Scottish Specialist Transport And Retrieval Annual Report 2015-16 Table of contents
1. Welcome 3 2. Introduction 4 2.1 Organisational Overview 4 2.1.1 Team Overview 4 2.1.2 SCOTSTAR Role 5 2.1.3 Mission Statement 6 2.2 Governance 7 2.2.1 Governance Framework Overview 7 2.2.2 Information Governance 7 2.2.3 Reporting Arrangements 7 2.2.4 Governance Arrangements 9 2.2.5 Patient Safety & Quality 9 2.2.6 Workforce and Communications 10 2.3 About the Service – SCOTSTAR in 2015 10 2.3.1 Report on Activity 10 2.3.2 Resource Use 15 1. Welcome 2.3.3 Finance and Workforce 17 2.3.4 Quality Performance Indicators (QPIs) and HEAT targets 19 3. Strategic Objectives 20 “I am pleased to present the 2015/16 SCOTSTAR Annual Report on 3.1 Longer Lives 20 3.2 Healthy Lives 20 behalf of the Scottish Ambulance Service and NHS Scotland. Our three 3.3 Safe 20 clinical teams operating in a ‘Once for Scotland’ model, continue to care 3.3.1 Risk Register 20 3.3.2 Clinical Governance 20 for some of the most sickest patients who require Specialist Transport 3.3.3 Adverse Events 21 and Retrieval between health care facilities throughout Scotland. 3.4 Effective 21 3.4.1 Clinical Audit Programme 21 It’s been another busy year for The construction of the new state they do; day in day out; to provide 3.4.2 Staff Governance 21 SCOTSTAR. Our Adult team of the art Specialist Transport and communities across Scotland with 3.4.3 Clinical Outcomes/ External Benchmarking 21 completed 287 primary and Retrieval base at Glasgow airport a Service which is safe, effective 3.4.4 Service Improvement 23 239 secondary Retrievals, our is now complete and was formally and clinically excellent.” 3.4.5 Research and Development 24 Neonatal team completed 1,428 opened by the Cabinet Secretary 3.4.6 Training and Outreach Activities 24 secondary Transfers and our for Heath, Wellbeing and Sport 3.4.7 Response Times 25 Paediatric team completed on 11 March 2016. Our teams are 3.5 Person Centred 26 323 secondary Retrievals. The now benefiting from this modern 3.5.1 Patient / Carer/ Public Involvement 26 SCOTSTAR teams are now fit for purpose accommodation 3.5.2 Partner Involvement 26 benefiting from the Scottish which is enabling our teams to 3.5.3 User Surveys / Feedback 28 Ambulance Service’s new state of come together under the same 3.5.4 Communications 28 the art larger and more capable roof to learn and train together 3.5.5 Stories 28 aircraft to enhance the care they and share their knowledge and 3.5.6 Staff Engagement Index 33 provide to patients. experiences. 3.5.7 Equity: Geographical Access 34 Pauline Howie OBE Our Specialist Transport and Whilst it is acknowledged that Chief Executive Officer, 4. Conclusions: Celebration & Risk 36 Retrieval teams working in there is still much to do to further Scottish Ambulance Service 5. Looking Ahead - Expected Change & Developments 38 partnership with a number of strengthen governance and future organisations supported the workforce models, the service Appendix 1 – SCOTSTAR Financial Performance 2015-16 39 Scottish Ambulance Service continues to evolve and I would Appendix 2 – Glossary 40 at several Major Incidents like to take this opportunity to throughout the year. thank all our staff for the work Equality & Diversity 42
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
2 3 2. Introduction
SCOTSTAR (Scottish Specialist Transport and Retrieval) is a division of the Scottish Ambulance Service (SAS) within the Service Delivery Directorate led by Daren Mochrie QAM the Director of Service Delivery that exists to provide a national service for the safe and effective transport and retrieval of neonates, children and adults in Scotland. Daren Mochrie, Director of Service Delivery Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison at the opening of the new base
It was launched on 1st April to track progress of the service Intensive Care Unit (PICU) a Critical Care Practitioner (CCP). partnership with the Ambulance triage and remote assessment. 2014 and has brought together against the previously agreed partners to provide an advice only It operates from the SCOTSTAR Service’s Ambulance Control On Friday 11 March 2016, Shona three existing services – Scottish deliverables. The stakeholders call service, whereby the duty Base at Glasgow International Centre (ACC), due to their close Robison, Cabinet Secretary for Neonatal Transport Service for SCOTSTAR are the Health SCOTSTAR and PICU consultants Airport, and covers the whole operational links and extensive Health, Wellbeing and Sport (Neonates), Emergency Medical Boards, service users, and the advise the referring clinician, which of remote and rural Scotland. experience in operational planning, officially opened the new purpose Retrieval Service (Adults), and wider NHS Scotland organisations prevents unnecessary transfers. call handling and transport built facility for our teams at Scottish Paediatric Retrieval such as Community Midwife Units SCOTSTAR retrieval operations in The Adults team has dispatch. There are essential links four functions: Glasgow International Airport. The Service (Paediatrics) into one and Rural General Hospitals. The Edinburgh concluded on 31 March between the different elements new facility brings the Service’s specialist service. The service Governance system included 2016 and the team now works • Secondary retrieval of of these different services provides a safe and dedicated an Advisory Group, chaired by from the new base in Glasgow. West of Scotland Air Ambulance critically ill and injured within the Scottish Ambulance transport service for a particular Dr Annie Ingram, reporting to helicopter and fixed wing patients from remote and Service and SCOTSTAR, which patient group who, because of the Chief Executives Group, operations into a single location, Scottish Neonatal Transport rural health care facilities; is an operating division of the their clinical condition, require and the production of an Annual alongside SCOTSTAR, Scotland’s Service (Neonates) • Telephone advice to remote Ambulance Service maximises an augmented clinical team Report, building on the system of national Specialist Transport and and rural hospital staff with the operational, clinical and cost during retrieval/transport, and Annual Reporting which the three The Neonatal team provides a regard to resuscitation and benefits through integration of the Retrieval Service for critically ill represent the most vulnerable of previous services had used. national service delivered by three safe transfer of patients transport infrastructure, technology children, babies and adults. patients transported in Scotland. regional teams in the West, South with critical illness; infrastructure and the specialist In total, SCOTSTAR teams The three established East and North of Scotland, all of • Primary retrieval of patients transport clinicians. In addition The base has immediate access completed 2,087 transfers national specialist transport which provide cross-cover for each with major trauma in West to this the Scottish Ambulance to specialist vehicles and aircraft and retrievals in 2015/16. teams are outlined below. other. They transfer and/or retrieve and Central Scotland; Control Centre has recently taken as part of a £9.5 million investment babies up to five kilograms. • Major incident pre-hospital over the Perinatal Advisory Service in patient care. It is the first time As a National Service, SCOTSTAR 2.1 Organisational Each neonatal transport is medical response. from NHS 24. This links in with anywhere in the UK that multi- ensures that critically ill patients Overview undertaken by a team of the co ordination role undertaken are transferred within and outside between one and three clinicians, disciplinary clinical retrieval 2.1.2 SCOTSTAR Role by the Specialist Services Scotland to the definitive level 2.1.1 Team Overview including consultants, Advanced teams operate from a single Desk in the ACC which allocate of care that the clinical condition Neonatal Nurse Practitioners base. The Cabinet Secretary Nearly 2,100 of the 740,000 missions to the retrieval teams. of a patient demands. All of the Scottish Paediatric Retrieval (ANNPs), middle grade doctors met with staff and was given a emergency incidents attended territorial Boards in Scotland Service (Paediatrics) and transport nurses. tour of the base and capabilities, annually by the Scottish The Ambulance Service is rely on the service and have an which included an overview of interest in the performance and In 2015-16, the Paediatrics team Ambulance Service are well placed to manage service Emergency Medical the specialist vehicles, aircraft, operation of SCOTSTAR. When provided a national service from attributable to specialist transport delivery and outcomes for Retrieval Service (Adults) and equipment available to use. the new Service was established, Edinburgh and Glasgow for the and retrieval, however these SCOTSTAR, by scheduling the There are approximately 85 it was agreed that the service retrieval for children from newborn The Adult team provides a take significantly longer and are availability of vehicles and drivers, would be funded nationally through to 16 years of age. The team is national service, with two teams complex in their delivery with many coordinating and integrating critical staff who work from the new top-slicing and that a governance predominantly consultant led; available 24 hours a day. Each being inter-hospital transfers. infrastructure with service provision base which includes the national system would be established, supported by trainees, nurse team is led by a consultant with whilst supporting the most efficient administrative and managerial which would include separate practitioners and nurses. The the second team member being The clinical coordination model for use of high value assets through functions of both SCOTSTAR reporting to allow stakeholders team works closely with Paediatric either a senior medical trainee or the Division is being developed in medically supported tasking, and the Air Ambulance Division.
