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Scottish Specialist Transport and Retrieval Annual Report 2014-15 Design: www.studio9scotland.com CONTENTS 1. WELCOME
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“I am pleased to present the first ScotSTAR Annual Report on behalf of 1. Welcome 1 the Scottish Ambulance Service and NHS Scotland. In this first year of operation, ScotSTAR has brought together three long-established services 2. Introduction 2 into a ‘One for Scotland’ model, further strengthening the clinical care provided to some of the most sickest patients who require Specialist 2.1 Organisational Overview 2Transport and Retrieval between health care facilities throughout Scotland.
2.2 Governance 3 As we look back on the first year of operation for ScotSTAR, there is much 2.3 About the Service – ScotSTAR in 2014 6 that we can be proud of. Our Adult, Neonatal and Paediatric Specialist Transport and Retrieval teams, working in partnership with a number of organisations, have undertaken over 2,600 retrievals providing high quality 3. Strategic Objectives 18 and timely clinical care to our patients while transporting them safely to the healthcare they need. 3.1 Longer Lives 18 The construction of the new state of the art Specialist Transport and 3.2 Healthy Lives 18 Retrieval base at Glasgow Airport is well advanced and due for completion in the summer of 2015. This base will provide our teams with modern fit 3.3 Safe 18 for purpose accommodation which will enable our teams to come together 3.4 Effective 19 under the same roof to learn and train together and share their knowledge and experiences. 3.5 Person Centred 25 The future direction of travel is very positive indeed and extensive work has been undertaken to further strengthen governance arrangements 4. Conclusions: Celebration & Risk 36 and future workforce models needed to continue to offer the NHS in Scotland and patients with a Service which is safe, effective and clinically 5. Looking Ahead 38 excellent and leading the way in how Specialist Transport and Retrieval Services are delivered.” Appendix 1 - ScotSTAR Financial Performance 2014/15 39
Appendix 2 - Glossary 40
Pauline Howie OBE Chief Executive Officer, Scottish Ambulance Service
1 ?.2. TITLEINTRODUCTION
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2.1.2 Link between ScotSTAR 2.2 Governance From the launch of ScotSTAR in ScotSTAR (Scottish Specialist Transport and Retrieval) is a division of and the Scottish Ambulance April 2014 significant progress has the Scottish Ambulance Service that exists to provide a national service Service been made regarding governance for the safe and effective transport and retrieval of neonates, children and 2.2.1 Overview of ScotSTAR and performance. Agreement adults in Scotland. It was launched on 1st April 2014 and has brought 2,600 of the 600,000 emergency Governance Framework to review Standard Operating together three existing services – Scottish Neonatal Transport Service incidents attended annually by the Procedures (SOPs) and work (Neonates), Emergency Medical Retrieval Service (Adults), and Scottish Scottish Ambulance Service are The governance arrangements towards shared clinical governance Paediatric Retrieval Service (Paediatrics) into one specialist service. The attributable to specialist transport for ScotSTAR have been split into processes has been achieved. service provides a safe and dedicated transport service for a particular and retrieval, however these take the following categories – staff, Performance is reported into the patient group who, because of their clinical condition, require an significantly longer and are complex information, financial, clinical and Ambulance Service Executive Team augmented clinical team during retrieval/transport, and represent the in their delivery with many being corporate. and Board regularly through the most vulnerable of patients transported in Scotland. In total, ScotSTAR inter-hospital transfers. Management Group. The Clinical teams completed 2,654 transfers and retrievals in 2014/15. Day to day management is Governance Group for ScotSTAR The clinical coordination model for undertaken by the Head of Service has been established. Work has Courtesy of Carol McCabe the Division is being developed in and Associate Medical Director; who been undertaken on the agreement The need for providing an Annual Report for ScotSTAR to the NHS Chief is undertaken by a team of between partnership with the Ambulance form the ScotSTAR Management of standards and the development Executives Group was agreed at the time of its launch, since ScotSTAR is one and three clinicians, including Service’s Ambulance Control Centre Team together with the clinical of provisional Quality Performance a national service that is funded nationally through top-slicing. The Health consultants, Advanced Neonatal (ACC), due to their close operational and service leads of each team. Indicators (QPIs) during the course Boards have an interest in the performance and operation of ScotSTAR and Nurse Practitioners (ANNPs), middle links and extensive experience in The diagram below sets out the of the year. rely on the service to move critically ill patients within and outside of Scotland. grade doctors and transport nurses. operational planning, call handling accountability arrangements. ScotSTAR therefore needs to provide information regarding service delivery to and transport dispatch. There justify efficient use of this funding. As ScotSTAR is a developing service, the Emergency Medical Retrieval are essential links between the purpose of separate reporting is to allow its stakeholders to track progress of Service (Adults) Scottish Ambulance Service and the service against the previously agreed deliverables. The stakeholders for ScotSTAR – being managed by Figure 1: ScotSTAR Governance Arrangements ScotSTAR are the Health Boards, service users, and the wider NHS Scotland The Adults team provides a national the Ambulance Service maximises organisations such as Community Midwife Units and Rural General Hospitals. service with two teams available 24 the operational, clinical and cost hours a day. Each team is led by benefits due to integration of the Chief Executive Scottish Ambulance Service The three established national specialist transport teams are outlined below. a consultant, with the second team transport infrastructure, technology NHS Scotland Board member being either a senior medical infrastructure and the specialist trainee or a critical care practitioner. transport clinicians. It operates from the Heliport at 2.1 Organisational Overview Glasgow, and covers the whole of The Ambulance Service is well remote and rural Scotland. placed to manage service delivery Scottish Ambulance Service 2.1.1 Introduction and overview the referring clinician, which prevents and outcomes for ScotSTAR, by of the three teams unnecessary transfers. The Adults team has four functions: scheduling the availability of vehicles Chief Executive and drivers, coordinating and Specialist Paediatric Retrieval Scottish Neonatal Transport Secondary retrieval of critically ill integrating critical infrastructure with Service (Paediatrics) Service (Neonates) and injured patients from remote service provision whilst supporting and rural health care facilities the most efficient use of high The Paediatrics team provides a The Neonatal team provides a Telephone advice to remote and value assets through medically Scottish Ambulance Service Scottish Ambulance Service national service out of Edinburgh and national service delivered by three rural hospital staff with regard to supported tasking, triage and remote Medical Director Director of Service Delivery Glasgow for the retrieval of children regional teams (West, East and resuscitation and safe transfer of assessment. from newborn to 16 years of age. North) from four centres (Glasgow, patients with critical illness The team is predominantly consultant Edinburgh, Aberdeen and Dundee), Primary retrieval of patients led; supported by trainees, nurse all of which provide cross-cover with major trauma in West and ScotSTAR ScotSTAR practitioners and nurses. An advice for each other. They transfer Central Scotland Associate Medical Director Head of Service only call service is also provided, and /or retrieve babies up to five Major incident Pre-Hospital whereby the duty consultant advises kilograms. Each neonatal transport Medical Response
