGENCYSERVICES

REVIEWGood Practice Guide for Ambulance Services

and their Commissioners


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Emergency Services Review

Good Practice Guide for Ambulance Servicesand their Commissioners

Au thor Jonathan Brother ton

Foreword Anthony C Marsh

Editors Claire Burden, Russell Emeny and Ian Merrick

The Emergency Services Review was co-ordinated byNHS Interim Management and Support on behalf of theOffice of the Strategic Health Authorities

Thanks go to everyone involved with the project


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Good practice guide for Ambulance Servicesand their commissioners

CONTENTS

Section Page

Foreward 1

1. Introduction 2

2. Ambulance Service Commissioning 3

3. Whole System Working and Effective Partnerships 4

4. Operational Performance - Understanding Demand 6

5. Operational Performance - Aligning Resour ces to Demand 7

6. Operational Perfo rmance - The Call Cycle and EmergencyOperations Centres

9

7. Escalation 11

8. Summary 12

Appendix A - Bibl iography 13

Appendix B - Emergency Access Algorithm 16

Appendix C - Example of Resource Escalatory Act ion Plan 17

The Emergency Services Review has produced a set of guidance and tools. Thefollowing publication is part of this series of documents. The publications are:

A comparative review of international Ambulance Service best practice Good practice guide for Ambulance Services and their commissioners Good practice in delivering emergency care: A guide for local health communities System resilience: A review of NHS emergency care performance during recent

winters Intensive support diagnostic toolkit: Tools and user guide

These publications are all available in PDF from http://www.osha.nhs.uk . Pleasecontact [email protected] for hard copies or with any queries.
http://www.osha.nhs.uk/mailto:[email protected]:[email protected]://www.osha.nhs.uk/


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FOREWORD

The Emergency Services Review was instigated following the winter of 2008 to identifya focused set of actions to support local health economies in the development ofresilient, sustainable and integrated emergency and urgent care systems. The reviewhas focussed on improving emergency ambulance service delivery through astrengthened whole-system approach. This guide is one of a number of tools that are aproduct of the review.

In acknowledgement of the excellent guidance notes and good practice that is availablefor Ambulance Trusts and their Commissioners this paper does not attempt to introduceadditional new ways of working. The overriding aim is to support commissioner drivendelivery and maintenance of key national performance standards by bringing togetherpreviously published guidance into a single point of reference. In doing this, a practical,pragmatic and accessible guide has been created.

We all recognise the importance of providing an excellent level of service and I hopethat this document will support further improvements.

Anthony C MarshChief Executive OfficerWest Midlands Ambulance Service NHS TrustNational Professional LeadEmergency Services Review Programme

1 Foreword


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Introduction 2

1. INTRODUCTION

1.1 This document draws together and signposts the majority of relevant, publishedUK Ambulance Service guidance. It is aimed at:

Ambulance Service Managers

o To highlight established good practiceo To share knowledge and expertise across the country

NHS Commissioners

o To highlight established models, techniques and efficiencieso To foster innovation and efficiency through informed commissioning of

ambulance serviceso To further ensure emergency care standards are commissioner-driven

and performance managed

Other partners in unscheduled care

o To advance improvements in unscheduled care pathways for the benefitof patients and local health communities

1.2 We have carried out an extensive literature review and have also consulted

senior ambulance service leaders, ambulance commissioning specialists andother ambulance service specialists. A full bibliography is contained in Appendix A, with full URLs.

1.3 The most relevant sections have been sign posted for easy navigation.Hyperlinks are included in the electronic version to take the reader to relevantdocuments without the need to search Department of Health and NHS websites.

1.4 If you would like to comment on this guide, please email [email protected] .
mailto:[email protected]:[email protected]


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3 Ambulance Service Commissioning

2. AMBULANCE SERVICE COMMISSIONING

2.1 Ambulance services should be commissioned to encourage shared ownership ofurgent care across healthcare systems. The system needs a congruent view ofurgent care requirements and priorities. Ambulance services should becommissioned by a consortium of Primary Care Trusts (PCTs) with agreeddecision making processes and a lead commissioner. This is now commonpractice, but must be universal, as described in the Guidance on the StandardNHS Contract for Ambulance Services .