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
4 5 2.1.3 Mission statement 2.2 Governance 2.2.2 Information Governance to support the continuous Coordination improvement of the national SCOTSTAR aims to provide the • Integration and provision of • Developing clear and consistent 2.2.1 Governance The NHS Scotland Information service through the use of clinical support to the Specialist operating procedures for Assurance Strategy is adhered to research, and ensures all studies highest quality clinical care through Services Desk (SSD), tasking and coordination of Framework Overview an integrated sustainable national all assets (including SAR) within SCOTSTAR. Information go through the agreed approval • Developing additional linkages including how to triage and Governance responsibility is process. During the course of service for the safe and effective to the wider SAS strategy, SCOTSTAR Governance prioritise across teams, Framework saw changes in delegated by the Ambulance the year the group has worked transport and retrieval of neonates, • Collaboration with other SAS • Appraising all options for to agree a minimum dataset for children and adults in Scotland. partners around related areas 2015/16, both to the structure of Service Chief Executive and function and location of of clinical practice, e.g. Major the division and the management Director of Strategic Planning and SCOTSTAR teams and developed To achieve this, SCOTSTAR coordination / referral, trauma and Major Incidents, Quality Improvement, who chairs a process for handling and aims to achieve four main team. In November 2015, the and further engagement with • Integrating Air Ambulance and previous Head of Service was the SAS Information Governance documenting research activities goals in 2016-17: internal and external partners SCOTSTAR more closely, and Committee which meets quarterly, undertaken by the SCOTSTAR within NHS Scotland, succeeded by the interim Deputy • Participating in induction training General Manager for Scottish to the Deputy General Manager team members. Documentation 1. Improve coordination • Developing links with for all coordination staff. Ambulance Service South West for South west and ScotSTAR. of research projects for and tasking of air and Scottish Patient Safety Programme in particular with Division and SCOTSTAR, Jim ScotSTAR has been integrated retrieval teams, regards to Paediatrics, Dickie, along with the recruitment SCOTSTAR is represented on within the SAS Research, 2. Consolidate and develop the of a new Associate Medical the committee, and reports to Development and Innovation workforce of multi disciplinary this Committee on any pieces database during 2015-16. Workforce Planning Director in spring 2016. The teams for the future needs governance arrangements for of work requiring collation and of the patients, and • Developing job appropriate management, Personal SCOTSTAR have been split analysis of data held across Additionally, in 2015-16 3. Work to coordinate and align training plans for enhanced nurse Protective Equipment (PPE), SCOTSTAR developed its own and paramedic grade staff, and protected training time, into the following categories – different Health Boards, to ensure all data reporting systems Information, Corporate, Patient all relevant permissions via Balanced Scorecards; and • Scoping the potential for a • Up-skilling of all staff including from the retrieval teams. Safety and Quality (formerly Privacy Advisory Committee and work commenced on bringing North SCOTSTAR team, Air Ambulance paramedics, 4. Develop governance Clinical Governance) and Caldicott Guardians are secured. SCOTSTAR datasets into the arrangements to integrate • Formalising links across teams • Exploring direct recruitment of Workforce and Communications The Information Governance Scottish Ambulance Service data to improve skill sets and doctors and nurses by SAS, and with the existing SAS warehouse thereby providing resilience, such as between (formerly Staff Governance). Committee reports to the main • Developing a centre of opportunities for automated governance frameworks. Paediatrics and Neonates, or SAS Audit Committee. excellence for SCOTSTAR reporting in the future. between CCPs and Adults, The diagram below sets out the training in collaboration To achieve these, in 2016-17 accountability arrangements The SCOTSTAR Research • Improving practices regarding with other partners 2.2.3 Reporting Arrangements SCOTSTAR will work towards: rostering such as fatigue for SCOTSTAR. & Development Group exists Reporting structures within Data and Information SCOTSTAR were updated and • Developing an integrated • Ensuring firm and strengthened during 2015-16 suite of measures to support appropriate governance NHS Chief to maximise the benefits of SAS Board service improvement, aligned arrangements for our data, Executives Group co-location of the SCOTSTAR with the wider service and • Providing regular feedback and Air Ambulance Teams at new SSD measures, to staff using data, the new operating base within • Using a single, shared • Developing measures the grounds of Glasgow Airport. data collection system, regarding access and equity, This new facility has created • Ensuring SCOTSTAR • Incorporating patient synergies between the four teams developments remain compatible feedback, and with wider integrated data SAS Chief Exec by generating opportunities systems, such as Badgernet, • Developing a list of for collaboration and joint “change ideas” to test • Making data reporting system working to ensure that person more real-time, accessible centred care and activities are and user friendly through considered in a joined up basis. the use of technology, SAS Medical GM - South West The Deputy General Manager Governance Director & Air Ambulance for SW and SCOTSTAR chairs • Developing SCOTSTAR clinical • Developing SCOTSTAR financial the monthly SCOTSTAR Senior governance arrangements governance arrangements to Leadership and Management to ensure integration with ensure integration with existing Team (SSLMT) which is existing SAS Clinical SAS Financial governance SCOTSTAR responsible for implementing, Governance framework, arrangements, and Deputy GM - SW Associate Medical reviewing and reporting overall & SCOTSTAR • Developing SCOTSTAR staff • Ensuring SCOTSTAR information Director reporting arrangements and governance arrangements governance remains aligned with performance within SCOTSTAR to ensure integration SAS Information Governance with existing SAS Staff practices and processes. and Air Ambulance. During the Governance framework, year significant progress has been Figure 1: SCOTSTAR Accountability Arrangements made regarding reporting and
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
6 7 performance. The Operational identify operational issues and to ensure that SCOTSTAR 2.2.4 Governance Arrangements Capabilities and Standard new capabilities, along with teams are provided with Operating Procedures (SOPs) developing SOPs for SCOTSTAR. appropriate administrative, Work is ongoing to further develop the governance arrangements for SCOTSTAR and to align Group chaired by Neonatal The Operational Support Group logistics and base support to them with the governance arrangements for the Scottish Ambulance Service as shown below: Manager, Mrs Ann Marie Wilson, chaired by Paediatric Lead, Ms ensure that frontline operations has been regularly working to Sandra Stark, regularly meets run as smoothly as possible.
SAS Clinical SAS Audit SAS Staff Governance Committee Committee Governance Committee SAS Board SCOTSTAR Advisory (Liaison) Executive Team / Senior Group Management Team / Op Management Team SAS National Clinical SAS Information SAS Heath, Safety SAS Developing Our Governance Group Governance Committee & Welfare Group Future Workforce Group SAS National SCOTSTAR / Air Amb SCOTSTAR/NHS Clinical National SOP Senior Leadership & Workforce Group Governance Group Strategy / Working Management Team Chair - Medical Group Chair - General Manger / Director Deputy GM Weekly Ops Group Meeting Chair - Deputy GM/HoS SCOTSTAR Patient SCOTSTAR Senior SCOTSTAR Heath SCOTSTAR Workforce & & Safety Group Management Team & Safety Group Communications Group
Patient Safety & Operational Operational Support Health & Safety Workforce and Quality Group Capabilities and Group Group Communications Chair - Associate SOP Group Chair Service Chair - Head of Group Lead/ Area Service Services / Service Figure 3: SAS Board Medical Director Chair - Service Lead Manager Lead Chair - Deputy GM
2.2.5 Patient Safety & Quality PSQG reports to the SSLMT and and the Joint Paediatric & Joint Air & EMRS Joint Paed & Neonates Clinical Governance & Clinical Governance & Above underpinned by on going communications represents SCOTSTAR on the Neonatal Clinical Governance Learning Group Learning Group with Teams via: Daily Huddle / Bi-weekly Brief / Use of Team Talk brief / Divisional Bulletins The SCOTSTAR Clinical SAS National Clinical Governance & Learning Group, which report Chair - Clinician and Chair - Clinician and Service Managager Service Lead Governance Group was Group which reports to the SAS to and undertake a number of superseded by the Patient Safety Clinical Governance Committee. the work streams noted above & Quality Group (PSQG) in on behalf of the PSQG. These 2015-16. This is a Tactical level The PSQG has two operational groups are jointly chaired group chaired by the Associate groups, Joint Air & Adult Clinical by both Clinical and Service Figure 2: SCOTSTAR Reporting Structure Medical Director. The chair of the Governance & Learning Group Leads and meet monthly.
Sandra Stark, Paediatric Nurse Consultant Ann Marie Wilson, Neonatal Services Manager
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
8 9 2.2.6 Workforce And solution for Neonatal, Paediatric designed and delivered a bespoke Communications and Adult retrieval in the North induction package to better of Scotland. However due prepare the SSD Supervisors for The Short Life Work Force Group, to changes in management their new role. When operational, introduced in 2014 to identify the personnel and post vacancies the desk will co-ordinate best options for employing staff in both NHS Grampian and and prioritise access to the and any transfer arrangements SCOTSTAR, these discussions SCOTSTAR Retrieval services, required in the future, was have been delayed in recent pre-hospital Trauma Teams, Air superseded by the Workforce and months. Following the recruitment Ambulance transport platforms Communications Group (WCG) of a Deputy General Manager and specialist neonatal cots and in 2015-16. This is a Tactical/ and Associate Medical Director beds for patients across the whole Operational level group chaired for SCOTSTAR later in summer of Scotland helping to ensure that by the Deputy General Manager 2016, discussions are now these finite resources are targeted supported by the Associate progressing regarding adopting a towards our most vulnerable Director of Human Resources. sustainable model for the future. and critically unwell patients. This group meets bi-monthly and is responsible for developing Clinical Coordination 2.3.1 Report On Activity proposals for future SCOTSTAR operating models for submission Development of a dedicated In 2015-16, SCOTSTAR to the SSLMT and to the SAS tasking and coordination hub completed 2277 transfers. In Alistair Kennedy, Critical Care Paramedic and Randal Mcroberts, Consultant, EMRS Primary Team Developing our Future Workforce for SCOTSTAR continues to comparison with the total activity Group. In addition, a key part of be taken forward as part of the of 2654 completed transfers in this group’s role is to provide a SSD project. Benefitting from 2014-15, this represents a 14.2% In addition, the Adults team took 268 advice calls in 2015-16, resulting in forum to formally engage with dedicated project management decrease. This is constituted 89 avoided transfers (33% of all calls received), compared to 247 advice the range of staff groups across support since October 2015, the of a 24% increase in paediatric calls in 2014-15 resulting in 81 avoided transfers (33%). The Paediatric the various specialist areas. desk is scheduled to become activity over the last year, 13% (East) team also took 64 advice calls during the course of the year, Importantly, this group has operational from summer decrease in adults’ activity and compared to 74 advice calls in 2014-15. membership from a range of staff 2016 in the Cardonald ACC. a 20% decrease in neonatal from across the four teams. activity. During this period of Activity breakdown of the SCOTSTAR teams is presented below. As the single point of contact time, the neonatal units have for SCOTSTAR operations, been experiencing shortages 2.3 About The Service 100% – SCOTSTAR In 2015 the desk will function as a of neonatal costs. This had an Retrievals Avg Mission Workload 80% communications hub. Utilising impact on activity as this restricts Completed Duration in Hours 60% 74% Service Model a newly procured and installed the movement and repatriation Adults - Primary 287 02:03:29 591 Hours call conferencing upgrade, numbers. This issue is included as 40% Adults - Secondary 239 06:55:34 1655 Hours As a result of co-location at the SSD staff will seamlessly part of the Maternity and Neonatal 20% 26% the new base, back office connect referring centres Service Review. There also All Adults 526 - 2246 Hours 0% functions have come together, with the relevant SCOTSTAR appears to be under-reporting Secondary Primary and Paediatric and Neonatal transport team for advice and of neonatal activity following Figure 5: Adults Activity Breakdown in 2015-16 transport teams are able to assist retrieval while giving live time the move to a new system each other when required. Transfers Avg Mission Workload updates on transport options. earlier in the year, resulting in 100% Teams also try to ensure Central to realising the project a period of loss of access to Completed Duration in Hours 80% standardisation when purchasing ambitions of improved tasking the database, which generated Planned 822 03:44:40 3078 Hours 60% 69% equipment. Regular discussions and coordination of specialist backlogs for certain teams. The Unplanned 302 03:08:10 947 Hours with the North of Scotland resources are the SSD issue has now been resolved 40% Uncategorised 114 03:48:41 434 Hours Regional Planning Group have Supervisors. In addition to and the teams have almost 20% 21% been underway since 2014 standard ACC systems training, caught up with the backlog. Total All Neonates 1238 - 4446 Hours 0% 10% regarding engaging stakeholders the project team and SCOTSTAR/ activity of SCOTSTAR teams for Planned Unplanned Uncategorised and identifying an optimum Air Ambulance service leads have 2015-16 is presented below. Figure 6: Neonates Activity Breakdown in 2015-16 100% Retrievals Avg Mission Workload 80% Journeys Less Journeys 1400 Completed Duration in Hours 1200 60% 65% Initiated Cancellations Completed Paediatrics - Road 235 05:32:14 1301 Hours 1000 40% Adults 720 194 526 800 Paediatrics - Air 88 07:55:41 698 Hours 20% 35% 600 Neonates 1478 50 1428 400 All Paediatrics 323 - 1999 Hours 0% Road Air Paediatrics 335 12 323 200 0 Figure 7: Paediatrics Activity Breakdown in 2015-16 All SCOTSTAR 2533 256 2277 Neonates Adults Paediatrics Cancellations Journeys Completed * Cancellations include journeys that were aborted or stood down after retrieval had been requested, either before or after a team had been mobilised, due to various reasons such as specialist input no Figure 4: Overall Activity of SCOTSTAR teams in 2014-15 longer being required, death of the patient, etc.
