Filling a ‘donut hole’ gap between technology-enabled care (TEC) and emergency response by using urgent community response (UCR) organizations. A just-published NHS guidance document developed in partnership with the TSA (Technology Services Association) is designed to provide guidelines for how TEC providers can utilize local UCR organizations in situations that typically now are answered by emergency ambulance services. According to the report, ambulance services receive around 2,600 daily calls from over 200 TEC providers, approximately 3% of all calls. What if UCRs can effectively supplement this, providing timely response to these call, treating people safely at home, and reducing demand on emergency ambulance services?
The guidance provides five “Gold Standard” indicators on whether TEC providers are ready for using UCR as an option versus referring to the local ambulance service, and clear standards for operating the TEC-UCR pathway:
1. There are direct referral routes in place from locally operating [TSA] Quality Standards Framework (QSF*)-certified TEC responder services into the UCR service, which don’t rely on clinician-to-clinician referral. (*TSA’s QSF is a United Kingdom Accreditation Service (UKAS) accredited scheme for TEC providers which aligns with the standards of a regulated service.)
2. Only activity which is inappropriate for UCR response is directed to 999, with responsibility being maintained by the TEC provider until this transfer of care occurs.
3. The UCR service has open lines of communication into its locally operating QSF-certified TEC responder services, which limit the amount of rejected referrals due to capacity limitations.
4. Training on appropriate referral reasons is available to local QSF-certified TEC responder services, with the UCR service having an ‘accept all’ approach to referrals from providers who’ve completed this training.
5. Induction and refresher training for TEC to UCR pathway is co-designed and co-delivered frequently, with at least quarterly plan-do-study-act (PDSA) approaches to understand the reason for and mitigate against future rejected referrals.
For those unfamiliar with the organization of TECs in the UK, TECs can be commissioned by local governmental authorities (e.g. borough or county councils) but some are private. Some TECs are local/regional, while other providers are national.
An idea of how TEC providers can work with both UCRs and ambulance services is in Dudley in the West Midlands near Birmingham. A gauge of the volume of calls to the local ambulance service was in a six-month audit (October 2020 – April 2021) of the North West Ambulance Service. It showed that of the 3,000 calls from telecare services to the service, 32% (959) required conveyance to ED, but 45% (1,347) were seen and treated and 23% (694) ‘hear and treat’ disposition (referred elsewhere), or closed by the emergency operations centre. Once implemented, the collaboration between Dudley Telecare and local UCR teams saw the number of ambulance callouts for injured fallers reduced by 85% within a month, with response within 45 minutes. In Warrington, between Liverpool and Manchester, the 24/7 UCR service reduced pressure on ambulance services while responding in less than 60 minutes. Outcomes are positive with 80% of people remaining at home following a visit.
The guidance includes information on requirements and best practices on how to map the pathway, developing a project team, implementation, measurement, and continual reviews. TSA Voice release; NHS Guidance: web page, PDF. Hat tip to TSA’s post on LinkedIn