In this section we look at how we receive the
referral, review the case and develop a care plan.
Initial referral and internal process
Referral information is received by the
unit in a number of ways, by telephone, dedicated
email or correspondence from both external and internal
sources. The allocated officer will carry out a call volume search
to determine if the patient falls within the defined criteria.
Cases are recorded using a case management system.
If the patient does not meet the criteria
the case is closed and the referrer advised accordingly, although
monitoring can be maintained towards a proactive
approach.
If the patient meets the defined criteria, the
patient’s GP details will be obtained and call volume details
recorded via an established format and made available to the
patient’s GP. If the patient is not registered with a GP, the
primary care trust or other relevant agency will be approached.
The unit reviews and updates approximately 140
cases each month. This review monitors any increase or
decrease in 999 activity. Where appropriate, the relevant agencies
involved in the patient’s care will be notified and a case
conference arranged.
Where appropriate, patient specific
protocols or individual dispatch protocols are agreed with the
patient and the involved agencies and signed off by our Medical
Director. These are held on our locality information system (see
below) so as to alert the 999 call handler, and/or the attending
ambulance crew, as to what action has been agreed. A full copy of
the plan is held by our clinical dupport desk, who are responsible
for the day to day management of the plan.
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Local structure within ambulance complexes
Each local ambulance station complex has a
responsibility for the local authority and PCT area and patients
under the unit’s management are aligned to a complex based on
geographic location. Each local ambulance station complex has a
nominated representative who is allocated responsibility to work
with the unit to review all cases in the area.
The unit assists local representatives with
this portfolio to enable the development of skills and processes
involved in building local contact networks, so that future cases
can be undertaken locally with the unit playing a supporting rather
than a lead role.
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Local multi-disciplinary forums
Invitations are made to the local authority
social services, primary care, mental health and acute trusts and
other relevant agencies to establishing a regular forum to enable
specific care plans.
This also allows health and social care colleagues to advise us
of any patients that may similarly be posing problems to the
respective agencies where we may be able to play a role in setting
up an appropriate care pathway. An additional benefit is that this
allow issues to be raised beyond the limits of this particular area
of work.
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Case conferences
The patient, carer and advocate are always
invited to participate. Written notification is always provided.
All clinical care issues are agreed by our Medical Director.
Information sharing protocols
Information sharing protocols are agreed
where necessary with partner agencies.
Reporting and governance
Activity reports are made available to our
local area committees and Clinical Governance Committee and our
commissioners. An annual report is published on our website and
made available to NHS London.
Locality information
There are different categorisations that make
up our locality information database. They are as follows:
- Individual dispatch or patient specific
protocols – care plan or other arrangements in relation to
individual patients.
- High risk register – patient addresses where
a previous incident has occurred that pose a potential risk to
ambulance staff.
- Safeguarding – unborn children deemed to be
at risk by safeguarding professionals and the police.
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