Safe Paramedic Non-conveyance Clinical Trial
Official title:
The Effect of a Specialist Paramedic Primary Care Rotation on Appropriate Non-conveyance Decision: a Controlled Interrupted Time Series Analysis
The National Health Service (NHS) in the United Kingdom is facing a 5% increase in demand
every year for urgent and emergency care services, and there is evidence that patients are
being taken to hospitals by ambulance services when they do not need to go. This is a problem
because emergency departments are becoming more crowded, which can lead to poorer quality
care. Also, less ambulances are available to respond to emergencies, because they are
queueing at hospital for a long time.
To improve the care Yorkshire Ambulance Service provide to their patients, some paramedics
have received additional training. These advanced paramedics have been very successful at
treating patients in their own home safely. However, their training is long and expensive, so
another role, the specialist paramedic role has been introduced. Their training does not take
as long and is cheaper to provide. However, the specialist paramedics do not appear to keep
patients safely at home more often than regular paramedics. Recently, the specialist
paramedics have taken part in a national paramedic programme, where they are given the chance
to work in GP surgeries and emergency call centres.
This study aims to see if specialist paramedics who have worked in a GP surgery for 10 weeks,
can keep patients at home safely, and without costing too much, more often than regular
paramedics.
The National Health Service (NHS) in the United Kingdom is facing a 5% year-on-year increase
in demand for urgent and emergency care services. In 2018/19, ambulance services in England
provided a face-to-face assessment to nearly 7.9 million incidents, of which 7.6 million were
conveyed to hospital. This conveyance rate of around 69% is occurring despite an increase in
urgent cases and is placing increasing demands on already crowded emergency departments
(EDs), leading to decreased availability of ambulances as turnaround times at hospitals
increase. ED overcrowding is a significant issue for patients, resulting in poorer quality of
care, increased healthcare costs and potentially, increased mortality.
Yorkshire Ambulance Service have been early adopters of initiatives to address inappropriate
conveyance, and have had paramedics working in the role of Emergency Care Practitioners
(ECP), since 2004. ECPs consistently have non-conveyance rates double that of other
paramedics in the Trust. More recently, the specialist paramedic (SP) role has been
introduced, although the educational programme is less substantial than that of the ECPs, and
non-conveyance rates have been no different to other paramedics within the Trust.
In 2018, Health Education England funded a pilot scheme to rotate paramedics into a range of
healthcare settings, with the aim of improving patient care and relieving pressures on
primary care, ambulance services and other parts of the NHS in a sustainable way. This pilot
also presents an opportunity to develop SPs and potentially, improve their rates of
appropriate non-conveyance which may deliver patient and cost-benefits of the role as
originally anticipated.
This study aims to evaluate whether the paramedics who have rotated into primary care, are
appropriately and cost-effectively increasing the level and trend of non-conveyance decisions
compared to a matched control population of YAS paramedics.
This study will use a dataset comprised of non-identifiable, routinely collected, ambulance
service data to undertake a controlled interrupted time series analysis. This is one of the
strongest quasi-experimental designs to detect change in the level and trend of paramedic
appropriate non-conveyance decisions. The cost-effectiveness analysis will examine the cost
per appropriate non-conveyance achieved for patients receiving care from paramedics who have
completed a 10-week rotation in a GP surgery compared with those receiving care from
paramedics who did not take part in the primary care rotational pilot.
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