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2.2.2 Information Governance The ScotSTAR Research & producing this Annual Report. The diagram below outlines the the Scottish Ambulance Service. Development Group exists to A reporting timetable has been governance and reporting framework As an interim arrangement all The NHS Scotland Information support the continuous improvement developed and implemented. In for the ScotSTAR, and the links ScotSTAR teams continue to use Assurance Strategy is adhered of the national service through addition ScotSTAR has initiated work between the Ambulance and the the systems they have in place to within ScotSTAR. Information the use of research, and ensures with Information Services Division ScotSTAR Advisory Group. and regularly review incidents Governance responsibility is all studies go through the agreed (ISD) to ensure retrieval data is locally. A highlight report on delegated by the Ambulance approval process. The Group linked to outcomes. The ScotSTAR Advisory incidents is included within Service Chief Executive and has also developed standards Group does not have a role in quarterly governance reports. Director of Strategic Planning in collaboration with Healthcare 2.2.3 Corporate Governance the performance or financial and Quality Improvement who Improvement Scotland, following management of the ScotSTAR as The ScotSTAR Clinical Governance chairs the Scottish Ambulance which provisional indicators have Following the implementation of the Ambulance Service Executive Group reports regularly to the Service Information Governance been developed and approved ScotSTAR, an Advisory Group has Team and Board are responsible Scottish Ambulance Service National Committee which meets quarterly. by the Ambulance Service’s been established to provide an and accountable for these, Clinical Governance Group and The Head of Service is a member Executive Team and the ScotSTAR external overview of the nationally reporting directly to the Scottish Clinical Governance Committee. of the Information Governance Divisional Group after a period of funded service, reporting into the Government as required. Issues and themes identified through Group, and report to the Group consultation. NHS Chief Executives Group. The the Ambulance Service governance Dr Andrew McIntyre, Associate Medical Director – ScotSTAR on any pieces of work requiring Advisory Group is chaired by Dr 2.2.4 Clinical Governance processes that impact on ScotSTAR collation and analysis of data Additionally, in 2014/15 ScotSTAR Annie Ingram who was nominated are fed back to the governance professional workforce model which held across different Health commenced work on collating data by the NHS Chief Executives Oversight of Clinical Governance group via Dr McIntyre. will be flexible and responsive to Boards, to ensure all relevant from all teams to allow for preparing Group to provide that role because within ScotSTAR is the responsibility the needs of NHS Scotland. permissions via Privacy Advisory monthly activity reports and quarterly of her previous experience and of the ScotSTAR Clinical Governance 2.2.5 Staff Governance Committee and Caldicott comparative reports, including involvement in both neonatal Group (chaired by Dr Andrew There will need to be a transitional Guardians are secured. measuring quality indicators and and adult retrieval services. McIntyre, Associate Medical The ScotSTAR workforce plan is a stage from the current workforce Director). The clinical governance medium to long term goal, which model to the future workforce model Figure 2: ScotSTAR Corporate Governance Framework structure for ScotSTAR reports and should not impede the current which, realistically, will take several responds to the Ambulance Service level of service delivery throughout years, although it is anticipated that Clinical Governance Committee via this transition. The current teams’ some changes in the non specialist Scottish National Clinical Governance Group. composition varies depending roles will be effected earlier if Ambulance Executive on the team and their location. feasible. There is currently a short- Advisory Service Board Management The ScotSTAR Clinical Governance Additionally, there is variation in life working group being chaired Group Team Group will oversee processes the workforce composition by the Scottish Ambulance Service dealing with incident reporting, between and within established Director of Human Resources guidelines, patient safety, and teams. There are approximately and Organisational Development, Divisional service developments. The Group 80 Whole Time Equivalents Agenda which includes the territorial Group will support innovation within for Change staff working within Boards involved in ScotSTAR to ScotSTAR while ensuring consistent ScotSTAR across a number of agree transitional arrangements approaches are developed territorial Boards, including nursing for Agenda for Change staff. across the service elements and staff, support staff, medical physics To ensure sustainability the Management in conjunction with the Scottish and administrative staff. There Scottish Ambulance Service Staff Group Ambulance Service. are approximately 40 consultants Governance Committee will work working a number of sessions closely with the territorial Boards It is intended that ultimately for ScotSTAR; and six fellows on and Regional Planning Groups to all ScotSTAR teams will use a placements to the service either ensure that workforce planning common system of electronic undertaking training placements for the future takes cognisance of Clinical Research & Service ICT Health Base Project incident reporting and review or as part of research fellow all the needs of the services to Governance Development Leads Group & Safety Group that will allow both oversight of schemes. The direction of travel ensure safe, effective and person- Group Group the process and transparency to for ScotSTAR is that of a multi- centred care.
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Figure 3: Overall Activity of ScotSTAR teams in 2014-15 2000 2.3 About the Service – ScotSTAR in 2014 1800 Retrievals 1600 Referrals Advice Calls 1400 Service Model for Neonatal, Paediatric and Adult currently underway, with the long- (Journeys Initiated) 1200 retrieval in the North of Scotland. term goal being having one contact Adults 1023 247 776 1000 With the ScotSTAR teams working point, within the Specialist Services 800 600 Neonates 1823 * 1823 in previous years as three distinct Significant progress has been made Desk providing logistical assistance 400 200 services from six bases, plans are towards achieving the desired service to the teams. The Perinatal Advisory Paediatrics 559 298 261 0 in place for the Paediatric and West model over 2014-15. The Neonatal Service (PAS) will be incorporated Adults Neonates Paediatrics All ScotSTAR 3405 545 2860 Neonatal teams to share a base at teams are starting to align their shifts. within ScotSTAR with pathways Advice Calls Retrievals (Journeys Initiated) Glasgow Airport with Air Ambulance The Paediatric rota is developed jointly for both the East and North of and Adult retrieval from August by the East and West teams. The Scotland being formalised via the Figure 4: Journeys Completed by ScotSTAR teams in 2014-15 2000 2015, as part of the new Scottish Adult retrieval rota is well established Specialist Services Desk. Out of 1800 Journeys Less Journeys 1600 Ambulance Service Air Ambulance and robust. Advice provision hours Neonatal calls are directed Initiated Cancellations** Completed 1400 Contract. Back office functions remains available within the teams. to Ambulance Control Centres to 1200 Adults 776 169 607 1000 will also come together at the new Discussions are ongoing about the resolve any potential clinical issues 800 600 base and agreement is in place possible expansion of the scope of and to provide lessons learned that Neonates 1823 36 1787 400 200 for medical physics support from ScotSTAR to include additional areas can be rolled out across teams. Paediatrics 261 1 260 0 NHS Greater Glasgow and Clyde. in the future, such as Extra Corporeal Adults Neonates Paediatrics All ScotSTAR 2860 206 2654 Paediatric and Neonatal transport Membrane Oxygenation (ECMO) and 2.3.1 Report on Activity Cancellations Journeys Completed teams assist each other when Paediatric High Dependency Unit. required and teams are working Projections are available for change In 2014-15, ScotSTAR completed Activity breakdown of the ScotSTAR teams is presented below. towards standardisation when in demand levels. 2,654 transfers. In comparison with purchasing equipment. Discussions the total activity of 2,323 completed Figure 5: Adults Activity Breakdown in 2014-15 with the North of Scotland Regional Clinical Coordination transfers in 2013-14, this represents Retrievals Avg Mission Workload in Adults - Planning Group are underway Completed Duration Hours Primary a 14% increase. Total activity of regarding engaging stakeholders Development of a clinical ScotSTAR services for 2014-15 is Adults - Primary 359 01:41:03 605 Hours Adults - and identifying an optimum solution coordination model for ScotSTAR is presented opposite. Secondary Adults - Secondary 248 07:12:35 1788 Hours All Adults 607 - 2393 Hours
Figure 6: Neonates Activity Breakdown in 2014-15 Transfers Avg Mission Workload in Completed Duration Hours Neonates - Unplanned Neonates – Planned 1212 04:35:43 5570 Hours Neonates - Planned Neonates - Unplanned 575 04:37:34 2660 Hours All Neonates 1787 - 8230 Hours
Figure 7: Paediatrics Activity Breakdown in 2014-15
Retrievals Avg Mission Workload in Paediatrics - Completed Duration Hours Air Paediatrics - Road 216 04:14:56 918 Hours Paediatrics - Road Paediatrics - Air 44 08:08:16 358 Hours All Paediatrics 260 - 1276 Hours
* Neonates West team take PAS calls. This workload is captured separately through the NHS24 systems. ** 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 longer being required, death of the patient, etc.
