Isle of Man Ambulance Service (IMAS) will be placing Clinical Navigators within the Emergency Services Joint Control Room (ESJCR) in the future. This will ensure that experienced clinicians will be able to conduct further clinical triage over the phone with people who call 999 seeking help to determine if they need an Ambulance sending to them or not, and ensure that patients get the appropriate level of treatment first time, whether that is in their home or in a clinical setting.
Contemporary good practice is for further clinical triage to be a core part of the Emergency call centre environment to ensure a patient is directed to the most appropriate service to meet their needs. Recent feedback provided by the CQC (Care Quality Commission) commented on the lack of clinical resource within the ESJCR.
When a 999 call is triaged, an Ambulance will be dispatched immediately if there is an immediate threat to life or limb. However, for all other calls, once the Clinical Navigators are in post, they will make contact with appropriate patients who have called 999 seeking urgent medical support and conduct a further clinical assessment of their current needs. They may still decide that an Ambulance should be sent and will dispatch one, or they may signpost callers to one of the other healthcare services provided by Manx Care which is more appropriate for their needs, for example the Minor Injuries Unit (MIU) at Ramsey and District Cottage Hospital or the Minor Eye Conditions Service (MECS) provided by Specsavers in Douglas. They will also consider the caller’s options for travel to the service being recommended to them.
IMAS currently responds to around 13,000 calls every year, a figure which increases on average by around 6% per year. It provides four Ambulances during the daytime period and three overnight, a model which hasn’t materially changed since 2005 when the service used to respond to just 5,000 calls per year. Ambulance resource – typically a double-crewed Ambulance – is sent to every Ambulance 999 call, irrespective of the patient’s clinical need. In many cases, patients with a non-urgent issue are frequently being seen by Paramedic and Emergency Care teams whose skill-sets could be used more effectively to treat people who require urgent or emergency care. This can result in delays in IMAS responding to calls for patients with a high clinical need, increases the Ambulance workload, and results in a high conveyance rate to the Emergency Department at Noble’s Hospital*. There are frequent occasions where patients would benefit more from being treated in another setting, and would receive faster access to care. The Clinical Navigator will be able to facilitate this.
The Clinical Navigators will be Registered Healthcare Professionals, for example a Nurse or a Paramedic, and will be supervised by a Senior Paramedic Officer. Initially they will work a long daytime shift seven days a week, including Bank Holidays, with a view to this being extended into the evening hours if required. Recruitment will begin shortly to fill these key roles.
Will Bellamy, Head of Isle of Man Ambulance Service, commented:
'I’m really pleased that the business case to install Clinical Navigators into the ESJCR has been approved, and am looking forward to seeing the impact that they will make to the people who call 999 seeking urgent medical support. They will become a core part of the IMAS team, and will provide valuable support to our frontline Ambulance crews by making sure we can continue to respond to those most in need within our community not only as quickly as possible, but with the appropriate level of skilled resource attending those incidents.
'Once we’ve recruited our new colleagues, we will continue to work with clinical teams across Manx Care and with other organisations across the Island to build further, appropriate care pathways to ensure the patients we serve get the right treatment first time, whether that is in their home, by the road or via the air.'
Dan Davies, Chief Executive of the Department for Home Affairs, added:
'The introduction of a clinician-led triage process in the control room is an important step forward in the collaborative work we are doing with Manx Care to develop our service and the way we respond to medical emergencies on the Island. I’m looking forward to welcoming our new colleagues once they have been recruited.'
*In the UK, average Ambulance to hospital conveyance rates are 50%, whereas in the Isle of Man these are currently around 75 – 80%.
The ESJCR is operated by the Department of Home Affairs (DHA) to serve all three Emergency Services (Police, Fire and Ambulance), and dispatches help to callers as quickly as possible. Isle of Man Ambulance Service (IMAS) is operated by Manx Care.