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
10 11 Specific pieces of information relating to activity within the SCOTSTAR services are presented below: Diagnosis Outside North Seat West Total Category Scotland Diagnosis Outside North Seat West Total Category Scotland Cardiac / Cardiology 1.6% 0.3% 3.7% 3.1% 8.7%
CVS 3.1% 16.1% 19.2% ECMO 0.0% 0.3% 0.0% 0.3% 0.6%
GI 3.1% 0.9% 4.0% Gastroenterology 0.3% 0.0% 0.3% 0.0% 0.6%
Metabolic 1.8% 3.1% 4.9% Metabolic 0.6% 0.0% 0.9% 0.6% 2.1%
Neurological 4.5% 13.4% 17.9% Miscellaneous 1.9% 0.0% 2.8% 0.6% 5.3%
Respiratory 10.7% 14.3% 25.0% Neurological 4.0% 0.0% 6.5% 9.6% 20.1%
Sepsis 5.4% 6.2% 11.6% Respiratory 13.0% 0.6% 14.6% 18.0% 46.2%
Toxicology 1.3% 5.4% 6.7% Sepsis 2.8% 0.0% 4.0% 3.7% 10.5%
Trauma 2.2% 8.5% 10.7% Surgical 0.0% 0.0% 0.0% 0.6% 0.6%
Total 32.1% 67.9% 100.0% Trauma 1.2% 0.0% 2.5% 1.6% 5.3% Figure 8: Adults Secondary Retrievals by Scottish Region and Diagnosis Category Total 25.4% 1.2% 35.3% 38.1% 100.0%
Figure 10: Paediatrics Retrievals by Scottish Region and Diagnosis Category
30% 50%
45%
25% 40%
35% 20%
30%
15% 25%
20%
10% 15%
10% 5%
5%
0% 0% Respiratory CVS Neurological Sepsis Trauma Toxicology Metabolic GI Respiratory Neurological Sepsis Cardiac Trauma Misc Metabolic GI ECMO Surgical
North West North Outside Scotland SEAT West
Figure 9: Adults Secondary Retrievals by Scottish Region and Diagnosis Category Figure 11: Paediatrics Retrievals by Scottish Region and Diagnosis Category
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
12 13 Diagnosis Outside North SEAT West Total Category Scotland
Repatriation 4.0% 0.2% 11.2% 20.6% 36.0%
ECMO 0.0% 0.0% 0.1% 0.1% 0.2%
Imaging / Investigation 1.2% 0.0% 3.5% 2.2% 6.9%
Intensive care 1.2% 0.0% 1.5% 0.7% 3.4%
Other 1.1% 0.0% 0.8% 1.6% 3.5% Clinical categories for neonatal new base in September 2015; equipment. A new Skoda Octavia transfers have been included only neonatal team delivery units four wheel drive response vehicle Outpatients 0.6% 0.0% 1.0% 1.4% 3.0% in the dataset since September remain operational in Edinburgh was leased for the Paediatric 2015 following the move to the and Aberdeen from April 2016. East team in 2015, and two new new Badgernet transport system. Octavia response cars have been Specialist care 0.6% 0.0% 1.8% 3.4% 5.8% From September 2015 to March The re-provision of neurosciences procured for the Adults team. 2016, the main clinical categories and paediatric care to the Little Several new vehicles are being Surgery 1.9% 0.0% 1.9% 2.6% 6.4% for neonatal transfers were – France site adjacent to the Royal medical (58% of all transfers), developed and funded by SAS Infirmary of Edinburgh is well and by charitable donations over surgical (30%), neurology underway. This will include a state Resources / Capacity 1.4% 0.0% 1.3% 1.1% 3.7% the coming year. New equipment (7%) and cardiac (6%). Annual of the art elevated helipad facility and drivers for the North neonatal figures for transfers by clinical improving access for helicopter category will be reported from team were also agreed in 2015. Uplift 10.3% 0.3% 7.2% 13.2% 31.0% transfers in and out of Edinburgh. 2016-17 to enable reporting for SCOTSTAR teams remain SCOTSTAR teams to remain Equipment / Vehicles committed to streamlining Total 22.3% 0.5% 30.3% 46.9% 100.0% as consistent as possible. and enhancing the quality of The teams within SCOTSTAR equipment where possible. Figure 12: Paediatrics Retrievals by Scottish Region and Diagnosis Category 2.3.2 Resource Use are committed to ensuring the Facilities provision of suitable equipment SCOTSTAR retrievals and for all retrievals, and teams transfers completed using different 40% Following the co-location of the work collaboratively to plan modes of transport in 2015-16 West SCOTSTAR teams at the the purchase of replacement have been presented below.
35% Paediatrics Adults Neonates SCOTSTAR Total 30% Road 235 193 1136 1564
25% Air 88 333 102 523
20% Total 323 526 1238 2087
15% Figure 14: SCOTSTAR Journeys by Mode of Transport in 2015-16
100% 10% 92% 80% 73% 75% 5% 60% 63%
40%
0% 37% 20% 27% 25% Repatriation Uplift Surgery Specialist Care Imaging Resources Other Intensive Care Outpatients ECMO 8% 0% Paediatrics Adults Neonates SCOTSTAR North Outside Scotland SEAT West Air Road Figure 13: Neonatal Transfers by Scottish Region and Reason for Transfer Figure 15: SCOTSTAR Journeys by Mode of Transport in 2015-16
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
14 15 base, featuring case cameras to assist debrief, within the territorial boards are based presentations and reflective learning, audit and transferred to SCOTSTAR during discussions on patients improve patient care with the financial year. SCOTSTAR’s retrieved in to both units regards to rapid sequence financial statements presented • The redesign and induction of anaesthesia; an under spend of £21,332 at the development of the • Reorganisation of clinical end of March 2016 (Appendix 1). paediatric website is being equipment carried on undertaken by two of the pre-hospital missions to Workforce consultants, Dr Tim Geary expedite response times. and Dr Andrew McIntyre. The diverse structure of Neonates workforce in different teams Adults is presented below: • New clip dock trial • Further development and Adults updates of the EMRS app 2.3.3 Finance And Workforce including a major incident The Adults team is staffed by call team call out function; Finance Consultants, Trainee Doctors, • Advanced CCP project Research Fellow, and Critical work continues with two Since April 2014, funding streams Care Practitioners (CCPs). The further CCPs undertaking are managed through SAS team, led by Clinical Lead Dr an post graduate certificate finance and regular meetings Stephen Hearns and Service in advanced practice; are conducted with the Territorial Lead Mr Stuart Daly, has had • Development of service Boards involved to ensure that two clinical teams available capability around the budgets are being managed every day during 2015/16 and is treatment of patients suffering appropriately. Each team has a able to provide additional teams Systems model. The ANNP’s developed maintenance and intensive care accidental hypothermia, as defined budget allocated from during major incidents or periods a training programme for the patient management. Working described in section 3.5.5; the SCOTSTAR budget; costs of increased activity. Medical There have been several strands paediatric nursing staff to proactively towards standardised • Project to utilise badge incurred by each of the teams staff from throughout Scotland of development in the use of undertake to enable them to documentation and data collection Information Technology to support work with the neonatal team, to following the integration of the work done by all three teams. undertake neonatal transfers nursing teams; neonatal and Significant changes have taken both elective and emergency. paediatric nurses Graham Latta place in 2015/16; the Neonatal and Clare Hargan have been team completed the move to the Three of the paediatric working together on combining new Cloud based BadgerNet nurses have completed their the transport logs. These will be platform in August 2015 and neonatal competencies and available for use for the teams at the Paediatric team started to are now working as part of the beginning of summer 2016. use it from April 2016 to record the neonatal nursing team as paediatric retrieval activity. The well as undertaking paediatric The nursing team have developed Adults team have completed retrievals. The nurses will have a training programme for adult the testing and feedback stages clinical placements within the intensive care nurses. The main for their new database, EMRS neonatal intensive care unit aim of this training is to support View, which was demonstrated to consolidate the training and assist the adult nurses that are at the 2016 Retrieval Conference that they have completed. caring for the critically ill children and will allow for run-sheets to The paediatric nurses and prior to arrival of the retrieval team. be completed electronically. clinicians will be working This programme will be ready to towards a training programme deliver from the summer of 2016. Innovation for the neonatal nursing team to undertake paediatric Team specific innovation SCOTSTAR teams are committed retrievals. This will also include achievements for 2015- to driving forward new initiatives clinical placements within the 16 included: and quality improvements and paediatric intensive care unit. have implemented several Paediatrics service innovations in 2015- Honorary contracts have been 16. Specifically, neonatal and agreed within NHS Greater • Quarterly joint PICU/ paediatric teams have been Glasgow and Clyde to allow SCOTSTAR Mortality and working towards an integrated the nursing team to go in to the Morbidity meetings are Alistair Kennedy, Critical Care Paramedic, EMRS neonatal/paediatric nursing clinical environment for skill hosted at the SCOTSTAR
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
16 17 still exist and were advertised for provide information on response delivery plan. More information a fellow in the South East and an times, clinical outcomes and on our performance against ANNP in West. Three dedicated quality issues relevant to the agreed externally reporting drivers were recruited in the teams; and to drive forward QPIs is available in sections North team, with recruitment the programme of continuous 3.4.3 Clinical Outcomes and process in place to appoint two quality improvement within 3.4.7 Response Times. drivers in the South East. SCOTSTAR, including clinical outcomes which showcased the SCOTSTAR remains 2.3.4 Quality Performance high standard of care delivered committed to ensuring key Indicators (QPIs) And and highlighted areas with goals are delivered by 2020, HEAT Targets scope for improvement, for example temperature control. such as clinical coordination, A suite of internal and external The measures are being agreements with territorial Quality Performance Indicators reviewed in summer 2016 to Boards, integrated and agile were provisionally agreed and ensure improvement efforts staffing structure, technology measured during 2015-16 to remain aligned to our overall model and demand levels.