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Specific pieces of information relating to activity within the ScotSTAR services are presented below: Figure 10: Paediatrics Referrals Breakdown by Health Board of Referral in 2014-15
Figure 8: Adults Secondary Retrievals by Location and Diagnosis Category Region Health Board Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Total NORTH Grampian 3 5 0 1 1 1 2 2 1 3 0 3 22 Diagnosis North West Total Highland 6 5 2 9 3 9 3 8 7 3 11 4 70 CVS 10% 14% 24% Orkney 0 0 0 2 0 2 1 0 0 0 2 0 7
Shetland 4 5 0 0 0 2 1 0 0 3 2 4 21 GI & Toxicology 2% 4% 6%
Western Isles 1 1 0 0 1 0 3 4 1 2 0 0 13 Metabolic 2% 3% 5% NORTH Total 14 16 2 12 5 14 10 14 9 11 15 11 133
SEAT Borders 2 1 2 4 0 0 0 0 1 2 7 0 19 Neurological 5% 8% 13% Fife 4 4 8 7 1 0 2 6 5 6 5 6 54 Respiratory 11% 14% 25% Forth Valley 2 6 3 1 4 5 2 3 9 10 5 7 57
Lothian 3 6 7 3 6 8 7 7 13 7 6 4 77 Sepsis 6% 7% 13% Tayside 0 3 7 3 1 3 3 2 6 0 1 0 29
Trauma 6% 8% 13% SEAT Total 11 20 27 18 12 16 14 18 34 25 24 17 236
Total 41% 59% 100% WEST Ayrshire & Arran 3 3 4 1 10 2 4 4 5 11 6 4 57 Dumfries & Galloway 0 2 1 0 1 0 0 1 2 5 4 6 22 Greater Glasgow 7 6 1 4 1 2 1 7 11 11 4 3 58 Lanarkshire 3 4 2 1 1 2 4 4 4 7 2 5 39
WEST Total 13 15 8 6 13 6 9 16 22 34 16 18 176 Figure 9: Adults Secondary Retrievals by Location and Diagnosis Category Outwith English Authorities 2 1 2 1 1 1 0 1 0 9 Scotland Northern Ireland 1 1 3 0 0 5 Outwith Scotland Total 2 0 0 1 2 1 1 1 2 3 1 0 14 ma au Tr 8% 10% Grand Total 40 51 37 37 32 37 34 49 67 73 56 46 559 C V 6% S Figure 11: Paediatrics Referrals Breakdown by Health Board of Referral in 2014-15
7% Paediatrics referrals by Scottish Region 14% 80 s i s p 70 e
S 60
6% G 33%
I 47%
2% & 50 29%
29%
T o
4% x 40 33% 39% 16% 16% 2% c 22% i 33% l 30 14% o 26% b 43% 3% a 39% 51% t 41% 37% e 49% 43% 34% M 20 28% 37% 73% 41% R 5% e 38% s 10 p 35% 31% 38% 27% ir 32% 29% 29% 15% 24% at ro 13% or 8% u 5% 16% North y 11% Ne 0 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 West NORTH Total SEAT Total WEST Total Outwith Scotland Total
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Figure 12: Neonates Workload Breakdown in 2014-15
Out of Hours Evenings Weekend Daytime Weekday Daytime % All Transfers (8pm-8am all week) (5pm-8pm all week) (Sat-Sun 8am-5pm) (Mon-Fri 8am-5pm)
Apr-14 18% 9% 10% 63%
May-14 18% 7% 19% 56%
Jun-14 20% 12% 14% 54%
Jul-14 15% 11% 14% 60%
Aug-14 20% 14% 12% 55%
Sep-14 17% 6% 14% 64%
Oct-14 22% 11% 11% 56%
Nov-14 24% 7% 15% 54%
Dec-14 13% 9% 15% 64%
Jan-15 24% 10% 10% 56%
Feb-15 26% 10% 20% 44%
Mar-15 22% 9% 11% 60%
Yr Avg 20% 9% 14% 57%
Figure 13: Neonates Workload Breakdown in 2014-15 2.3.2 Resource use Equipment / Vehicles as required. The Glasgow and Neonates Workload Breakdown Edinburgh Neonatal Transport Yearly (Average) Monthly Facilities The teams within ScotSTAR teams have also procured new 120% are committed to ensuring the items from charitable sources. M T W T F S S provision of suitable equipment 20:00 The new base at Glasgow Airport for all retrievals, and teams work ScotSTAR teams are also committed • 100% which will accommodate the Out of Hours Air Ambulance and ScotSTAR collaboratively to plan the purchase to streamlining and enhancing • 8pm-8am all week (20%) West teams is currently under of replacement equipment. In the quality of equipment where • 80% construction. The completion date 2014, the Scottish Ambulance possible; for example, the Adults 07:59 is scheduled for August 2015, Service, through ScotSTAR, has team continues to develop the 08:00 provided funds to replace two equipment carried in response to 60% with delivery units remaining in • Edinburgh and Aberdeen. A small VentiPac ventilators with the more evolving experience, new equipment • Weekday Daytime Weekend working group is taking forward versatile Oxylog 3000+ ventilator on the market and learning from • Mon-Fri 8am-5pm Daytime 40% the project planning of the internal for the Paediatric Retrieval Service partner retrieval service experience. (57%) (14%) • specification and the relocation of all in Edinburgh. Also in 2014/15, ScotSTAR is committed to constantly • teams. Contingency arrangements transport bags and retrieval assessing and updating equipment 20% 16:59 have been developed for the West clothing have been purchased for packs in response to feedback 17:00 Neonatal and Paediatric teams when the Paediatric Retrieval Service in from our clinicians and rigorous 5pm-8pm all week • 0% Yorkhill Children’s’ Hospital closes in Glasgow, and plans are in place appraisal of each clinical job. They (9%) June 2015, with support from NHS for the purchase of routine stock also continuously look for ways to 19:59 Jul-14 Apr-14 May-14 Jun-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Greater Glasgow and Clyde. and servicing of equipment/parts simplify kit, reduce weight and adapt
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new technology where there are teams to be benchmarked against version 8. As well as providing rapid Adults clear benefits to patient care. The other services. An Information access to the Adults team’s Standard Adults team have been provided Communication and Technology Operating Procedures and rural Five critical care practitioners completed post graduate certificates in critical care retrieval from Glasgow with two new response cars by the (ICT) Group for ScotSTAR has facility and receiving centre guides, Caledonian University – part of the MSc in retrieval medicine being developed by Adults. Ambulance Service in May 2015. been identified and their work plan it now also provides guidance for The Adults team contributed to development on the new NHS Wales EMRTS service. is being developed. major incident management, patient Adults team members published four peer reviewed publications. triage pathways, a variety of clinical Systems Adults team members contributed chapters to four text books including the new Oxford Handbook of Huge changes are underway in the calculators, incident reporting, Retrieval Medicine and the ABC of Retrieval Medicine. There have been several strands systems currently in use within the staff contacts, rotas, teaching First 6 month audit of pre-hospital blood project; 18 blood transfusions delivered to seriously injured of development in the use of teams; with the Neonatal service presentations and access to national patients with no adverse incidents. Information Technology to support planning the move to the new guidelines. The Adults team has the work done by all three teams. BadgerNet platform and Adults also developed a new state of the art Prototype of new intubation packs developed by Adults and Helimed 5 lead paramedic prior to being Systems are in place in all three developing a new database to allow database to allow mobile data entry commercially produced on the open market for other pre-hospital and retrieval teams internationally. teams to provide ScotSTAR with for run-sheets to be completed which is being trialled at present. Avalanche and near drowning critical care response for hypothermic cardiac arrest patients. The East Paediatric team have also invaluable information in monitoring electronically. Within the Paediatrics Major incident response improved in light of responses to the Clutha helicopter crash, the George Square been developing an App based on teams’ activity. Data is collected team, the integration has meant tragedy and the Rest and Be Thankful bus crash. that data previously recorded within the EMRS App. for each referral / advice call and All team members completed two day simulation “training the trainers” course. each transfer (Including those PICANet from two teams has been All team members completed newly developed human factors and team resource management course. stood down) in the three teams to transferred to one ScotSTAR record It is also planned to develop an generate activity information for created in the database, with custom external website for the ScotSTAR Numerous new SOPs developed including crush injury and retrievals by life boat. monthly and quarterly reports and fields added in. teams to share rotas and other confidential documents securely. for audit purposes. Data is also Neonates provided into national collaboration The award winning EMRS App The teams also intend to move the use of one database following their datasets for benchmarking (such developed by the Adults team SOP and guidelines being reviewed and almost complete by Nurse Consultant and Clinical lead. as: Paediatric Intensive Care continues to go from strength to co-location at the new base. 2nd Fabian HFOV now in use within the service. Audit Network (PICANET) for strength. Since its introduction in Paediatrics and Transport Interest 2009 it has proved a very successful Group for Neonates), which additional resource for the clinicians Anne Mitchell provides a highlight of innovations in the past year in the Neonatal team: allows the performance of the involved in Adults. The App is now on “Over the last year both West and East teams secured charitable funding to replace and upgrade Innovation one road vehicle each. This equipment allows for oscillatory ventilation, TTV ventilation, flow wave monitoring and end tidal CO2 monitoring as well as nitric. Teams continue to provide en route therapeutic hypothermia and can initiate cerebral function monitoring. The West team All three teams within ScotSTAR are committed to drive forward new initiatives and quality improvements and have have been involved in the design and development of a replacement charitable ambulance”. implemented several service innovations in 2014-15:
Paediatrics Data on the usage of different modes of transport for transfers/retrievals completed by the three ScotSTAR services in 2014-15 has been presented below. A Mortality and Morbidity meeting was conducted for Spring 2015, which will have input from PICU and Figure 14: ScotSTAR Journeys by Mode of Transport in 2014-15 ScotSTAR. Paediatrics Adults Neonates Retrieval bags are planned to be rationalised and harmonised service wide. Paediatrics Adults Neonates