2.2 The 2005 Department of Health report, Taking Healthcare to the Patient -Transforming NHS Ambulance Services , contains a number of commissioningrecommendations including:

PCTs should integrate ambulance commissioning within their strategiccommissioning plans for all urgent and emergency care

The commissioning of NHS Direct, out of hours services, and other urgentcare services should be integrated to produce a coherent service model

SHAs should work with PCTs to ensure that Ambulance Trust resources areincluded in capacity plans for primary care and for urgent care

2.3 Driving change: Good practice guidelines for PCTs on commissioningarrangements for emergency ambulance services and non-emergency patienttransport services is designed to assist PCTs in leading the commissioning

process to achieve the necessary system reform outlined above.

2.4 World Class Commissioning (WCC) aims to improve the health and wellbeing ofpeople in England through improvements in the way that health and careservices are commissioned by PCTs. The new World Class Commissioningsupport and development website brings together:

The latest WCC news The most relevant WCC events and master classes The best guidance, tools and case studies A discussion forum to share ideas and concerns

2.5 Two useful documents demonstrate how the North West of England has adoptedthe World Class Commissioning framework for the commissioning of AmbulanceServices:

World Class Commissioning of Ambulance Services in the North West World Class Commissioning Competency Framework

2.6 The Primary Care Foundations Urgent Care a practical guide to transformingsame day care in General Practice has much to attract commissioners of

ambulance services. It has a suite of recommendations on pages 6 and 7. Casestudies two and eight highlight more appropriate use of ambulance services.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://wcc.networks.nhs.uk/http://wcc.networks.nhs.uk/http://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WORLD%20CLASS%20COMMISSIONING%20v4.pdfhttp://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WORLD%20CLASS%20COMMISSIONING%20v4.pdfhttp://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WCC%20Competencies.pdfhttp://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WCC%20Competencies.pdfhttp://www.primarycarefoundation.co.uk/page9/page19/page19.htmlhttp://www.primarycarefoundation.co.uk/page9/page19/page19.htmlhttp://www.primarycarefoundation.co.uk/page9/page19/page19.htmlhttp://www.primarycarefoundation.co.uk/page9/page19/page19.htmlhttp://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WCC%20Competencies.pdfhttp://www.seftonpct.nhs.uk/Library/Better_Life_Better_Health/Planning_for_better_future/NWAS%20WORLD%20CLASS%20COMMISSIONING%20v4.pdfhttp://wcc.networks.nhs.uk/http://wcc.networks.nhs.uk/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Web


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Whole System Working and Effective Partnerships 4

3. WHOLE SYSTEM WORKING AND EFFECTIVE PARTNERSHIPS

3.1 The Department of Healths Guidance on the Standard NHS Contract for Ambulance Services explains how the Contract can be used as a tool forassuring accountability between Providers and PCTs and for improvingperformance. The guiding principles and expected behaviours in section 2outline a whole system approach where effective partnerships are fundamental.

3.2 To commission and provide ambulance services that are safe and provide valuefor money there needs to be:

An agreed vision for emergency and urgent care An effective mechanism to enable a whole systems approach

3.3 The Health Care Commissions Not Just a Matter of Time a review of urgentand emergency care services in England is an extensive review focussing onhow services are accessed, delivered and managed across an area. It highlightsa lack of awareness and understanding of the range of new services that havebeen introduced in recent years. It also identifies many of the problems patientsexperience on the pathways they follow into urgent and emergency care. Wherepatients are dealt with by the first service they contact, their care usuallyproceeds smoothly. But where patients are transferred or referred betweenservices, they can experience problems. A summary of its recommendations arecontained in Next Steps on pages 52-60.