Dr Allan Jackson, Lead Clinician & Dr David Rowney, Paediatric Retrieval Consultant
and from as far away as London emergency medicine trainees the service is able to respond and the South Coast of England also work within SCOTSTAR to the demands placed upon form the EMRS consultant group as part of their training. it, and to ensure consistent working clinical sessions within working practices across the the team. A new CCP joined From 1st April 2016 all paediatric service. Dr Allan Jackson, Lead the team in 2015 in a seconded retrieval will be delivered from Clinician, provides enhanced position. The team has recently the SCOTSTAR Base, and at clinical guidance to the teams. gained approval to provide sub- the time of report development The medical rota for the teams specialty training in Pre-Hospital there were six substantive is delivered differently within Emergency Medicine (PHEM), a Band 6 nursing posts within the three sites, with some great achievement for the service. SAS for SCOTSTAR with one teams allocated whole time
service lead, Paediatric Nurse equivalents and others based Paediatrics Consultant Ms Sandra Stark. Dr on Programmed Activities (PAs). David Rowney provides clinical Support staff are also essential to The Paediatrics team comprises consultants, nurse consultants, leadership to the team as Lead the efficient running of the team specialty doctors, trained PICU Clinician. Six PICU consultants and include medical physics, nurses and PHEM / anaesthesia and one anaesthetic consultant pharmacy and administrative / PICU senior medical trainees. undertake additional sessions. support, which is provided locally. Any vacancies on the rota are There are six dedicated drivers filled by internal locums. shared with the neonatal The Neonates team has run Apart from nurse practitioners team. Plans are in place to successful rounds of recruitment and consultants, PICU recruit 5 additional Band 6 in 2015 to resolve recruitment consultants continue to provide nurses and 2 further shared challenges and gaps existing telephone advice and support drivers over summer 2016. previously. In 2015, a Band 6 to the referring hospitals. As post was appointed to the West part of the agreed training Neonates team and a Band 7 West nurse programme, all trainees must commenced ANNP training. Two undertake transport work. Senior The Neonates team is managed nurse posts were successfully PICU Grid trainees now have by the Strategic Service appointed for the North team, dedicated transport sessions. Manager, Mrs Ann Marie with discussions planned for They undertake two 6 week Wilson who provides strategic extending two further part time blocks within their two year PICU management and leadership rotational posts due to finish their The EMRS Team Vix Monnelly, Trainee and Rod Kelly, Trainee, South East Neonatal Team training. Senior anaesthetic and to the service to ensure that secondment. However vacancies
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18 19 Standards agreed through Improvement Standards (HIS) Neonates 3. Strategic Objectives the national clinical Clinical Governance Standards. governance framework. All incidents are entered into The team has had an ongoing • Undertaking various audits and the BadgerNet database and participation within local, regional produce reports to the National reviewed. Adults use an in-house and national audit programmes. Clinical Governance Group. developed system called Sphere It also contributes to the national • Considering local and to record critical incidents and data standards and benchmarking national Significant monitor any issues through the tools which are currently being Adverse Event learning monthly case reviews. Critical developed by the UK-wide and recommendations. Incident reporting for all teams Neonatal Transport Interest • Reviewing clinical will be harmonised through the Group (TIG) which reports to the Datix reports. Scottish Ambulance Service British Association of Perinatal • Promoting learning Datix System in the future. Medicine (BAPM). The service and development. is committed to participating in the implementation of regional • Considering and promoting The practice of conducting peer case reviews. collaborative working to debriefs between the retrieval • Overseeing and promoting implement agreed pathways. team members following each quality improvement activities emergency retrieval continues. within SCOTSTAR. Adults This provides an opportunity for • Identifying and producing team members to discuss any proposals for specialist The Adults team continued to relevant issues and to identify clinical procedures and have Quarterly clinical governance learning points. The outcome equipment for approval by meeting with remote and rural of Significant Adverse Events the SCOTSTAR Senior colleagues and SAS in 2015-16. is reported through the Scottish Leadership and Management The Adult team has developed Ambulance Service Patient Team and the National 117 clinical and non clinical SOPs Safety Group to the Clinical Clinical Governance Group. that form the backbone of their Lisa Curatolo, Critical Care Paramedic/EMRS Graham Latta, Transport Nurse, West Neonatal Team Governance Committee. clinical governance structure This group reports into the to ensure safe and efficient operations. They continue to Ambulance Service Clinical 3.4 Effective issue weekly updates to SOPs Governance Group and a and communication briefs. 3.1 Longer Lives trained to undertake retrieval, 3.3.2 Clinical Governance number of the clinicians currently 3.4.1 Clinical Audit Programme including updating their knowledge working from SCOTSTAR are 3.4.2 Staff Governance Work is ongoing under the of equipment, air and road safety. Clinical Governance is members on this Group. The SCOTSTAR teams have a long auspices of the Scottish Details of the learning and outreach crucial to the effectiveness of Associate Medical Director attends standing history of participation The NHS Scotland Staff activities undertaken by the team SCOTSTAR. Work is underway appropriate Clinical Governance in audit programmes and Ambulance Service’s Information Governance Standards apply are available in Section 3.4.6. to align ScotSTAR Patient Safety and Board meetings as required. continuous improvement Governance Committee and within SCOTSTAR and a plan is in and Quality Group with the SCOTSTAR Research and initiatives. In 2015-16, all place to ensure regular monitoring existing SAS Clinical Strategy 3.3.3 Adverse Events Development (R&D) Group to link SCOTSTAR is committed to SCOTSTAR teams have continued and continuous improvement. As arrangements, and to provide three years worth of retrieval data ensuring the rate of sickness participating in several audit part of the SAS arrangements, regular reporting to the SAS Critical incident reporting continues to the outcomes data held by ISD absence remains equal to programmes as detailed below. an annual staff governance audit Clinical Governance Committee. to play a key role in ensuring that as a pilot study. In August 2015, or as close to the national is undertaken and reported via The bi-monthly SCOTSTAR standards of care on retrieval an initial study was approved average as possible. Paediatrics SAS staff governance structures. Patient Safety and Quality Group are maintained. Currently the to link these data to provide a will provide assurance and teams record issues on their local The team follows the Paediatric baseline of outcomes from the 3.3 Safe 3.4.3 Clinical Outcomes/ evidence to the SAS Clinical systems historically in place, and Intensive Care Society (PICS) implementation of SCOTSTAR in External Benchmarking Governance Committee that discuss these at team meetings Standards for transport of critically 2014/15, with an annual exercise 3.3.1 Risk Register SCOTSTAR is compliant in all and SCOTSTAR PSQG. ill children. Post mission debriefs carried out in subsequent years Following the agreement of areas of clinical provision, by: are undertaken and recorded as provisional indicators last year, to follow up on outcomes. Based A risk register is maintained Paediatrics team has continued a routine and cases are reviewed SCOTSTAR has measured clinical on the trends shown by the yearly and regularly updated by the • Ensuring care delivered by to have regular morbidity and weekly in collaboration with outcomes in 2015-16. In 2015-16, linkage, patient outcome indicators SCOTSTAR Management Team clinical teams is effective mortality meetings in 2015-16 PICU colleagues. This allows 98.4% of SCOTSTAR Emergency will be developed by 2020. and reported along with other through ongoing research, which provide an important forum detailed review of each case missions were completed with divisions to the Ambulance audit and review. for discussion and reflection on in an open, transparent and requisite team members. 99.3% 3.2 Healthy Lives Service Executive Team and • Supporting the development specific retrieval episodes that supportive environment. The of the completed missions were onwards to Scottish Ambulance of clinical standards agreed may have been challenging. purpose of the meeting is to focus without equipment failures and Efforts have continued in 2015-16 Service Governance Committees. through the National Clinical Neonates have a system in on improvements to the overall 99.6% of the completed missions to ensure that staff at all levels in Any risks that affect the Governance Group. place following the seven service, including the referral were without vehicle/ambulance the three teams are adequately territorial boards are shared. • Implementing Clinical dimensions of the NHS Healthcare centres, patients and staff. failures in flight or on road.
