6 Essential Actions Winter Learning Workshop

1. Managing Admission Volume
Dr Jim Ward
Medical Director
Scottish Ambulance Service
1

2. % Unscheduled Cases managed by
Telephone or Face-to-Face
Assessment by week
28.0%
29.0%
30.0%
31.0%
32.0%
33.0%
34.0%
35.0%
36.0%
37.0%
38.0%

3. IJB Non-conveyance rate
2018/19
3
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
0
10000
20000
30000
40000
50000
60000
70000
80000
IJB
Incident Count % Not Conveyed

4. Interventions
• Governance processes
• Feedback to staff
• Feedback to Health Boards
• Move from ‘See and Treat’ to UK
JRCALC guidelines
• Clinical Decision Making Framework
• Prof- Prof support
4

5. A Tale of Two Cities
5
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
1 - Most
Deprived
2 3 4 5 6 7 8 9 10 - Least
Deprived
Distribution of Scottish Ambulance Service Responses by SIMD Decile
Edinburgh Glasgow

6. Hospital / IJB Specific
QEUH No SAS arrivals per day
by source
142
Ambulance
arrivals per
day
103 = 999 calls
23 GP calls
16 IHTs

7. IJB / SAS challenge
Glasgow
City 65%
W Dun 10%
E Ren
8%
S Lan
6%
E Dun
6%
% Admissions from IJBs
to QEUH

8. SBC opportunities by IJB
• Overall Conveyance Rates:
– Glasgow City 78%
– W Dun 80%
– E Ren 80%
– S Lan 82%
– Angus 62%
– Dundee City 61%
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9. High volume clinical codes
(Glasgow City)
• Falls > 65 years codes; 12% of 999
volume, 78% conveyance n=4470.
• Breathing Difficulties codes; 11% of
volume, 79% conveyance of whom 38%
have a NEWS score of 3 or less.
• Mental Health codes; 63%
conveyance….
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10. Shifting the balance of care.
What is possible?
• 40% non conveyance is deliverable – culture /
practice/ professional and patient expectations
• Beyond this needs more detailed work with IJBs re
non ED alternative support;
– Access to support teams
– In and out of hours GP support
– Secondary preventions based on SAS
attendances
– High Intensity User interventions
• Resourcing
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