A Sepsis 6 compliance audit is planned to look at compliance of the referring hospitals in having completed the Road 216 242 1705 Sepsis 6 bundle. Road
Tracheal tube (mal) position/ retaping/ retubing on retrievals audit has been scheduled. Air 44 365 82 Air
Encouraging the use of video conferencing during the referral to enhance assessment of the situation. Total 260 607 1787
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2.3.3 Finance and Workforce The make-up of workforce in by undertaking sessions for different teams and their unique each other, which helps maintain Finance challenges are presented below: Neonatal retrieval skills as well as fostering closer relations between Since April 2014, funding streams Adults the teams. are managed through Scottish Ambulance Service Finance and The Adults team is staffed by Apart from nurse practitioners and regular meetings are conducted Consultants, Trainee Doctors, consultants, PICU consultants with the Territorial Boards involved Research Fellows, and Critical continue to provide telephone to ensure that budgets are being Care Practitioners (CCPs). One advice and support to the referring managed appropriately. Each team new Registrar was appointed in hospitals. The PICU at Yorkhill has a defined budget allocated August 2014 and two in February has between one and two senior from the ScotSTAR budget; costs 2015. Two clinical teams have PICU trainees selected by the UK incurred by each of the teams been available every day during national grid training at any time. within the territorial Boards are 2014/15. However, there have been As part of the agreed training transferred to ScotSTAR during recent issues regarding covering programme, all trainees must Dr Allan Jackson, Lead Clinician – Neonates the financial year. ScotSTAR’s trauma desk by both Adults CCPs undertake transport work. financial statements presented an and Helimed 5 Paramedics. The The medical rota for the teams under spend at the end of March team has accommodated various The established clinical coordination is delivered differently within 2015 (Appendix 1). Work is also observers where possible and had model of close involvement and the four sites, with some teams underway with the Ambulance a medical student starting elective liaison with the duty PICU consultants allocated whole time equivalents Service Finance around capital with the team recently. during the initial referral period and and others based on Programmed items and asset transfer. confirmation of logistics continues. Activities (PAs). Support staff Paediatrics This will be reviewed once the are also essential to the efficient Following the end of the Variation transfer arrangements required in The teams have worked ScotSTAR clinical coordination running of the team and include Order for Neonates, additional funding the future. Work is also underway collaboratively on a number of The Paediatrics team consists of system is functioning. medical physics, pharmacy and has been required to address nursing with medical staff to identify the Neonatal/Paediatric transfers consultants, nurse consultants, administrative support, which is staff numbers. Hardware costs are requirement for retrieval to be part Workforce plan is in development specialty doctors, trained Paediatric Neonates provided locally. The Scottish anticipated for re-procurement of vital of job plans and to ensure equity with succession planning for Intensive Care Unit (PICU) nurses Ambulance Service has provided equipment over the next 1-2 years, around sessions between all teams. specialist roles (Doctors, ANNPs, and Pre-Hospital Emergency The Neonates team is managed the Neonates team with a significant which has been maintained but not ANPs & CCPs) Medicine (PHEM) / anaesthesia / by the Strategic Service Manager, level of support, which has been replaced since purchased in 2003-04, In addition to the existing staff, New full time transport staff are PICU senior medical trainees. Any Mrs Ann Marie Wilson who provides crucial in delivering the level of care notably incubators and trolley bases there are plans in place to transfer recruited through the Scottish vacancies on the rota are filled by strategic management and the teams offer, such as frontline and associated kit. the Emergency Drivers currently in Ambulance Service when internal locums. Between both leadership to the service to ensure ambulance crews or drivers from the West Central into ScotSTAR before appropriate teams there are thirty three nurses that the service is able to respond Scottish Ambulance Service. Having Workforce the move to the base. Additional New skills requirements and participating on the retrieval rota to the demands placed upon it, access to air transport is an essential drivers in the North and the South ongoing training needs are and where possible nursing staff and to ensure consistent working element for Neonates, particular Following meetings with Territorial East will also be recruited to provide identified for all Staff are involved in audits and feedback practices across the service. The when undertaking transfers from Boards, including Management a more robust and responsive Development of a common sessions. Dr McCormack provides team has a Nurse Consultant who is remote and rural communities. and Human Resources (HR) service while ensuring that front line ScotSTAR brand via a a sessional commitment to the an experienced Advanced Neonatal colleagues, a Project Group has crews are not taken away for long consultation exercise with Adults team, one of his roles is Nurse Practitioner (ANNP), who The Neonates team has been facing been established chaired by the retrievals (if adequate funding can the teams Paediatric Lead. This facilitates provides clinical leadership to all the a number of challenges regarding Scottish Ambulance Service Director be identified within budget). Organisational Development future collaboration between the teams, to ensure evidence based recruitment, particularly in the North of HR to oversee the workforce plans exercise with staff has been Paediatrics and Adults teams. consistency in clinical practice. team. The service has considered for the staff involved in ScotSTAR, Significant progress has been made undertaken throughout Senior Paediatric and Neonatal Dr Allan Jackson, Lead Clinician, alternative staffing models to deliver to identify the best options for on a number of workforce issues in summer 2014 staff are continually discovering provides enhanced clinical guidance a sustainable nursing workforce employing/sharing staff and any this first year of operation: ways of overlapping their skills to the teams. by recruiting additional staff in the
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West and South East teams. There Clinical Coordination in place. The National Identity of is a future risk with staff availability/ ScotSTAR will have been embedded recruitment of ANNPs nationally. ScotSTAR will provide retrieval with training and education coordinators to support all retrievals arrangements firmly in place for Dedicated drivers are presently and transfers as part of the wider ACC all staff. Working relationships shared with PICU in the West of Specialist Support Desk initiative. throughout the teams will be further Scotland; the other two regions do Additional telephone software will enhanced with clear understanding not have dedicated drivers. The lack be provided by Avaya. By 2020, it is of roles and responsibilities. of dedicated drivers can result in intended to have a well established delays/cancellations to elective and Specialist Services Desk, coordinating Management Structure repatriation work; and it is planned ScotSTAR, Air Ambulance, Special to increase drivers in the North and Operations Response Team and The management structure will South East teams within available Trauma. ScotSTAR will have be reviewed periodically and any funding. additional expertise in the coordination necessary change implemented of Extra Corporeal Membrane to assist ScotSTAR in its aim of Oxygenation (ECMO) and Major striving to be a world class service 2.3.4 Quality Performance Indicators (QPIs) and HEAT targets Incidents and a flexible system will be in relation to Quality Ambitions. embedded that can be readily rolled Provisional Quality Performance out to new services. Technology Indicators have been put in place to drive forward the programme of It is envisioned that the Trauma A sustainable model will be in place continuous quality improvement Desk will be an integral part of the with a central hub with clear clinical within ScotSTAR, including clinical Specialist Services Desk with a stable justification / activity for each delivery outcomes to showcase the high system and operating hours in place unit, with ICT shared and accessible standard of care delivered and by 2020. Similarly it is intended that amongst all teams. A replacement also to highlight areas which will PAS will also be fully incorporated programme with greater shared focus on improvement, for example and established within ScotSTAR and equipment and efficiencies will be temperature control. Specialist Services Desk which will be adopted. Electronic collation of available to users across the country. patient records will be in place and A set of external and internal the use of air/land ambulances by the provisional indicators for 2015-16 Agreements with Territorial Boards teams will be as efficient as possible. have been approved by the Scottish Ambulance Service Executive Team Work is ongoing with the Territorial Activity and Demand and agreed by the teams following Boards involved to ensure a period of consultation. Work has arrangements are in place in Demand levels are anticipated to been completed to agree methods relation to staff, information, stabilise by 2020, however trend of collecting data and reporting financial and clinical governance. analysis will be conducted at regular frequencies for these, and definitions intervals. Discussions regarding have been agreed for each Staffing Structure new areas of scope will have been parameter being reported. resolved with a clear process in 2020 will see increased ability and place for investigation of additional 2.3.5 Ongoing 2020 Developments integration between the ScotSTAR workload in the future. Rotas will be teams including cross-cover for robust and build resilience through ScotSTAR is committed to ensuring certain roles, built on the foundation cross-cover. Provision of transport certain key deliverables and work of a flexible staffing model, transfers advice will be facilitated by Specialist is ongoing to ensure these are based on clinical need rather than Services Desk where appropriate. delivered by 2020: staff availability, and consistent criteria