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20 21 the annual EMRS Retrieval for delegates to interact with. Paediatrics Conference. This conference was Speakers were welcomed from first held in 2005 and is aimed Adult Retrieval Victoria and South The team continues to collaborate at clinicians, managers and Africa for the first time to share and build on relationships with other interested groups involved their experiences. Each conference other service providers. A number in medical retrieval work. The is also followed by individual of the team assisted with the conference has grown in size and feedback from delegates and this delivery of The Royal College of reputation each year and now has is incorporated into planning for Surgeons of Edinburgh’s Diploma 200 delegates attending from adult, the following year’s conference. in Retrieval and Transfer Medicine. Paediatric and Neonatal retrieval services. These delegates come The conference has a strong Neonates from services throughout Scotland scientific component with a and the UK, along with services in dedicated free paper session Neonates has progressed and North America, Europe & Australia. as well as two lightning poster implemented the majority of the sessions. These forums allow Neonatal Quality Framework The international reputation of presentation and scientific scrutiny (QF) over the course of the the conference also attracts of current research in retrieval year. Time-specific plans are in global experts in retrieval medicine as well promoting place to achieve the outstanding Dr Stephen Hearns, Lead Consultant, EMRS medicine to speak at the Retrieval innovation across services. QF elements. The Neonatal Conference. As well as ensuring an team continues to introduce oversubscribed delegate list every Over recent years the conference technological advances within A spot check established all UK organisations met factors with discussion on the year, speakers attending from has expanded its footprint on transport (such as HFOV, CFM that equipment checks were the mobilisation time target effects of teamwork, equipment, FinnHEMS, Norskluftmabulanse, social media with a specific and NIRS monitoring) to emulate documented for 95% of the of less than one hour. In and culture. The highlights Sydney HEMS, MedSTAR (South conference Twitter feed. This therapies available within NICUs missions and pre/post mission comparison, for SCOTSTAR from the conference were: Australia) and other international generates publicity for the and provide cutting edge care checks were documented paediatric teams, 47.1% of all services allows SCOTSTAR to conference and also allows for for the benefit of our patients. for 96% of all completed paediatric air retrievals and • Benchmarked data was build links with these services real time interaction during the SCOTSTAR missions. 0.7% 46.4% of all paediatric road presented on the number of and ensure best practice. conference for people unable to Adults of all SCOTSTAR retrievals retrievals were mobilised in total and ventilated transfers, attend in person. This year the either started from or were less than an hour, highlighting and the time it took to get The programme for the conference conference will have a real time The team has maintained the completed outside of Scotland. our unique challenges. teams mobile and at the changes every year based on core Twitter moderator to facilitate this. quality of service provided to • Dr Salvo gave a presentation patient bedside. 81% of all topics such as Human Factors and rural patients and professional Benchmarking on the Italian PICU Network time critical transports in the Innovation in Retrieval Medicine 3.4.4 Service Improvement colleagues through active TIP.Net which has been UK were mobilised in less but also encompassing hot topics programmes of audit, training, Paediatric Intensive Care collecting data since 2004. than one hour. In comparison in retrieval medicine. In 2016, the Service Improvement practices rural outreach and clinical Audit Network (PICANet) is an • The history of the referral with the national benchmark, conference continued to innovate have continued in all three teams governance. The team continues international audit of paediatric and transport dataset 77.3% of all SCOTSTAR time with filmed case based scenarios within SCOTSTAR over 2015-16: to develop its reputation intensive care which collects data collected by PICANet, and critical neonatal transfers met on all children referred, admitted how it had changed over the mobilisation time target of and transported to Paediatric the years was presented. less than one hour in 2015-16. Intensive Care Units (PICUs) in • Sisters from Great Ormond • 83% of all emergency the UK and Ireland. PICANet Street Hospital and transfers in the UK met had their Annual Meeting on Birmingham Children’s hospital the national time to patient 4 November in London, the discussed the role and value bedside target of 3 hours and highlights from which were: of Family Liaison Teams to the 30 minutes. In comparison units and families of patients. with the national benchmark, • The team presented a lay 92.9% of all SCOTSTAR report presenting their data for Following the move to BadgerNet emergency neonatal transfers the first time, which showed for recording paediatric retrieval met the target of time to that over 6,000 very sick activity from April 2016, the team patient’s bedside within 3 children were transported to will consider options and identify hours and 30 minutes. PICU last year. Of these, 77% an optimum solution for submitting • There were three poster were transported by paediatric SCOTSTAR data to PICANet. presentations from the intensive care transport teams. SCOTSTAR South East In comparison, SCOTSTAR A group of staff from the Neonatal Team on transport Paediatric retrieval team Neonatal team attended the equipment, Cerebral Function transported 323 children Transport Interest Group annual Monitoring (CFM), and in 2015-16, accounting for conference in Brighton on 12 and pre-arrival checklists. 5.4% of all UK transports. 13 November 2015. The main Jo Gallagher, Transport Nurse, West Neonatal Team and David Percival, Critical Care Paramedic, EMRC • Nearly 75% of retrievals for theme of the meeting was human Each year, the Adults team hosts
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22 23 internationally as a leading invited as speakers at conferences, team in 2015/16 have been: retrieval service through its annual and had abstracts and posters conference, research programme, accepted at national and • Joint neonatal /paediatric academic achievements and international meetings. They have team days including north and its links with partner services also reviewed articles, commentary South East neonatal teams. throughout the world. or chapters, and published articles • Completion of the Bronchiolitis in journals such as Infant. guideline – ready for 3.4.5 Research And circulation to all staff. Development In 2015-16, the Adult team • Joint Adult/Paediatrics have published several articles outreach training and During the course of the year in Resuscitation, Emergency education in Orkney the SCOTSTAR Research and Medicine journal, European conducted in September 2015 Development (R&D) Group has journal of Emergency Medicine, • Outreach training for Islay was worked to agree a minimum Transplant International and the conducted in September 2015 dataset for SCOTSTAR teams journal of Paramedic Practice, and • Feedback sessions were and developed a process for team members have been invited conducted for Inverness, Jimi Ronaldson, Critical Care Paramedic and Randal McRoberts, handling and documenting to speak at national, European Paisley, Monklands and Consultant, EMRS research activities undertaken and International conferences Ninewells hospitals; with link by the SCOTSTAR team about the work the service does. clinicians identified and agreed members. Documentation of The team has also had a leading for each referring hospital. obstetric haemorrhage, sepsis, Outreach Training Trips to Patient Targets (for research projects has been role in setting up an international trauma and cardiac arrest resulting in 36 hours of Emergency Transfers only) integrated with the SAS Research, aeromedical research collaborative Neonates including post-mortem c section. teaching materials now – As a whole SCOTSTAR Development and Innovation group involving retrieval services available to service. teams have complied with database during 2015-16. from Scandinavia and Australia. The Advanced Neonatal Nurse In February 2016, SCOTSTAR • Argyll GP update course. their individual time to patient Practitioners are in the process Adult team, SAS teams (including • Emergency obstetric bedside targets for emergency Dr Chris Moultrie, appointed In addition the team also of undertaking a post graduate SORT), and Police Scotland CPD course. transfers in 74.7% retrievals as a funded Clinical Research organises the annual Retrieval certificate in Education. They hosted and participated in a • Major incident tactical for the year 2015-16. Fellow to the service in August & Pre-hospital Care conference, have a lead role in coordinating multiagency Major Incident command course. 2014, has continued his research including delegates from the UK, the in house training and training event. The focus was • All team members These composite targets are on analysing growth trends and Europe and Australia representing education for the neonatal and on multiagency integration in completed Team Resource category weighted averages of forecasting patterns of activity Adult, Paediatric and Neonatal paediatric teams. They also have response to a terrorist incident. Management training individual mobilisation and time within the SCOTSTAR teams, retrieval services receiving a lead role in coordinating the The training included a table top • Team members have once to patient targets of the teams. which aims to use mathematical universally positive feedback. training and education for the exercise, presentations from again been instrumental in SCOTSTAR identifies modelling to make SCOTSTAR remote and rural area and work the police, skills stations and a the development and delivery slippage from these targets; teams more available and more 3.4.6 Training And alongside adult and paediatric clinical multi- casualty scenario. of the Diploma in Retrieval efficient. Dr Moultrie is a member Outreach Activities colleagues to ensure that this including where possible of the R&D group and has been training and education support and Transfer Medicine exam reasons for delays and any involved in the development of Extensive training activities have is delivered to staff in the remote The highlights of learning activities run by the Royal College of exceptional circumstances quality control within the Adults been developed and conducted and rural referring hospitals. conducted in 2015-16 have been: Surgeons of Edinburgh. affecting targets. The main team and QPIs for SCOTSTAR. within the SCOTSTAR teams areas identified as reasons for over the past years and this has The highlights of learning activities • Outreach training was 3.4.7 Response Times slippage from compliance with Staff within the three teams are continued in 2015-16. Staff from conducted by the Neonatal delivered to Mull, Benbecula, mobilisation targets were: also directly participating in many adults, paediatrics and neonates team in 2015-16 have been: Shetland, Coll, Lochgilphead, Response Times Targets research activities and holding have been working together to Shetland, Islay Campbeltown, • Paediatrics: Mobilisation Wick, Stornoway and Following agreement of memberships of professional develop the training and simulation • Outreach training of air retrievals and time Stranraer; with dates being provisional indicators for 2015-16, groups or as course faculty, for room within the SCOTSTAR Base. provided for Arbroath, to reach patient’s bedside planned for the upcoming year. SCOTSTAR has measured the example, the Paediatrics retrieval They have identified essential Shetland, Lochgilphead, for air retrievals. • Joint training exercise at following response time targets: team members have been equipment that would be required Campbeltown and Perth. • Adults: Mobilisation invited to speak at conferences for this facility and are working • Ongoing joint team training Scottish Fire and Rescue of Helimed 5 (night) and deliver presentations, and with a number of charities that days with paediatric/ Service Training Centre, Uiall. • Compliance with Mobilisation and Glasgow King Air have authored publications and are keen to be involved in this neonatal teams. • A further two CCPs Targets for Emergency (day and night). book chapters, lectures, editors project. A structured induction have commenced a post Transfers (Time critical of case histories, abstracts, package has been developed for Adults graduate certificate in for neonates) – As a posters. They have also chaired all staff, and daily safety briefing advanced practice. whole SCOTSTAR teams The main circumstances meeting sessions, and examined huddles have been introduced. In 2015-16, team members • All CCP team have now have complied with their affecting these targets in 2015- for the Diploma in Retrieval participated in an Obstetric completed training programme mobilisation targets for 16 were availability of suitable and Transfer Medicine. Paediatrics Emergency training day including with London’s Air Ambulance emergency transfers (time aircraft leading to challenges lectures, small group teaching and Institute of Pre-Hospital Care. critical for neonates) in 55.6% in competition/prioritisation of Similarly the Neonatal transport The highlights of learning activities clinical scenarios encompassing • Further work was completed retrievals for the year 2015-16. missions between services and team members have also been conducted by the Paediatric normal and complicated births, on Education Modules for • Compliance with Time also the many other missions
