Trust develops a service whereby a paramedic offers rapid response and timely care to local citizens, avoiding emergency department attendances and improving patient safety

Challenge:

A cycle response unit (CRU) in Northampton, was proposed, planned, implemented and measured, to ascertain the benefits to patients, the community and the organisation. CRUs have proved to provide fast response times in areas with high call volumes, built up pedestrianised areas and housing warrens.

This cost effective resource was a visibly socially engaging enterprise for the community, preventing 999 calls and A&E attendances. The CRU was set up by one paramedic, who used resources from other services, data from own service and training and sustainability initiatives. The trial period was successful, leading to further implementation of the CRU in Northampton.

Actions:

An initial proposal was developed, outlining aims and objectives, time scale and measures, by the cycle response paramedic. Preparation of equipment and responder took place. A service response bicycle was prepared and equipped with safety lights, panniers and clinical equipment. The responder independently undertook training with another service in responder cycling proficiency.

Uniform was sourced with the support of East Midlands Ambulance Service (EMAS), which met health and safety regulations and requirements. The objectives of the cycle response unit (CRU) were to contribute to high level performance by providing timely, quality care and management of patients and provide a visible community based, approachable service to local citizens.

A clear standard operating procedure was developed and approved by managers within the service. Communication of the trial was made by there sponder and the service, including with despatch and duty managers. There was a clear area for response and the CRU responded to all categories of 999 emergency calls. Whilst not on calls, there sponder engaged with the public in a proactive manner and maintained an approachable position in the local community.

Hard to reach groups, such as the homeless and frequent callers were targeted to offer health promotion and education, offering alternative methods and pathways to meet health and social care needs. The CRU responder interacted with these vulnerable adults such as was the effectiveness of this, that many of the homeless adults would seek out the responder for health advice.

As the responder was regularly on duty, on many occasions the responder could follow up on these vulnerable adults and monitor their condition offering health advice. National targets were met 99% of the time in terms of response times and over 100 calls were responded to in 10 weeks.

Each shift call times (deployment, time on scene and outcomes) were monitored to form a mid-pint review. Slight changes were made to despatch method and stand-by point to improve the service and engagement with the community. There were no adverse incidents to note with regards to health and safety, governance or equipment. Improvements are still to be made, including increasing the number of jobs given by despatch, the need to be able to conduct a 12 lead ECG and expanding the number of responders.

Results:

Patient safety has improved with hard to reach groups being a real focus of the service. The visibility of the cycle responder in the town centre, being approachable - and approaching patients with health and social care needs, that might otherwise be neglected. This allowed for health promotion and education, avoided attendance to the Emergency Department (ED) and reduced 999 calls. Financial benefits of theCRU, were in the cost of each response and non-conveyance to the ED by directing patients to relevant care pathways for their health needs. The cost to respond made a saving of £8000 over 10 weeks with the CRU.

Spread:

The CRU initiative has spread throughout the community of Northampton, with local business supporting the responder in terms of standby points and community engagement. Further engagement with the hospital and the multi-disciplinary approach to frequent attenders has helped maintain effective and safe patient care.

Discussions with local general practices have enable alternative care pathways to be followed, alongside the use of the new local urgent treatment centre, offering appointments to patients seen by the cycle responder. Within the ambulance service, the CRU has been well received and has seen to meet the aims and objectives set.