3.4 A vision for emergency and urgent care: the role of ambulance services , whichwas published by the Ambulance Service Network, outlines the challenges facinghealth services across the Western world: an ageing population; an increase inlong-term conditions; and changing expectations and demands from patients andthe public. Ambulance services have a vital role to play in addressing thesechallenges and ensuring all patients get the right care, in the right place, at theright time. This report outlines how ambulance services can work with thecommissioners and providers of health and social care to save lives, improvehealth and tackle inequalities. There are also a set of urgent care case studies on the Department of Health website that demonstrate whole system integration.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.cqc.org.uk/_db/_documents/Not_just_a_matter_of_time_-_A_review_of_urgent_and_emergency_care_services_in_England_200810155901.pdfhttp://www.cqc.org.uk/_db/_documents/Not_just_a_matter_of_time_-_A_review_of_urgent_and_emergency_care_services_in_England_200810155901.pdfhttp://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.dh.gov.uk/en/Healthcare/Urgentcare/DH_4119561http://www.dh.gov.uk/en/Healthcare/Urgentcare/DH_4119561http://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.cqc.org.uk/_db/_documents/Not_just_a_matter_of_time_-_A_review_of_urgent_and_emergency_care_services_in_England_200810155901.pdfhttp://www.cqc.org.uk/_db/_documents/Not_just_a_matter_of_time_-_A_review_of_urgent_and_emergency_care_services_in_England_200810155901.pdfhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179672&Rendition=Web


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5 Whole System Working and Effective Partnerships

3.5 Pressures within emergency and urgent services affect the whole health andsocial care system. Faster, more convenient access to emergency care cannotbe delivered and sustained without co-operation across the system. TheEmergency Care Networks Checklist (ECNs) provides a how to guide to createthis key mechanism for achieving and managing that co-operation. This checklistreaffirms that availability of intelligent data is crucial to managing the emergencycare system. Ambulance Trusts providing demand and clinical data on actualillness on a regular basis can support commissioners and ECNs to takeownership of activity. Data provided at practice level can enable GPs andPractice Based Commissioners (PBC) to support action to find appropriatealternatives to hospital care. More specifically, Measuring the Benefits of theEmergency Care Practitioner (ECP) details how ECNs can determine theeffectiveness of more recent initiatives such as the ECP role. It includes sectionson:

Quantifying the Benefits Measuring Against Target Cost Effectiveness of ECPs in the Emergency Pathway Calculating the Business Case Return on Investment

3.6 The Emergency Access Algorithm produced by the Emergency Services Review(appendix B) outlines emergency and urgent care pathways. This algorithm canhelp commissioners and providers to improve their understanding of accesspathways into emergency care systems; along with potential solutions to improve

access and reduce delays across the whole health and social care system.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4086939http://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/ECP_Benefits_document_June_07.ashxhttp://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/ECP_Benefits_document_June_07.ashxhttp://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/ECP_Benefits_document_June_07.ashxhttp://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/ECP_Benefits_document_June_07.ashxhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4086939


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Operational Performance Understanding Demand 6

4. OPERATIONAL PERFORMANCE UNDERSTANDING DEMAND

4.1 The primary purpose of analysing call data is to understand demand. It assists Ambulance Trusts in improving response times from when the call is connectedto the ambulance control room (call connect) to the time a vehicle arrives atscene by best matching their resources to the natural patterns of demand. Suchanalyses should be shared with commissioners to support decisions for furtherinvestment, either in ambulance services or other community based options.Operational planning needs to explicitly link with commissioned activity and theresultant financial envelope attached to this, as per schedule 3 of the StandardNHS Contract for Ambulance Services .

4.2 An analysis tool for Ambulance Trust data was developed by the Department ofHealth in 2007 - Analysing ambulance call-cycle data for call connect target . Thepurpose of this is to provide a structure for operational managers to identify thecauses of performance problems and to focus improvement effort in the placeswhere it will have the most benefit. It highlights where the main problems lie andconcentrates on the call cycle stages from call connect to vehicle arrive at scene.This helps Trusts to improve call connect performance.

4.3 Further reference to the scope of this analysis tool is captured in section 3 ofImproving Ambulance Response Times: high impact changes and response timealgorithms for NHS Ambulance Services (High Impact Changes). There arealso good practice examples of understanding demand.