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24 25 that the aircraft undertake out reviewing the figures every • Overall Patient with retrieval. From a paediatric month with Air Ambulance, Satisfaction Score strategy “Towards 2020: Taking Care to the Patient”. The key ambition of the project is to create and perspective, insufficient paediatric Bond and Gama Aviation. staff a desk in the Cardonald Ambulance Control Centre that will prioritise access to and coordinate the resource can be a likely issue in 3.5.2 Partner Involvement activity of, our specialist resources. The desire to implement the desk has been articulated for a number case the single team is already 3.5 Person Centred of years and several iterations of plans and proposals of the functions to be managed by the desk out or exhausted and unable to The teams have close links have proliferated since. My first objective on becoming project manager in October 2015 was to clarify work following shift over-runs. 3.5.1 Patient / Carer/ with other adult, Neonatal and which of these proposed functions were to be tackled first. It was agreed that initial work would focus on Public Involvement Paediatric transfer and retrieval SCOTSTAR coordination, Air Ambulance tasking and provision of the Perinatal Advisory service with the SCOTSTAR have considered services in the UK and abroad, following deliverables in mind: possible solutions to resolve these All teams involve the patients (or and continue to build links challenges and identified that: their parents / carers) in decision with similar services through 1. To better prioritise patients who need access to specialist resources making as far as possible and reciprocal visits and attending • Clinical coordination parents are invited to travel with 2. To improve tasking of air assets conferences such as the will improve logistics baby in the ambulance, when 3. To improve coordination of SCOTSTAR assets. Transport Interest Group and greatly in the future. clinically and logistically possible PICANet annual conferences. • Continuing the ongoing and appropriate. Parental In an effort to realise these objectives the project team have implemented the following; work to increase paediatric presence is documented and The teams also work resource, and increased monitored for each Paediatric and • Recruitment and training of SSD Supervisors to be responsible for ensuring that the expected collaboratively with other blending of the teams Neonatal transfer. Paediatrics improvements in tasking and co-ordination are managed day to day and for ensuring that the SAS teams internally and including breaking down and Neonates have been actively agreed QPI’s are met and reported. territorial and special NHS the historical age-related monitoring their feedback • Installation of a custom designed and procured call conferencing solution, to facilitate improved Boards externally to continually boundaries between teams. through regular questionnaires tasking and coordination of assets. As the planned single point of contact for access to the enhance service delivery and • A pragmatic review of the over the past years. SCOTSTAR teams the desk will also utilise this upgrade to better coordinate this activity. patient care provided to the services provided to different • Procurement and installation of a filter for the call management system used in ambulance control to public. Peter Lindle provides an types of stakeholders, from From April 2016 onwards, allow SSD staff to focus their attention on those calls requiring a response from a specialist resource. RGHs to Teaching hospitals. SCOTSTAR is implementing an excerpt outlining how his role as • Improved cover for the Trauma Desk and enhanced access to senior clinical decision making This may enable a refinement electronic system for collecting SSD Project Manager involves support to help with the tasking and prioritisation of access to specialist resources. of performance targets continuous parent/carer feedback, interactions with SCOTSTAR • Delivery of a custom training package for all current and recruited SSD staff that focuses on based on patient need. and will report on the following teams to ensure the SSD project • Possibility of regularly indicator from 2017 onwards: is delivered successfully: enhancing their understanding of specialist assets and helps to improve tasking decision making.
The project team has worked closely with the SCOTSTAR service and clinical leads throughout the implementation phase of the project. As a former helicopter air ambulance paramedic based in Glasgow, I have had the opportunity to work alongside representatives from each of the SCOTSTAR teams for a number of years. Prior to our A project group has been meeting monthly since October 2015 and the SCOTSTAR leads have been collocation in the new Glasgow base, the majority of that experience had been with the Adults team very generous with their time despite their already significant workload. Their support has proved responding to pre-hospital missions and retrieval calls. Working with the team added an extra dimension invaluable, particularly with regards to the specialist training of SSD staff. Each of the SCOTSTAR leads to the role. When we weren’t actively engaged on a tasking we now had access to the knowledge and produced and helped deliver a bespoke training package to prepare our staff for their new role. The experience of a group of senior clinicians who were always willing and eager to deliver impromptu feedback received from the training sessions has been very positive, with the SSD staff unanimously training sessions on critical care topics and just as willing to learn from our previous experience in agreeing that they have been made to feel very welcome and part of the SCOTSTAR team. The project pre-hospital care. Together we developed a daily simulation training schedule and set of air ambulance team would like to take this opportunity to thank the SCOTSTAR, Air Ambulance and ACC management paramedic critical care competencies. The interactions between our services also led to the creation teams for their continued support of the Specialist Services Desk project. of the Critical Care Practitioner (CCP) role, a development opportunity that several air ambulance paramedics were to benefit from. SSD Supervisor trainees from Peter’s team have provided the following quotes highlighting their positive experiences of interacting with SCOTSTAR teams: Due to the complex nature of our joint air tasks we found post mission de-briefs to be a useful improvement tool. When issues relating to our equipment or processes were identified they were “The SCOTSTAR clinician’s enthusiasm and passion for quickly resolved on base, however the most commonly discussed issues by far were related to the appropriateness of tasking. The helicopter could respond with a standard paramedic crew or if requested their role was contagious. The time and effort they put could bring along the EMRS Trauma Team (Doctor and CCP). Requests for a helicopter emergency into their training with us was invaluable but the scenarios response could be routed through either of three geographically distinct ambulance control centres and just made everything come together and made us realise made by anyone in the organisation, regardless of their level of understanding of the capabilities of the just how important their role is and what sort of complex aircraft or distinct crew configuration options. challenges they face.” James Dempsey, Practice Developer, ACC Prior to my clinical training, I spent several years working in our ambulance control centres as a call handler and dispatcher. Being able to look at the tasking issue from these two viewpoints has proved “There is one thing I have noticed about all the teams and invaluable in my current role as Specialist Services Desk Project Manager. that is the energy and passion they all have for their roles. I want to bring that to the Specialist Services Desk.” The Specialist Services Desk Project is an integral part of the Scottish Ambulances Services wider Steven Hunter, SSD Supervisor
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26 27 3.5.3 User Surveys / Feedback Adults Referring unit feedback was monitored during the year through an annual survey conducted centrally by the SCOTSTAR Management Team for all three teams and the overall Service User Satisfaction Score was calculated Importance of Training and Protocols as 97.8% for the division as a whole. Feedback and comments received from the survey are presented below: A young man was discovered in a field early one morning in cardiac arrest. He had been lying out overnight in an ambient temperature of -6C, and his core temperature had dropped to 21 degrees, most patients will not survive when their body temperature falls below around 30C. As well as dispatching a local crew to attend the incident, the Ambulance Control Centre alerted the Trauma Desk to task the team to respond in one of the Scottish Ambulance Services Air Ambulance helicopters. The ground paramedics moved the patient to the local hospital where he was met by the team. Using a recently developed Hypothermia Standard Operating Procedure the team referred the patient to the Cardiothoracic Centre at Edinburgh Royal Infirmary, who accepted this patient for emergency re-warming on ECMO. After rapid intubation and ventilation the patient had mechanical CPR commenced by the Autopulse and was immediately transferred by the EMRS team in Helimed 5 to Edinburgh. On arrival the patient was placed on Extra Corporeal Membrane Oxygenation (ECMO) life support by the cardiac surgeons and re-warmed. His heart was restarted within a couple of hours; he was extubated the same evening and discharged from the Intensive Care Unit the following day with normal neurological function.
As far as we know this is the first time that a patient suffering prolonged hypothermic cardiac arrest has been successfully treated with in-flight mechanical CPR and emergency ECMO to subsequently survive with a normal neurological outcome.
This case highlights a number of important factors in making sure that this patent received the best possible care to increase his chances of making a full recovery. These include good communication and decision Figure 16: Feedback from SCOTSTAR Referring Units making between all the teams involved. This meant that the patient received the chain of survival from the local crew giving him CPR right through to the advanced care he received from the Adult Retrieval team and the to From April 2016 onwards, an electronic system of collecting continuous referring unit feedback is being implemented. post resuscitation care at the Royal Infirmary. It also highlights the importance of the advanced training and the protocols used by the Adult Retrieval team in the treatment of this patient. 3.5.4 Communications patients and parents as well as discussions between Bees Nees communication with relevant Media, SCOTSTAR Deputy Effective communication is outside parties. For example, General Manager and Scottish Adults essential in keeping the staff as Neonates routinely have Ambulance Service Media Trauma Care informed of progress and discussions with parents Manager, it has been agreed changes related to the service. following a diagnosis of their that filming for a third season With this in mind, the new baby’s condition including its A patient who had fallen down the stairs of a flat and had potentially sustained a traumatic brain injury. involving all three teams at the management structure for implications and regarding the Due to the serious nature of the patient’s injury, the EMRS team attended the incident. Working alongside new base would commence in SCOTSTAR has included a ongoing care and treatment the Accident and Emergency ambulance crew, they were able to give a pre-hospital anaesthetic then Workforce and Communications of their baby; all staff are April 2016 for a period of eight intubate and ventilate the patient before safely transferring him to a hospital with neurosurgical facilities. Group, with membership trained in effective methods of weeks. The series would be from a range of staff across communicating with parents. screened on BBC in October the teams. The group’s remit Majority of transport staff are 2016. EMRS was involved in includes providing a forum experienced in communication, filming of ‘Countryside 999’ to formally engage with the but a communication scenario TV programme in 2015 and range of staff groups across has been added to the transport continues to maintain close links the various specialist areas. course to build resilience. There with different media aspects. is also a strong focus on inter- The branding exercise has been site communication, with ongoing 3.5.5 Stories completed and recognisable regular meetings with the North branding integrating the team to ensure sustainability The following stories provide ethos of the three teams to of service delivery model. the identity of the Scottish an insight into a usual day Ambulance Service developed. Within Paediatrics, three 1 hour at work for the SCOTSTAR programmes were screened in teams and also highlight the In addition, the teams have the fall of 2015 on BBC Alba importance joint working between their own mechanisms for as part of the second series of SCOTSTAR teams and partners internal communications with Paediatric Retrieval. Following to enhance overall patient care:
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28 29 Adults
Importance Of Carrying Bloods
The team are able to carry O negative blood on both primary (pre-hospital) and secondary retrieval missions. An example of where this blood helped a patient was when a patient in a rural location suffered from severe internal bleeding following the birth of a child.
