The London Ambulance Service today announced a new initiative designed to improve their response to emergency calls. The new scheme named ' Complimentary Rapid Access for Patients' will enable ambulances to turn around much quicker at hospital.
Instead of the traditional handing over of a patient to the A&E department, which takes valuable time, the patient will instead be placed into a sturdy plastic shell. All paperwork will be affixed to the outside of the shell; then as the ambulance passes the hospital the patient will simply be slid out of the back of the vehicle. There will be no need for the ambulance to actually stop moving.
Experts estimate that this new proceedure will enable ambulance crews to reach more patients within the allotted eight minute target. Ambulance staff will be discouraged from stopping at the hospital for a cup of tea or a toilet break, as the government considers ambulance crews as being able to work twelve hour shifts without such luxuries.
Of course this isn't true; but it wouldn't surprise me if some bright spark hasn't suggested something similar.
It's 'silly season'; April approaches and with it the cut-off point for us to hit our government mandated eight minute ORCON target. Normally around this time of year certain management types in ambulance trusts across the country start sweating.
Some trusts have already had inaccurate figures, I couldn't possibly comment on whether other trusts have similar problems; lets just say that it wouldn't surprise me in the least if we hear more accounts like this whether it's due to computer error, human error or someone purposefully 'massaging' the numbers.
From Monday, in order to try and improve our ORCON, the London Ambulance Service is going to stop us from doing any 'administrative' hand-over.
How we book patients into hospital in the past has gone something like this. We arrive at the hospital. We show the nurse the patient and let them know what is wrong with them. The nurse tells us where they want us to put the patient. The nurse gets on with looking after the patient. The ambulance crew heads to the reception area and 'books the patient in' by giving the receptionist all the relevant details. Paperwork is generated by the reception staff that enables the clinical staff to perform such tasks as sending off blood for tests and arranging x-rays.
From Monday we will no longer be talking to the receptionists – instead the nursing staff, as well as looking after the patient, will have to book in the patient. Or send a relative to book the patient in for them.
No possibility for anything to go wrong there then…
In my memory this has been tried twice before; at least once when I was myself an A&E nurse. Neither time has it worked in the patient's favour. The ambulance crews would hand over to us nurses, then we'd have to make sure that the patient was booked in. Sometimes (because A&E nurses are occasionally busy) paperwork would be forgotten, or lost, and the patient would disappear off the system.
This obviously can have serious effects on the safety of the patient, especially patients who are sat out in the waiting room.
This is why we book our patients in at reception – it's because then we can be sure that the hospital has responsibility for the patient. That the patient shouldn't get lost in the system.
It's that bit more work for us, but we do it because it gives us peace of mind.
I'm not sure how this is going to be enforced. I suspect that for a few weeks we'll have some Team Leaders or Duty Officers sitting at the hospitals making sure that we follow the protocols. I leave it to the imagination of the reader as to the effect such staff could have on ORCON if they were working on ambulances instead.
I also suspect that this initiative will only last for around a month. April brings in the new year of ORCON targets, and so a rapid turn-around at hospital won't be so important after April 1st.
Until this time next year.
What I do hope is that no-one dies because of this. If someone does die, sitting in the waiting room, or in the toilets I know that the hospital will do all they can to shift blame on someone else. That blame will doubtless be on the ambulance service; and it won't be the manager who thought up this idea, it'll be the poor bloody road crew who get the short end of the stick.
Part of our Visions and Values is –
We will demonstrate total commitment to the provision of the highest standard of patient care. Our services and activities will be ethical, kind, compassionate, considerate and appropriate to the patients’ needs.
Could someone please explain how not bedding our patients securely down in hospital fits this value? The last time this was tried patients disappeared and spent hours waiting for treatment while the hospitals didn't know they were there.
All this is to fit in with the clinically irrelevant ORCON standard (do click on this link – it makes interesting reading when the BMJ agree with us. Particularly “The strategies introduced to meet the targets can be detrimental to patient care and also have adverse effects on the health, safety, wellbeing, and morale of paramedics.“).
It is just another way that the ORCON standard is having a negative impact on the effective and humane treatment of our patients. Anyone who wants to disagree should take a look at my proposed solution, and then tell me that ORCON is the ideal measurement.
If we really want to be living up to our Visions and Values I think we should be kicking and screaming at the government to get ORCON measurement off the table, or at least made vastly less important. It's not evidence based and it's having a detrimental effect on patient care – and this latest initiative is just one more example of this.
I want my management to take this in the manner that it is meant. As a call to realise that bending over backwards to fulfil the inappropriate targets set by the government is no way to lead a service, and that we need to start pushing back against these diktats. That we, as ambulance trusts, need to start fighting for our patients, so that they get the service that they deserve, not what the government finds easy to measure.
No sooner than I hit publish for this post than I note that Mousethinks has written about the problems caused by slavishly following the A&E targets.
(And if I do get sent my P45, anyone got a job for a jumped up first aider who is experienced in all sorts of internety stuff?)