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and onwards to Scottish Ambulance The Ambulance Service Medical The Neonatal team have a system in debriefs are undertaken and Operating Procedures (SOPs) that 3.1 Longer Lives Service Governance Committees. Director delegates day to day place following the seven dimensions recorded as routine, and cases are form the backbone of their clinical Any risks that affect the territorial clinical governance responsibilities of the NHS Healthcare Improvement reviewed weekly in collaboration governance structure to ensure safe Work is ongoing under the auspices boards are shared. to the Associate Medical Director Standards (HIS) Clinical Governance with PICU colleagues. This allows and efficient operations. These of the Scottish Ambulance Service’s who liaises with the Ambulance Standards. All incidents are entered detailed review of each case in an SOPs are regularly updated in light Information Governance Committee In 2014/15, there were not any Service Clinical Governance Group into the Neonatal team database open, transparent and supportive of ongoing experience and event and ScotSTAR Research and high level risks to report other and the territorial boards. The Badger and reviewed. The Neonatal environment. The purpose of the analysis. Over the course of the Development (R&D) Group to link than coping with the increasing Associate Medical Director attends team are always looking for ways meeting is to focus on improvements current year the service has been three years worth of retrieval data demand for the service with the appropriate Clinical Governance to improve service delivery and to the overall service, including the working on rationalising the number to the outcomes data held by ISD current workforce and rotas. and Board meetings as required. generate awareness and confidence referral centres, patients and staff. of SOPs and devising a new set as a pilot study. This will provide However work has been ongoing among the staff and the units served. of Service Administrative Policies a baseline of outcomes from the with all three teams to ensure 3.3.3 Adverse Events Neonates (SAP). A set of rural clinicians’ implementation of ScotSTAR in contingency solutions and internal The Adults team use an in-house guidelines are also being developed 2014/15, with an annual exercise cover remains in place. It is also Critical Incident reporting methods developed system called Sphere to The team has had ongoing to give concise information on carried out in subsequent years to planned to expand the operational have been in place within the teams record critical incidents and monitor participation within local, regional clinical conditions to enable easy follow up on outcomes. Therefore hours of the Trauma Desk to 24/7 over previous years, and following any issues through the monthly case and national audit programmes. It access for rural colleagues. patient outcome indicators will be as part of the implementation of the the implementation of ScotSTAR reviews. They also hold quarterly also contributes to the national data developed by 2020. Specialist Services Desk to ensure critical incident reporting continues clinical governance meetings which standards and benchmarking tools 3.4.2 Staff Governance primary missions are consistently to play a key role in ensuring that are open to everyone including which are currently being developed coordinated safely and effectively to standards of care on retrieval remote and rural colleagues by the UK-wide Neonatal Transport The NHS Scotland Staff prevent any risks that could arise. are maintained. The practice of 3.2 Healthy Lives throughout Scotland. Interest Group (TIG) which reports Governance Standards apply conducting a debrief between the to BAPM. The service is committed within ScotSTAR and a plan is in 3.3.2 Clinical Governance retrieval team members following Efforts have continued in 2014-15 The outcome of Significant Adverse to participating in the implementation place to ensure regular monitoring each retrieval continues. This to ensure that staff at all levels in Events is reported through the of regional collaborative working to and continuous improvement. As Clinical governance is crucial to the provides an opportunity for team the three teams are adequately Scottish Ambulance Service implement agreed pathways. part of the Scottish Ambulance effectiveness of ScotSTAR. Aligned members to discuss any relevant trained to undertake retrieval, Patient Safety Group to the Clinical Service arrangements, an to the Ambulance Service Clinical issues and to identify learning points. including updating their knowledge Governance Committee. annual staff governance audit Strategy there are arrangements Adults of equipment, air and road safety. is undertaken and reported via Details of the learning and outreach in place to ensure comprehensive Critical Incident reporting for all and regular reports to the Scottish teams wil be harmonised through The service has had regular clinical Scottish Ambulance Service staff activities undertaken by the team governance meetings over the last governance structures. are available in Section 3.4.6. Ambulance Service Clinical the Scottish Ambulance Service 3.4 Effective Governance Committee. There is Datix System in the future, whereas year with increasing participation a ScotSTAR Clinical Governance in the interim all three services 3.4.1 Clinical Audit Programme from rural colleagues through Workforce Principles for staff ScotSTAR is also committed to Group that meets regularly to record issues on their local systems. the use of video conferencing – involved in ScotSTAR have been ensure the rate of sickness absence discuss case studies; it includes In-house quality assurance ScotSTAR teams have a long these quarterly meetings include developed along with the Scottish remains equal to or as close to the remote and rural colleagues along meetings continue to be held for all standing history of participation in two longitudinal audits each. Ambulance Service Directors national average as possible. with wider clinical stakeholders retrieval staff on a six-monthly basis. audit programmes and continuous Additionally, the service also has of Human Resources and the when appropriate. This group improvement initiatives. In 2014-15, internal Continuing Professional Territorial Boards involved (Greater reports into the Ambulance A six monthly retrieval morbidity all ScotSTAR teams have continued Development (CPD) meetings Glasgow & Clyde, Lothian, Tayside 3.3 Safe Service Clinical Governance and mortality meeting is held for participating in several audit and peer review sessions which and Grampian). Consultation Group and a number of the Paediatrics and was introduced programmes. are useful in exploring ways arrangements with all staff affected 3.3.1 Risk Register clinicians currently working from during the year. This provides an to continually improve service have been drawn up. Staff ScotSTAR are members on this important forum for discussion Paediatrics delivery, followed by a service governance is a central component A risk register is maintained and Group. The Clinical Governance and reflection on specific retrieval business meeting to discuss to the agreement with the Scottish regularly updated by the ScotSTAR Plan also identifies the clinical episodes that may have been The relevant team follows the service development. Ambulance Service and the Territorial Management Team and reported governance arrangements with challenging. It is planned to run Paediatric Intensive Care Society Boards. A project group will be along with other divisions to the a potential to have an MOU in this quarterly and combine it with (PICS) Standards for transport of The Adult team has developed 117 established for workforce to oversee Ambulance Service Executive Team place with the Territorial Boards. colleagues from Glasgow. critically ill children. Post mission clinical and non clinical Standard the workforce plans for the staff