She was being treated and receiving transfusions at her local hospital, however her condition was getting progressively worse, and team was called to retrieve her to a hospital in the central belt. She lost consciousness shortly after take-off and the team were able to commence a transfusion of O negative Kate Campbell, Advanced Neonatal Nurse Practitioner, West Neonatal Team blood on the flight, helping to resuscitate and stabilise the patient.
Neonates Neonates Time Critical Transfers Clinical Coordination and Coastguard On arrival back in Glasgow airport with infant from example 2 (at 04.00), there was a third emergency A baby boy was born at term in a rural hospital by caesarean section. The following day he referral received from a GG&C level 2 neonatal unit. A term baby boy had been delivered 2 hours became unwell with breathing difficulties, colour changes and reduced oxygen saturation. previously by emergency caesarean section. He was asystolic at birth and required resuscitation to The local consultant examined the infant and suspected congenital heart disease with a duct which he responded. At two hours of age he was showing signs of hypoxic ischaemic encephalopathy dependant lesion (time critical). She notified PAS and the neonatal team were alerted. The and was being referred to a tertiary centre for whole body therapeutic cooling. This was a time critical neonatal team were about to leave on a back to base transfer. That was rescheduled quickly. transfer and the neonatal team had just arrived from the Western Isles with the infant from example 2. It was decided that the most efficient way to expedite the transfer of infant 3 was to ask the referring The fixed wing aircraft was sought for the transfer but it was unavailable. As the neonate needed to unit for infant 3 to accept infant 2. The original receiving unit for infant 2 was a similar acuity unit but be urgently moved, Air desk contacted the coastguard and requested use of one of their teams and an hour’s ambulance drive away. The referring unit for infant 3 accepted infant 2. The family of infant 2 helicopters. This was quickly approved and the team were mobilised within an hour of first referral were informed that their infant for non-clinical reasons needed to be moved to a different hospital than to retrieve the newborn. The baby and his mother were uneventfully transferred to Glasgow. first anticipated. The neonatal team arrived at infant 3’s cot side within four hours of age and initiated whole body therapeutic cooling and then uneventfully moved the baby to the receiving level 3 unit.
There was excellent team work and communication between the rural referring team, PAS/ Air desk, the This example highlights the ability of the team to reorganise to expedite further emergency referrals. Even coastguard team, the receiving neonatal and cardiac consultants, the neonatal retrieval team and the obstetric though the neonatal team had just completed two long distance transports, they efficiently reorganised to bed manager (who provided a bed for the mother post section). facilitate a further time critical retrieval. There was excellent communication between the neonatal transport team, PAS, the referring and receiving centres.
Neonates Paediatrics Simultaneous Transfers Clinical Coordination Just after the helicopter above landed in Glasgow, there was a referral from a Western Isle consultant A 2 year old child presented to A&E with a diagnosis of croup. Her condition deteriorated and she was about a day one newborn who had breathing difficulties reduced oxygen saturation and a metabolic referred to the paediatric retrieval team. The air resources were tasked through the airdesk and the team acidosis. The infant from example 1 was efficiently transferred to the receiving tertiary centre and the arrived at the referring site within an hour and a half of referral. The referring team managed this child neonatal retrieval team quickly prepared to retrieve infant number 2. until the retrieval team arrived and then both teams worked together to stabilise the child. The child was prepared for transfer. While the team were preparing equipment, the neonatal ANP established a videoconference with the rural consultant and was able to assess the infant and advise on management. Air desk secured the fixed wing The mother was unable to travel with the child as she was 36 weeks pregnant and this was extremely plane for the transfer and ambulance links were organised. The fixed wing left Glasgow with the neonatal distressing for her. The father decided to travel with the team and his child to the receiving hospital. team less than two hours after landing with the infant from example 1. The infant from the Western Isles was uneventfully transferred back to Glasgow. The child subsequently had a short intensive care stay and was discharged home 6 days after admission. The family were extremely grateful that the father could travel with his child. The transport journey for the child is complete when we are in a position to facilitate a parent travelling with their child. This example demonstrates the challenges of receiving a second emergency referral when still dealing with the current one. The use of videoconferencing allowed the neonatal team to clinically assess the infant so they The referring unit were extremely grateful for our prompt arrival at their hospital and for the help, advice were able to advise management and triage urgency. There was excellent communication between the referral and support from the receiving unit and the retrieval team. centre, PAS/ Air desk, the neonatal receiving team and the neonatal transport team.
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
30 31 This retrieval highlighted excellent communication and team working with the referring unit, the receiving unit, 3.5.6 Staff Engagement Index to complete a short online or and efficient coordination of Air desk, air ambulance, the road crews and the retrieval team. paper questionnaire and provide all transfers and retrievals. Ms A new tool has been designed information on their experience Sandra Stark and Mrs Ann with staff in NHS Scotland to of working for NHS Scotland, in Marie Wilson, Paediatric and Paediatrics help individuals, teams and your team and your Health Board. Neonatal Service Leads, share Health Boards understand and Staff Engagement Index will be their experience of the moving improve staff experience, the ECMO Transfer reported from 2017 onwards. idea being that positive staff to the new SCOTSTAR Base at Glasgow Airport including the A child was referred from Northern Ireland to the Paediatric intensive care unit for ECLS support. The engagement will result in positive Staff engagement has always child was already on maximum respiratory support and was continuing to deteriorate both from a patient experience. As the tool been a priority for SCOTSTAR as benefits that this co-location has respiratory and cardiovascular state. An ECMO team consisting of a paediatric intensivist, paediatric is rolled out, it is intended that having an empowered workforce brought, and some views from surgeon and perfusionist were tasked to go to the referring unit and to cannulate and commence ECLS. all team members will be asked is key to smooth service delivery their staff members’ perspective: The process for this took the majority of the night, trying to ensure that the team members that were required were available and that the resources were available to undertake this retrieval. The Air desk tasked the fixed wing aircraft to this retrieval. The child’s condition was deteriorating and even once on ECLS support took a significant period of time to stabilise before they were ready to leave the referring The move to the SCOTSTAR base at Glasgow Airport unit. There were also weather issues that had to be considered prior to leaving the referring unit. has been an amazing experience so far. There were pressures on the fixed wing crew as they had other jobs that had been delayed whilst this retrieval was taking place. The air desk staff re-tasked these jobs to the other available resources. From a paediatric perspective it has been an exciting development. The retrieval nurses are now based in the SCOTSTAR base working a 12 hour shift pattern. This has meant that the retrieval nurses are now more involved in the development of the service. Their enthusiasm and commitment is like a breath of There was excellent team working and communication with the Air desk, the air ambulance team and the fresh air. They are focussed on developing and moving the service forward to ensure that we provide the retrieval team to ensure that this journey back to the receiving unit was as seamless as possible. This was a best service that we can for the critically ill children and their families throughout Scotland. highly stressful adrenaline rushing situation and although unstable on ECLS support the child arrived safely back to the receiving unit. From a neonatal perspective, the team have settled into the new base and have started to integrate with the paediatric team and share workloads. We have started to develop shared working practises. We have also been involved in shared training sessions with the Adults and Air wing colleges. We have also managed to facilitate nursing staff from the North team coming down to gain some clinical time at the new base. The South East team will hopefully be able to spend time at the new base over the coming year.
Annmarie Wilson and I have been working together on the integration of the paediatric and neonatal transport nurses. The Advanced Neonatal Nurse Practitioners (ANNPs), some of whom are in the process of undertaking the post graduate certificate in education, have developed a competency based training programme which was delivered to the paediatric nurses and three of them now work with both the neonatal and paediatric teams. We are hoping to develop this further this year and develop a training programme for the neonatal nurses to undertake.
There is continuing collaboration with the Paediatric intensive Care Units in both Glasgow and Edinburgh and the neonatal units in Glasgow to allow the retrieval nurses to undertake clinical placements in both neonatal and paediatric intensive care. These placements will ensure that their skills in intensive care nursing are kept up to date and also inform them of any changes in nursing management of the critically ill infant and child.
The move has also allowed us to work collaboratively with the Adults team and the Air Ambulance Service helping us to understand the needs of all of the teams, how they all function and operate. It will be exciting to see what developments the year ahead is going to bring.
Staff perspective and views:
“It has been an amazing experience with cross team working and an appreciation of how all teams operate.” “It is a great place to work, working with people who understand retrieval/transport and all it involves.” “It is amazing to be part of SCOTSTAR and help develop the service for the future.” “I love my job and knowing that we are there to help the critically ill children and their families that use our service makes it all worthwhile.” “It is a fantastic place to work – the facilities and an appreciation of what the other teams do.”
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32 33 Edinburgh Paediatric Intensive Care Unit Team
3.5.7 Equity: Geographical will allow SCOTSTAR to link Health Board of Referring Access data related to geographical units in 2015-16 (excluding access and monitor to ensure retrievals from referring units A study to link Adults, Paediatric the service remains equitable outside of Scotland). and Neonatal activity data to across different areas in Scotland. outcomes data including patients’ SCOTSTAR teams collect The map opposite shows Health Board of Residence referring unit data for all retrievals. secondary SCOTSTAR and Health Board of Treatment The data below shows secondary retrievals by Health Board of was approved in 2015. This SCOTSTAR retrievals by Referring units in 2015-16.