4.4 There are a number of other demand analysis tools and service improvementoptions available to Ambulance Trusts. More recently, with developments incomputer aided dispatch systems (CAD), Ambulance Trusts have the opportunityand capability to generate their own forecasts and deployment models.Commercial options are also available and have been used successfully by anumber of Ambulance Trusts.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179313&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179313&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076966http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_076966http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179313&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091451?IdcService=GET_FILE&dID=179313&Rendition=Web


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7 Operational Performance - Aligning Resources To Demand

5. OPERATIONAL PERFORMANCE - ALIGNING RESOURCES TO DEMAND

5.1 The process of managing emergency and urgent care demand in the local healthcommunity is a shared responsibility of Commissioners and Providers. It shouldbe a key focus of ECNs. Taking Healthcare to the Patient - Transforming NHS

Ambulance Services defines an ambulance service that provides both highquality call handling and clinical advice (hear and treat), and safe and effectivemobile healthcare (see and treat). The hear and treat and see and treatmodels, along with accompanying examples of good practice, are outlined insection 4 and appendix D. Further examples of good practice are in the casestudies section of Changing Times - Sustaining Long term Performance AgainstCall Connect for NHS Ambulance services (Changing Times) and A vision foremergency and urgent care - The role of ambulance services .

5.2 Effective matching of resources to demand is a fundamental requirement ofachieving Call Connect performance. Processes such as unit hour methodologyshould continue to be used in driving efficiency. Section 2 of High ImpactChanges contains useful how to guides and good practice examples of:

The front loaded model - an increased proportion of fast response vehiclesand community response

Matching resources to demand the fundamental basics of having rostersthat reflect demand patterns

5.3 For further depth to this topic, the case studies section of Changing Times includes reports and checklists on demand profiling of both call handling andoperational resources. Similarly Best Practice Guidelines on AmbulanceOperations Management contains straightforward yet effective recommendationsof demand-based cover that Ambulance Trusts may review against their owncurrent operations.

5.4 Changing models of care have significant workforce implications in terms ofdevelopment, structure and working patterns. The effective engagement andmanagement of people optimises a Trusts capacity to be successful in attaining

short term targets whilst delivering an agenda for sustainable long term change.Changing Times contains more on effective engagement, with staff in its criticalsuccess factors. There are also good practice examples in High ImpactChanges . Understanding the call cycle is key to engaging internal and externalpartners in their contribution to making change for the better. These elementsare explored in 'Changing Times' Managing Information Checklist and CallManagement Cycle Algorithm .
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112305http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112305http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169070&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169070&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112305http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112305http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.nhsconfed.org/Publications/Documents/A%20vision%20for%20emergency%20and%20urgent%20care.pdfhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269


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Operational Performance - Aligning Resources To Demand 8

5.5 Ambulance Trusts typically develop their Community Response infrastructurewith a range of response models. These include Community First Responders,staff responders, co-responder schemes (Police, Fire, Military Services, etc) andstrategically located automated external defibrillators (AEDs). High ImpactChanges (section 2) outlines some of the fundamentals of operating acommunity response model. Changing Times highlights the need for communityresponse to be complimented by a strong governance framework andorganisational integration. This will optimise availability and utilisation whilstmaintaining the interest and commitment of those individuals involved.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683


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9 Operational Performance - The Call Cycle and Emergency Operations Centres

6. OPERATIONAL PERFORMANCE - THE CALL CYCLE & EMERGENCYOPERATIONS CENTRES

6.1 Ambulance Trusts should develop systems and processes that minimise delay intheir call-answering, call-processing and dispatch functions. The significantimprovements in computer aided dispatch systems need augmenting with localknowledge and experience. Consistently successful EOCs will develop dispatchguidelines and performance measures to ensure the right resource is dispatchedto the right patient at the earliest possible time.

6.2 To achieve this, the 999 call management cycle can be broken down intocomponent parts to identify activities that dont add value. Key performanceindicators (KPIs) need to be established for each component, with performancemonitoring mechanisms and triggers put in place. The call management cyclealgorithm contained in Changing Times shows a range of possible high-impactchanges, both operationally and EOC based, that trusts can make to achievesustained performance improvement and improved patient care. The ResponseTimes Algorithm contained in High Impact Changes also offers guidance on callcycle management as well as indicative times for each component against whichto benchmark a Trust and / or set as an internal KPI.