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involved in ScotSTAR, to identify the PICANet data were unveiled. conference has grown in size and best options for employing/sharing This might be something we reputation each year and now has staff and any transfer arrangements may be in the future able to 200 delegates attending from Adult, required in the future. expand on in terms of linking Paediatric and Neonatal retrieval data to outcomes. services. These delegates come 3.4.3 Clinical Outcomes/ External from services throughout Scotland Benchmarking A group of staff from the Neonatal and the UK along with services in team attended the Transport Interest North America, Europe & Australia. Following the agreement of Group Annual conference in Belfast provisional indicators for 2015-16, on 27 and 28 November 2014, the The international reputation of ScotSTAR will externally report on highlights of which were: the conference also attracts the following clinical outcomes: global experts in retrieval Benchmarked data was medicine to speak at the Retrieval Compliance with relevant presented on the number of Conference. As well as ensuring transfer standards total and ventilated transfers, an oversubscribed delegate list Missions completed with and the time it took to get teams every year, speakers attending from requisite team members mobile and to reach the patient’s FinnHEMS, Norskluftmabulanse, bedside. Sydney HEMS, MedSTAR (South In addition a number of internal There were various Australia) and other international clinical outcomes have been agreed presentations including a study services allows ScotSTAR to build and will be monitored to encourage on measuring the impact of links with these services and ensure Over recent years the conference has Surgeons of Edinburgh’s Diploma in therapies available within NICUs a culture of continuous quality noise and vibrations resulting best practice. expanded its footprint on social media Retrieval and Transfer Medicine. and provide cutting edge care for improvement. from a neonate travelling in an with a specific conference Twitter the benefit of patients. ambulance. The programme for the conference feed. This generates publicity for the A Glasgow based Production Benchmarking There were four podium changes every year based on core conference and also allows for real Company filmed a series on the Adults presentations in total from topics such as Human Factors and time interaction during the conference Scottish Paediatric Retrieval service The Paediatric Retrieval service both the West and South East Innovation in Retrieval Medicine, for people unable to attend in person. which was screened on BBC Alba Throughout the period of submits data to PICANet for teams including one podium but also encompasses hot topics In 2015, the conference was held in the autumn of 2014. Filming is expansion over the last two benchmarking. PICANet had their presentation from the South East in retrieval medicine. For example on 23 and 24 April at the Beardmore currently underway for Season 2 to years, the quality of service Annual Meeting on 5th November team which won the prize. in 2015, there was a session on Hotel in Glasgow. be aired in Summer/Autumn 2015. that the Adults team provides to in Manchester, the highlights of A parent information and retrieval of highly infectious patients, rural patients and professional which were: feedback mobile app was such as confirmed or suspected 3.4.4 Service Improvement The service continues to audit colleagues has continually developed and presented by Ebola patients. Each conference is parent/carer and referring hospital improved, evidenced by the overall The team presented a decade the Southern West Midlands also followed by individual feedback Service Improvement practices have feedback through annual surveys. positive feedback received through of data including an overview of Maternity and Newborn Network from delegates and this is continued in all three teams within the service user conducted by how this was analysed. (SWMMNN) team. The incorporated into planning for the ScotSTAR over 2014-15: Neonates the service in 2010. This has It was announced that new prize winning app includes a following year’s conference. been achieved through active outcome measures are being dashboard to view feedback Paediatrics Neonates has progressed and programmes of audit, training, developed for PIC, however data and allows for quarterly The conference has a strong implemented the majority of the rural outreach and clinical these are not likely to impact on data download. scientific component with a The Paediatric team continues Neonatal Quality Framework governance. The Adults team the transport. dedicated free paper session as to collaborate and build on (QF) over the course of the year. continues to develop its reputation A new ‘Empathic 30’ satisfaction Each year, the Adults team hosts an well as two lightning poster relationships with other service Time-specific plans are in place internationally as a leading questionnaire is being rolled out annual Retrieval Conference. This sessions. These forums allow providers. A Paediatric simulation to achieve the outstanding QF retrieval service through its annual from February 2015 to collect conference was first held in 2005 presentation and scientific scrutiny day was provided by team members elements. The Neonatal team conference, research programme, standardised satisfaction data. and is aimed at clinicians, managers of current research in retrieval for colleagues in Adults. A number continues to introduce technological academic achievements and Plans to link Yorks/Midlands and other interested groups involved medicine as well as promoting of team members assisted with the advances within transport (HFOV, its links with partner services Neonatal intensive care data to in medical retrieval work. The innovation across services. delivery of The Royal College of CFM, NIRS monitoring) to emulate throughout the world.
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The last few years have seen the Alexandra Hospital in Paisley, which team as well wherein they have addition, retrieval simulation study Two successful team training Mobile ECMO training – loading team win three prestigious awards. he undertakes part-time, split with undertaken collaborative work with days are organised and staff are days have been run during the and unloading ECMO equipment In 2010 the service was awarded the his role as Clinical Research Fellow. the Department of Psychology at also encouraged to attend relevant autumn. in the King Air. British Medical Journal (BMJ) group He is undertaking an MD with the the University of Glasgow. The retrieval conferences including Adult Three Edinburgh based PICU award for being the top secondary University of Glasgow investigating Adults team has taken a leading and Neonatal retrieval conferences. nurses are in the final stage Neonates care team in the UK. 2011 saw the the use of mathematical modelling role in setting up an international of retrieval training requiring service winning the BUPA Foundation to make ScotSTAR teams more aeromedical research collaborative There is a strong commitment to completion of supernumerary The team has always been award for the development of the available and more efficient. His group involving retrieval services from education within the team. The missions. committed to meeting the Adults iPhone app. The app also research fellowship primarily Scandinavia and Australia. Over the Glasgow and Edinburgh based teams A number of staff from the team educational needs for both the staff achieved runner up position in the focuses on analysing growth trends past 12 months several articles have collaborate to provide an outreach were involved in examining the involved in delivering the service, NHS Scotland eHealth awards. The and forecasting patterns of activity been published in Resuscitation, education program. This has been Diploma in Retrieval Medicine and the units that use the service. service ran a user survey in 2013 with within the services. Dr Moultrie is Emergency Medicine Journal, incorporated into an NHS Education and Transfer Medicine at the This is an essential element to the positive reviews. part of the Research Division, is a European Journal of Emergency for Scotland (NES) sponsored project Royal College of Surgeons in service model within Scotland as member of the R&D group and has Medicine, Transplant International and involving the use of a Clinical Skills Edinburgh in December many of the midwifery units are in a The team further developed its been involved in the development of the Journal of Paramedic Practice, Managed Educational Network Referring hospital feedback remote and rural location. Courses preparedness to provide on scene quality control and key performance and team members have been invited (CSMEN) Mobile Skills Unit. This sessions were conducted at are currently accredited by NES and critical care at the location of indicators for ScotSTAR. Under the to speak at national, European and targets remote and rural referring sites the Borders General Hospital, assessed by external personnel. multiple casualty incidents in 2014. auspices of the R&D Group, work International conferences about the throughout Scotland. Team members Ninewells Hospital Dundee, This has included refining the major has also been initiated on a study work the service does. provide scenario teaching, using mid- Wishaw General Hospital, Royal The Pre-Transport Care incident plan and the individual that will link activity data from the fidelity mannequins (SimBaby and Alexandra Hospital Paisley, Course has been developed action cards for the service. The services to the outcomes data held In addition, the team also organises SimJunior), for colleagues working Crosshouse Hospital Kilmarnock for professionals required to team has also optimized their by ISD to follow up on our patients the annual Retrieval & Pre-hospital in the Paediatric Intensive Care Unit and St John’s Hospital Livingston deal with a sick newborn prior stocks of equipment and drugs to and ensure equity of service. Care conference, including (PICU), during induction of medical Outreach multidisciplinary to transport to Neonatal facility. enable assisting other services on delegates from the UK, Europe staff, medical teaching, multidisciplinary simulation based education was There has been up-take for scene / in rural hospitals with these Staff within the three teams are and Australia representing Adult, training and various staff study days delivered to staff in the Borders this course from midwives, incidents. also directly participating in many Paediatric and Neonatal retrieval during the year. General Hospital. GPs, Ambulance personnel, research activities and holding services receiving universally Training associated with Anaesthetists, Obstetricians, A&E 3.4.5 Research and Development memberships of professional groups positive feedback. The team has also been running an introduction of ScotSTAR Staff and Paediatricians. Since the or as course faculty, for example, in-house Retrieval Nurse Education logistical systems to both East introduction of the course, there