Adults Neonates Paediatrics SCOTSTAR Total
Ayrshire & Arran 1.2% 2.5% 1.6% 5.3% Borders 1.0% 0.5% 1.5% Dumfries 0.6% 1.4% 0.6% 2.6% Fife 1.7% 1.4% 3.2% Forth Valley 1.3% 1.3% 2.6% Grampian 10.4% 1.8% 12.2% Greater Glasgow 0.3% 23.5% 2.3% 26.1% Highland 8.5% 3.0% 2.1% 13.7% Lanarkshire 4.3% 2.6% 6.9% Lothian 13.5% 2.0% 15.5% Orkney 1.1% 0.5% 0.1% 1.6% Shetland 0.6% 0.5% 0.5% 1.5% Tayside 3.8% 1.3% 5.0% Western Isles 1.6% 0.4% 0.3% 2.3% Total 13.8% 67.7% 18.5% 100.0%
Figure 17: SCOTSTAR retrievals by Health Board of Referring units in 2015-16 Figure 18: SCOTSTAR retrievals by Health Board of Referring units in 2015-16
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
34 35 4. Conclusions: Celebration & Risk
The second year of operation for SCOTSTAR has seen over 2,000 successful retrievals with patient care at the heart of the clinical decision making, while bringing together the teams at the new base at Glasgow Airport and strengthening the Garry Fraser, QAM MSc DIMC RCSEd SRPara Jim Dickie, QAM BSc PGDip MCPara, service with required changes to the General Manager - SW and National Air Ambulance Service Deputy General Manager – SW and SCOTSTAR management and reporting structure.
In addition, the following have SCOTSTAR Ambulances to to SCOTSTAR is laying mobilisation for air and road to 95.8% demonstrating a clear Cardiac Arrest (OHCA) for been achieved to support support clinicians, improve down the foundation for retrievals has seen an 11.75% upward shift, and compliance primary missions improved from effective service delivery: on coordination of assets, establishing a specialist and 13.89% improvement year with mobilisation for time critical 71.5% to 78.6% over the same and data capture, and paediatric response and the on year, respectively. Within the retrievals increased from 71.9% period, whereas for secondary • Development of a • Development of a evolvement of a separate Adults team, intubated transfers to 82.8%. Proportion of babies retrievals it remained at 100% SCOTSTAR Local structured induction paediatric rota should with End Tidal Carbon Dioxide with blood sugar levels greater for both periods showcasing Delivery Plan, package for all staff. support winter pressures, (ETCO2) monitoring for primary than 2.6 Millimole (MMol) continued excellence. Proportion • Procurement of new • National cot capacity missions increased from 91% to per litre on completion also of ventilated patients with vehicles, including 4 new The new base is now well constraints, necessitating 94.6% and proportion of advice increased from 96.9% to 99%. temperature > 36 degrees vehicles being funded by established and provides greater transfers purely for capacity calls followed up increased (excluding OHCA) for secondary SAS (2 Ambulances and opportunity for joint working and the West team getting from 90.7% to 93.9% over Within the Paediatrics team, retrievals improved from 76.8% 2 Operational Support which has already been taken involved in long calls to 2014-15. Within the Neonatal between April-September to 80.2%. Missions completed vehicles) and 1 new forward by the neonatal and find cots. The service team, compliance with time to 2015 and October-March without any monitoring and Ambulance being funded paediatric teams, supporting is working closely with patient bedside for emergency 2016, proportion of patients ventilator failures improved from by charitable donations, each other when demand is high. Scottish Government and missions increased from 81.8% transferred more than once for 99.1% and 99.3% to 100% for • Introduction of a daily the Neonatal Managed to 92.9% and proportion of the same illness/injury in a month both over the same period. Safety Briefing Huddle, In addition to the achievements Clinical Networks (MCNs) international transfers increased decreased from 1.4% to 0%, and • Increased joint training there have been a number of regarding these concerns from 0.32% to 0.63%. proportion of patients requiring a In summary, this has provided an and joint working between challenges in this year including: • And aircraft availability Cardio Pulmonary Resuscitation expected mix of achievement and teams, for example the leading to longer mobilisation Within 2015-16, SCOTSTAR has (CPR) while in care of team ongoing risks and challenges, but Adults Major Incident CPD • Workforce recruitment times especially at night. further accomplished distinct decreased from 1.3% to 0%. the risks have been addressed day, and progress towards and succession planning Clinical coordination through improvements between the first with mitigating actions in place. development of national issues, in terms of Trauma SSD will improve logistics and second half of the year, Over the same period, proportion guidelines and SOPs, Desk cover for Adults in future, with a possible several of these coinciding of missions with emergency The next year of SCOTSTAR will • Clinical Simulation and and successfully filling refinement of performance with the shift to the new base diversions decreased from further strengthen our operations Skills facilities being vacancies for neonatal indicators based on the in September 2015. Overall for 3.3% to 0.6%, and compliance at the central base, central developed further by the and paediatrics. This is location of the aircraft the division, the proportion of with decision to mobilisation co-ordination and an ongoing teams including the potential an ongoing risk currently at the time of referral. international transfers increased for road retrievals saw a commitment by all the teams to for charitable donations to being addressed with the from 0.4% to 1.1%. There were 14.8% improvement. Time to provide the most effective and support infrastructure for this, territorial boards involved. SCOTSTAR has celebrated no missions with equipment arrival at patient’s bedside safe retrieval and transfer for • Monthly and quarterly • Increasing demand, and numerous successes over the failures for either road or air for road and air retrievals patients across NHS Scotland Balanced Scorecards winter pressures within course of the year, as, in 2015- retrievals since September 2015. also improved by 12.5% and and out with when required. for the three teams, the teams, particularly 16 SCOTSTAR has achieved a Over the same period within 4.7%, respectively. Within the • Planning the introduction paediatrics. The continued number of improvements over the Neonatal team, compliance Adults team, proportion of of SAS Cab Based leadership from the 2014-15. Within Paediatrics, with time to patient bedside for RSI successful at first attempt Jim Dickie Telehealth equipment within Paediatric Nurse Consultant compliance with decision to emergencies increased from 90% excluding Out of Hospital Garry Fraser
SCOTSTAR Annual Report 2015-16 SCOTSTAR Annual Report 2015-16
36 37 5. Looking Ahead - Expected Change & Developments Appendix 1 Scotstar Financial Performance 2015-16
Forecast Budget Revised Budget Actual Variance % Variance 2015/16 2015/16 2015/16 2015/16 2015/16
Total Managerial 1,060,416 1,176,846 1,213,647 -36,801 -3%
Total Adults 1,818,000 1,817,418 1,756,492 60,926 3%
Total Paediatrics 1,135,963 1,198,962 1,229,534 -30,572 -3%
Total Neonates 3,004,330 2,792,335 2,764,531 27,804 1%
Total Transport 2,850,251 2,850,252 2,850,277 -25 0%
Dr James Ward Medical Director, Scottish Ambulance Service SCOTSTAR Total 9,868,960 9,835,813 9,814,481 21,332 0%
“In the last year the delivery of the new SCOTSTAR base sets the scene for exciting developments both within SCOTSTAR and in extending SCOTSTAR’s role within the wider NHS and emergency service family in Scotland.
Key to the strategic progress of opportunities for Scotland; these The overall aim for the future SCOTSTAR and fully realising include ensuring an adequate is to further strengthen links the benefits of the co-location is pre-hospital critical care response. between SCOTSTAR and SAS the aim to further align capacity Within the work to improve the clinical governance, to strengthen between the three SCOTSTAR management of major trauma links with Scotland’s charity air families. Opportunities for within Scotland is work to improve ambulance, and to align a single improved joint working both Scotland’s resilience in terms of system for governance between within secondary and potentially pre-hospital critical care provision SCOTSTAR pre-hospital team and within primary retrieval of critically for major incidents and mass ill patients will be scoped and casualties and work to improve Board pre-hospital teams such as implemented. integration and training with the Tayside Trauma and Medic-1 in Scottish Ambulance Service (SAS) Edinburgh.” Within the wider health and care Special Operations Teams around landscape in Scotland there Scotland’s response to the anti- are significant challenges and terrorist strategic threat level. Dr James Ward
SCOTSTAR Annual Report 2015-16 SCOTSTARScotSTAR Annual Report 2015-16
38 39 Appendix 2 Glossary
A&E Accident and Emergency NHS National Health Service
ACC Ambulance Control Centre NICU Neonatal Intensive Care Unit
ANNP Advanced Neonatal Nurse Practitioner NIRS Near-infrared Spectroscopy
ANP Advanced Nurse Practitioner PAS Perinatal Advisory Service
BAPM British Association of Perinatal Medicine PAs Programmed Activities
BBC British Broadcasting Corporation PIC Paediatric Intensive Care
CCP Critical Care Practitioner PICANet Paediatric Intensive Care Audit Network
CFM Cerebral Function Monitoring PICS Paediatric Intensive Care Society
CMU Community Maternity Unit PICU Paediatric Intensive Care Unit
CSMEN Clinical Skills Managed Educational Network PSQG Patient Safety and Quality Group
ECMO Extra Corporeal Membrane Oxygenation QF Quality Framework
EMRS Emergency Medical Retrieval Service QPI Quality Performance Indicators
EQIA Equality Impact Assessment R&D Research and Development
HEAT Health Efficiency Access and Treatment SAP Service Administrative Policies
HEMS Helicopter Emergency Medical Service SAS Scottish Ambulance Service
HFOV High Frequency Oscillatory Ventilation SCOTSTAR Scottish Specialist Transport and Retrieval
HIS Healthcare Improvement Scotland SEAT South East and Tayside
HR Human Resources SFRS Scottish Fire and Rescue Service
ICT Information and Communication Technology SNBTS Scottish National Blood Transfusion Service
ISD Information Services Division SOP Standard Operating Procedures
MCN Managed Clinical Network SORT Special Operations Response Team
MD Doctor of Medicine SSLMT SCOTSTAR Senior Leadership and Management Team
MedSTAR Medical Specialist Transport and Retrieval TIG Transport Interest Group
MOU Memorandum of Understanding TRM Trauma Resiliency Model
NES NHS Education for Scotland WCG Workforce Communications Group
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40 41 Equality & Diversity
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