6.3 A lack of EOC leadership 24 hours a day was highlighted as a key risk inChanging Times . Such leadership needs to ensure adequate focus onperformance against internal KPIs where variation is monitored, understood and

minimised. Setting internal targets encourages staff to better their individual andteam performance. The objective should be to challenge the best performingindividual or team and not accept that achieving the target is enough. Real-timemanagement information provides early indicators that a system or process isunder pressure. Early intervention in a pressured system or process can preventcrisis management. Avoiding crisis management reduces variation in the longterm. Changing Times also contains an extensive case study on a programmeof EOC improvements made by one Trust.

6.4 Section 2 of High Impact Changes contains useful how to guides and goodpractice examples of dynamic deployment plans (moving resources closer to the

predicted source of the next call). Such deployment plans require robustcommunications to exist between operational managers and the EOC, withsuccess largely dependant on a regular review process that includes theoperations team.

6.5 Supporting reference material on Emergency Operations Centres can be found inthe Ambulance Improvement Checklist .
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Webhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4085178http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4085178http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073683http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296?IdcService=GET_FILE&dID=169071&Rendition=Web


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Operational Performance - The Call Cycle and Emergency Operations Centres 10

6.6 A part of the call cycle that Ambulance Trusts have limited control over is thehandover time at hospitals. Delays in the handover of care between theambulance and the hospital services represent a poor patient experience. TheSouthwest SHA document, Ensuring Timely Handover of Patient Care , providesCommissioners, Acute Trusts, Ambulance Trusts and Primary Care providerswith an improvement framework. It highlights the key issues with currentsystems and offers practical guidance. The 14 recommendations for actioncontained in appendix 1 should ensure timely handover of patient care. Furthergood practice on managing hospital handover is contained on page 24 ofChanging Times .
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089072http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086296http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089072


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11 Escalation

7. ESCALATION

7.1 Year round capacity planning and accompanying escalation plans are recognisedas essential for all health care organisations. Resourcing Escalatory ActionPlans (REAP) have been adopted by all Ambulance Service Trusts in England, toensure a structured set of arrangements when normal operating functions arechallenged, either through loss of staff, resources, or external factors includingperiods of high demand. Each Trust will have a variety of strategic and tacticaloptions in their REAP that are most suitable to deal with the situation. The profileof REAP status must be consistently high and as such they need to be routinelyshared with the nominated leads across the local health community whounderstand their impact.

7.2 REAP can have a tendency to focus on internal capacity and escalationprocesses. REAP management can be enhanced where escalation plans areintegrated across local health economies. Step 8 of the Emergency CareNetwork Checklist and checklist 2 of Driving change: Good practice guidelines forPCTs on commissioning arrangements for emergency ambulance services andnon-emergency patient transport services explain the requirement for, and keycomponents of, local health community escalation plans. Appendix C includesan example of a REAP.

7.3 One of the obvious symptoms during periods of pressure is ambulance handoverdelays. The table in Figure 2 of Ensuring Timely Handover of Patient Care

illustrates a suggested local health community escalation plan for handoverdelays.
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Summary 12

8. SUMMARY

8.1 A key to success is a shared vision of patient care and a commitment to wholesystem commissioning of emergency and urgent care.

8.2 Emergency Care Networks are a tested model and provide the opportunity foreffective, collective progress in reducing delays and improving outcomes forpatients. Providers need to engage with the Networks and seek shared solutionsto difficult issues.

8.3 System intelligence, both qualitative and quantitative, needs to be accessible andmeasures need to be achievable and tangible. Pursuing targets should not be asufficient objective for a network working in partnership to provide high qualitypatient care.

8.4 We hope that you have found this guide helpful and wish you well in working withcolleagues across the health and social care services to provide safe andeffective emergency and urgent care.


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13 Appendix A Bibliography

APPENDIX A BIBLIOGRAPHY

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