ScotSTAR has an active Research within the Paediatrics team staff have 3.4.6 Training and Outreach Programme in the recent years. and West teams including has been an increasing demand and Development (R&D) Group been invited to speak at conferences Activities Clinical Feedback Sessions are also retrieval documentation and for this from Community Midwifery which is working with the wider and deliver presentations, and have conducted by the team to provide equipment. Units. This course is supported by Scottish Ambulance Service R&D authored publications and book Extensive training activities have annual feedback to referring units. group to develop a robust research chapters, lectures, editors of case been developed and conducted within governance structure and develop histories, abstracts, posters, chaired the ScotSTAR teams over the past Video conferencing capacity has been appropriate research infrastructure meeting sessions, and examined for years and this has continued in their introduced at each of the feedback to ensure sustainability of research the Diploma in Retrieval and Transfer first year of operation as ScotSTAR: sessions in the last year and has activity within ScotSTAR. In Medicine. now become the standard practice in 2014, the ScotSTAR R&D group Paediatrics outreach/ feedback discussions. primarily worked with Healthcare Similarly the Neonatal team members Improvement Scotland to develop have also been invited as speakers The team conducts both outreach During the year team members were Quality Standards and Indicators. at conferences, abstracts accepted education and internal training for also updated on changes in SOP’s/ ScotSTAR appointed Dr Chris at national / international meetings, team members. Retrieval team policies through regular electronic Moultrie as a funded Clinical reviewed articles / commentary / members attend equipment and retrieval updates and onsite training. Research Fellow to the service in chapters, and published articles in vehicle familiarisation updates August 2014. Dr Moultrie is an ST4 journals such as Infant. Research and retrieval simulation scenario The highlights of learning activities in Emergency Medicine at the Royal has been a central part of the Adults training sessions annually. In conducted by the Paediatric team in 2014 have been:
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team visits and simulation training Adults 3.4.8 Review of Clinical Pathway professional diagnostic and the Neonatal team parents are given which is currently under review. therapeutic guidelines wherever the opportunity to see and hold their The team has developed a post Review and Changes to Clinical clinically possible. They also baby, if clinically appropriate, prior to Neonatal Therapeutic Hypothermia graduate diploma in retrieval and Pathway participate in guideline development transport. Parents are invited to travel Course has been developed jointly transfer medicine accredited by and are well represented at relevant with baby in the ambulance, when with the Scottish Cooling Group the Royal College of Surgeons The teams are committed to guideline groups. clinically and logistically possible/ in order to ensure that there is a (Edinburgh) which is the only reviewing and proposing changes appropriate. Documentation of standardised approach across retrieval diploma qualification to clinical pathways wherever For example, as per the Neonatal parental presence is done for each Scotland to the new treatment of in Europe. The team is also relevant in the interest of Transfer Guidelines, the service Paediatric and Neonatal transfer and therapeutic hypothermia. involved in a simulation project clinical excellence, and support documents the discussions between this is audited for transfers of using a medium fidelity simulator, local services wherever possible. healthcare staff and women/parents/ all urgencies. The highlights of learning activities in addition to delivering air families undergoing transfer. conducted by the Neonatal team in wing paramedic training. The For example, the Neonates Discussion prior to transfer will be Paediatrics and Neonates 2014 have been: service also has regular internal team provides advice to the voice recorded in the future using have been actively monitoring CPD events, a regular outreach local services to ensure a clear the PAS model. their feedback through regular All Neonatal transport staff have programme. referral pathway exists for Dr Stephen Hearns, Lead Clinician – Adults questionnaires over the past years. completed an accredited specific conditions not wholly Annual parent/carer feedback will be certification in newborn life support. The highlights of learning activities managed within the local unit 3.5 Person Centred monitored in the future through an All staff caring for babies within conducted by the Adults team in 3.4.7 Response Times (e.g. therapeutic hypothermia). annual survey conducted centrally Neonatal teams have undergone 2014 have been: 3.5.1 Patient / Carer/ Public by the ScotSTAR Management training and maintaining Response Times Targets Improvements to Local Delivery Involvement Team for all three teams and competence in the management Revamp of daily teaching/ of Care reported through the following of child protection issues, in line training which includes ‘skills Following agreement of provisional All teams involve the patients (or their indicator from 2016 onwards: with NHS Education for Scotland’s and drills’ format. indicators for 2015-16, ScotSTAR Professionals working within the parents / carers) in decision making Core Competency Framework Presentations given recently will report on the following response ScotSTAR teams follow agreed as far as possible, for example, within Overall Patient Satisfaction Score for the Protection of Children. at London Trauma Conference time targets: All nursing staff have been by Dr Hearns and Mr Daly. supported to maintain appropriate Several outreach training trips Compliance with Mobilisation skills with performance being throughout remote and rural Targets for Emergency Transfers formally reviewed on an annual Scotland. (Time critical for neonates) basis through appraisal. Daily teaching continues and Compliance with Time to Ongoing site visits and training new structure is re-evaluated Patient Targets (for Emergency have been conducted for remote and adjusted accordingly. Transfers only) and rural areas. TRM training days (x3 days Outreach training was provided being run). These composite targets are for Stranraer, Montrose, Perth, Simulation course at Scottish category weighted averages of Caithness, Elgin, Vale of Simulation Centre, second of individual mobilisation and time Leven. Inverclyde, Skye, Fort four days planned. to patient targets of the teams. William, Islay, Stornoway and Multi-agency major incident ScotSTAR will also robustly monitor the Emergency departments at exercise training with Scottish asset readiness, team readiness Monklands , Inverclyde and the Ambulance Service and and asset allocation times internally. Western (Glasgow) hospitals. Scottish Fire and Rescue Future team training and Service (SFRS). ScotSTAR will additionally report orientation will be facilitated by Trialling of desk-top version on slippage from these targets; ANNP staff. of new Adults database. identifying where possible reasons Competencies have been matched for delays and any exceptional to reflect all ScotSTAR staff. circumstances affecting targets. Courtesy of Bees Nees Media / MG ALBA
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3.5.2 Partner Involvement through reciprocal visits and improve the patient care provided 3.5.3 User Surveys / Feedback past years, feedback for which has Team for all three teams and attending conferences such as to the public. A case in point is the been consistently positive. Annual reported through the following The teams have close links with the Transport Interest Group and story below highlighting the value of The Paediatrics and Adults teams referring unit feedback will be indicator from 2016 onwards: other Adult, Neonatal and Paediatric PICANet annual conferences. the partnership between the Adults have been actively monitoring monitored in the future through an transfer and retrieval services in team and the Scottish National referring unit feedback through the annual survey conducted centrally Overall Service User Satisfaction the UK and abroad, and continue The teams also work with other Blood Transfusion Service (SNBTS) use of a questionnaire over the by the ScotSTAR Management Score to build links with similar services NHS organisations to continually to patient care: The following feedback from users highlights the benefits of ScotSTAR to referring users:
Collaboration with the SNBTS allows the Adults team to have blood available immediately to take on all missions where it may be of benefit to a patient before arriving at hospital. O negative blood is now routinely carried by the Dr Andrew Duncan, Consultant Paediatrician and Head of Clinical Services in NHS Borders recently wrote to service on Scottish Ambulance Service air ambulance helicopters - enabling critically ill patients to be given a blood commend the very high standard of care and support that was offered by the Neonatal transport team: transfusion more quickly. “They managed a very complex clinical and emotional situation to a very high standard SNBTS dispatches blood to the Adults base in a trauma blood box, a special storage and transport container which with exceptional professionalism and provided good support to staff in our Neonatal unit. keeps three units of blood inside at the same temperature as it would be in a blood fridge in the hospital blood The advice you were able to offer us I think was very helpful in maximising opportunities for bank. The trauma blood boxes are packed and renewed every day by SNBTS lab staff to ensure that the Adults intensive care for this infant...” team always has blood suitable for transfusion and ready to deploy.
