Hundreds of patients saved from lengthy A&E wait thanks to ambulance pilot

A North East Ambulance Service (NEAS) pilot scheme to reduce the number of patients attending Sunderland’s A&E departments has proved so successful it is being extended.

Funded by the All Together Better Sunderland vanguard partnership, NEAS’s Paramedic Pathfinder has helped more than 800 patients avoid lengthy A&E waits by diverting them to more appropriate places for treatment.

Since the pilot began last September, instead of being taken to A&E 815 people have been successfully referred to alternative care providers in Sunderland, including: GPs, Urgent Care Centres, The Recovery at Home Team, The Palliative Care Team and The Emergency Ambulatory Care Unit at Sunderland Royal Hospital.

Due to its success, NEAS has now secured funding to continue the Pathfinder scheme in Sunderland for another 12 months and is looking at ways to extend it further.

Pathfinder involved the training of around 100 NEAS ambulance clinicians to use a grounding-breaking clinical triage tool for patient assessments. The pathfinder triage tool works by enabling clinicians to recognise symptoms rather than the need to make a definitive diagnosis. Ambulance clinicians work from the top of the Paramedic Pathfinder flow chart to the bottom and must eliminate all other possibilities before going onto the next step. This helps them make extremely accurate face-to-face patient assessments and confidently choose the most suitable place for treatment. 

As well as improving the patient’s experience by providing care tailored exactly to their needs, Pathfinder is helping to significantly reduce the load on Sunderland’s A&E departments.

Libby Hodges, unit manager for emergency ambulatory care at City Hospitals Sunderland, said: “We know paramedics have a huge amount of knowledge and experience, which they are now able to utilise much more by using their clinical judgement alongside the Pathfinder tool, making the whole process quicker, smoother and ultimately better for our patients.

“The types of patients we see in our department are people who need to be assessed but don’t require emergency care. By allowing them direct access to our department, paramedics are able to bring patients straight to us for assessment, avoiding a wait in a busy A&E for the patient and taking the pressure off the emergency department.”

Lesley Dobson, matron for the Urology Department at City Hospitals Sunderland, added: “A patient going into the Emergency Department would have to be assessed by a nurse and then a medical review, followed by a further wait for a urologist, all of which could take some time. It could be a problem such as a blocked catheter, which isn’t a life threatening emergency but is extremely painful and uncomfortable for the patient. By being admitted directly to the department, they are seen and treated much quicker.”

Paul Aitken Fell, Consultant Paramedic at the North East Ambulance Service said: “With a 47% increase in emergency admissions over the past fifteen years, we urgently need to look at ways to reduce this figure. That’s why we’re delighted to secure more funding to enable our Pathfinder scheme to continue for another 12 months.

“Pathfinder isn’t a silver bullet but it’s definitely a start. The scheme is working particularly well in Sunderland where there’s a good choice of alternative care providers and it’s great to see more than 800 patients avoiding a lengthy wait in A&E and getting the care most appropriate to their needs.

“Our ambulance clinicians will err on the side of caution when taking patients with non-critical conditions to A&E but Pathfinder is giving them the confidence and endorsement to choose another option and ensure patients get the right care, in the right place, at the right time”.

Philip Foster, Chief Officer, Sunderland Care and Support and Chair of the All Together Better vanguard partnership said:

“All Together Better Sunderland – the programme bringing health and social care services together for local residents – is funding this work to expand the Pathfinder scheme even further.

“The scheme provides a seamless link to a range of services available in the community to paramedic clinicians, as an alternative to taking a patient to the Accident and Emergency Department. These Out of Hospital services include the 24/7 Recovery at Home a service that offers short term specialist support for patients and the Community integrated Health and Social Care teams focused on enabling the patient to be treated and supported in the community if they do not need to be in hospital.

“Using the Pathfinder scheme, NEAS and All Together Better Sunderland can increase safe care, closer to home and avoid unnecessary admission into hospital”

This is the latest project operated by NEAS which is designed to reduce the burden on emergency services. Others include the introduction of advanced practitioners, who offer a more in-depth triage and treatment for urgent care cases, and a system called Flight Deck, which helps hospitals manage their demand by providing real time updates on system-wide pressures.