Thursday, 12 November 2015

A novel approach for managing the growing demand for ambulance services by low-acuity patients

SPHPM PhD candidate Kathryn Eastwood has had her research on low-priority patients utilising ambulance services published in the Australian Health Review.
Her study is the first comprehensive report of any secondary triage service within Australia, and found that the Referral Service operating in metropolitan Melbourne has had a meaningful effect on the way calls for emergency ambulances are managed. 

Last month at the Paramedics Australasia International Conference (PAIC) she was one of two PhD candidates from the school awarded the best paper prize for her presentation at the Adelaide conference.

For her PhD Kathryn conducted a descriptive epidemiological review of Ambulance Victoria data, Victorian Admitted Episodes Dataset, and data from the Australian Bureau of Statistics.

The aim of the study was to describe the Ambulance Victoria secondary triage service and the overall impact ambulance resourcing has on emergency service providers and practitioners.

“The low-acuity workload makes up most of our workload, I therefore believe that by beginning to address this issue, we can see improvements in patient outcomes, ambulance service efficiency and paramedic welfare,” Kathryn said.

Kathryn grew concerned about paramedic fatigue and the increasing low-acuity workload during her 16-year career as a Mobile Intensive Care Ambulance (MICA) paramedic.

“With the increasing demand that I've seen in my years as a MICA paramedic I've also seen an increase in strain upon my colleagues due to fatigue and decreasing job satisfaction,” Kathryn said.

“I noted that a large proportion of our workload consists of cases that do not require any paramedic or hospital intervention. Sometimes it’s due to abuse of the system, but sometimes it’s also due to a lack of other viable options or knowledge on what is available in the community.

“In the years since 2006, I have seen demand continue to rise and I know that more cases could be undergoing this secondary triage, so I decided to do my PhD in this field to investigate the possibility of this occurring,” she said.

The AV Referral Service aims to divert low-acuity patients to more suitable forms of primary health care and between 2009 and 2012 almost 73 per cent of suitable cases were managed away from emergency ambulance dispatch with alternative services such as doctor or nurse home visits.

The AV Referral Service was also able to divert almost 33 per cent of Ambulance Victoria cases away from emergency departments to more suitable primary health care services.

The findings of the study indicate that the Ambulance Victoria Referral Service is a sustainable secondary triage service that alleviates demands on the emergency health care system.

Kathryn is now conducting a large retrospective linkage project to investigate the impact and safety of the secondary triage referral service, to see whether this service can be extended to more cases.

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