A patient in the North of Scotland was one of the first patients to benefit from the partnership between Adults and SNBTS, when she suffered from severe internal bleeding following the birth of her third child. She was being treated and receiving transfusions at her local hospital, however her condition was getting progressively worse, and Adults Ms Margaret Kerr, Neonatal Unit Manager at the Dumfries and Galloway Royal Infirmary, recently provided the was called to take her to Glasgow’s Southern General Hospital. She lost consciousness shortly after take-off and the following feedback on the service provided by Neonates: Adults team gave her a transfusion of O negative blood on the flight. “Our unit in Dumfries delivers Level 2 services to the families in Dumfries and Galloway. We The patient has stated that this, along with the team’s involvement and expertise, saved her life and has extended also support the Community Midwifery Unit (CMU) in Stranraer with any Neonatal problem. As gratitude to the Adults and the donors for being life savers. The patient is now well and at home with her baby son. part of the West of Scotland Managed Clinical Network we rely on the services of the Neonatal transport team to transfer sick and premature babies from Dumfries or the CMU to a higher level In taking blood on board for the first time, Dr Neil Hughes, of care anywhere in Scotland in an efficient timely way. Consultant in Pre-Hospital Medicine, said: For the past 10 years or maybe longer, we have come to depend on the support from the transport team. They provide an excellent retrieval and repatriation service, training programmes “The Emergency Medical Retrieval Service helps on stabilisation of the newborn and they are always available for advice on any aspect of patients when they need it most. We will also attend Neonatal care. major trauma incidents in Scotland, to provide emergency care for patients who are critically injured The transport team are professional, approachable and supportive. We have a named link at the scene. contact who keeps us up to date with any changes in service. “As O negative is the only blood group that can safely This service has become an invaluable and integral part of safe Neonatal practice, that allows be given to anyone in an emergency, a transfusion us as a district general to continue to deliver level 2 care”. in these circumstances can buy precious time for critically ill patients. We would like to extend our thanks to all O negative blood donors for making this possible.”
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3.5.4 Communications short presentation “a day in the life” staff are trained in effective methods 3.5.5 Stories from each of the teams. The event of communicating with parents. ScotSTAR realises that effective was closed by Dr James Ward and a The majority of transport staff are These stories demonstrate the value that ScotSTAR teams add to overall patient care: communication is essential in keeping further event will be planned in 2015 experienced in communication, but the staff informed of progress and to continue momentum towards a a communication scenario has been Twin Boys with Twin Toys changes related to the service. With more cohesive national team. added to the transport course to this in mind, the ScotSTAR Head of build resilience. Plans were well established for the launch of ScotSTAR on the 1st of April last year Service has worked collaboratively To mitigate any remaining concern when a patient in the Western Isles went into preterm labour at 26+ weeks with a twin with the Scottish Ambulance Service within the teams regarding loss of Similarly the Adults team from its pregnancy. She was assessed at the Western Isles Hospital and labour was considered Communications Team to develop identity, a branding exercise has been inception has maintained close too advanced for a safe in-utero transfer. The ScotSTAR process had only been a Communication Plan to ensure carried out with ownership from all links with many different aspects facilitated earlier that day. A call was made to the Perinatal Advisory Service, where ScotSTAR communicates regularly involved. A new recognisable brand of the media. In 2014 the service plans were made for the twins to be delivered in Stornoway with expert help from a and effectively with all internal and integrating the ethos of the three was approached by a documentary Neonatal transport team, before being transferred to a Neonatal unit on the mainland. external stakeholders. teams while simultaneously clarifying company for Channel 4. To the end
that the Division is an integral part of of achieving their goal of maintaining After receiving the information from the Perinatal Advisory Service, the Neonatal Over the summer months all teams the Scottish Ambulance Service has relationships with rural partners, a Services at ScotSTAR organised for two Neonatal teams and their equipment to (except Paediatrics) were visited been developed and agreed. newsletter Spindoctor is regularly be flown to Stornoway, to provide the intensive care the infants required. This included by the ScotSTAR Head of Service sent out to all Adults service users. two intensive care incubators. and Scottish Ambulance Service In addition, the teams have their This regular feature highlights
Organisational Development Lead own mechanisms for internal recent activity of the Adults team The Scottish Ambulance Service organised for a plane to be flown from both Glasgow to discuss how the implementation communications with patients and along with service improvements, and Aberdeen to Stornoway. The aircraft have the capacity to carry one team with an of ScotSTAR was impacting on parents as well as communication updates and clinical governance intensive care incubator, so two aircraft were deployed to transfer both teams and the the teams, including their hopes with relevant outside parties. For developments. Similarly within the twins. Since the inception of Neonatal transport in the West of Scotland this is the only and concerns for ScotSTAR in the example, as Neonates routinely Paediatrics team, filming for the occasion both planes have been tasked simultaneously to retrieve sick or premature future. This was a valuable exercise have discussions with parents second series of Paediatric Retrieval babies. Ambulance crews were also organised in Stornoway to transport the teams to and culminated in an event held in following a diagnosis of their baby’s has been completed and three x 1 the maternity unit. Edinburgh on 30 October 2014 with condition including its implications hour programmes will be screened the teams to discuss the results of and regarding the ongoing care in autumn 2015 on BBC Alba. An hour after the teams arrived in Stornoway, the twins were born, 2 minutes apart the meetings, the branding and a and treatment of their baby; all and both weighing 1 kilogram. Both babies were then stabilised, transferred into the intensive care incubator and flown to Glasgow.
88 days after their birth and one week before their due date, Mum and Dad took their babies home. The parents have informed us that they are now making rapid progress and are two lively, happy little boys who are a continual source of delight.
Mrs Anne Marie Wilson, Neonatal Strategic Manager, and the team extended thanks to the Service staff involved that night, particularly Andy Moir (Head of Air Ambulance) who helped bring all the logistical components of this transport together in a seamless way. They are also grateful to the staff from PAS for the coordination and conference calls which facilitated communication between the different hospitals, transport team and the Scottish Ambulance Service on several occasions that night.
First time two fixed wing aircraft were together on West of Scotland tarmac for a Neonatal transfer.
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Rest and Be Thankful Bus Crash Following the incident, Dr Tim Parke, the consultant in charge of the emergency department on the day of the incident passed on their thanks to the Adults duty teams and those who responded to the major incident declaring: On the afternoon of Thursday 26th March the Adults team were requested by West Ambulance Control Centre (ACC) to respond to a bus crash at the Rest and Be Thankful near Arrochar. Two trauma teams “As the duty Emergency Department Incident Controller for Southern General Hospital yesterday, and a site Medical Incident Officer (MI) were immediately dispatched and the services’ major incident I would like to add my thanks to those of Stephen’s. The input of advanced pre‑hospital skills by plan was initiated. Following an excellent response from team members, there was an the Adults team senior Adults team clinicians, well experienced in primary incident response, allowed for a very Consultant performing a coordinating role with the service administrator at the team base, a CCP in ACC controlled flow of patients from the site thus protecting the overload of receiving NHS resources. and a further five full medical teams were on stand-by to respond to the incident if further resources were Of the patients arriving at the Southern, all had been correctly triaged with the appropriate deemed necessary by the two initial responding teams. The duty teams who attended the incident were advanced interventions in place, including one patient with particularly complex critical injuries. - Richard Price, Stuart Daly, Dave Stoddart, Graham Percival and Ross Moy. The Scottish Ambulance Service can rightfully be proud of having such a world class asset at its disposal. Thanks to all at the scene and co-ordinating at the base.” On arrival at the incident scene the Adults teams liaised with the Ambulance Incident Officer who was coordinating the Scottish Ambulance Service (SAS) response at the incident. The Adults team medical incident officer worked alongside the Scottish Ambulance Service incident officer to Use of technology in the Paediatrics team coordinate the triage, treatment and transportation of all the 52 individuals In the later part of January 2015, amidst a bad weather spell, an eight week old baby was admitted to a District involved in the crash. The weather on scene was atrocious with very high General Hospital in a remote part of the North of Scotland. Following assessment it was agreed that the baby was winds and heavy showers of rain and sleet. Mr Daly has noted that, “the requiring to be transferred to a Paediatric Intensive Care Unit (PICU). Unfortunately issues with bad weather translated weather on scene was some of the worst I have encountered for a long to restriction on air resources and the inability of the Paediatrics team to be physically present at the location. time with very high winds and intermittent rain and sleet showers making communication and all aspect of the job very challenging.” The Paediatrics consultant in charge of organising the transport logistics decided to video-conference through One of the Adults teams took the role of forward medical team and went to the General Hospital. This enabled the team to to assess the patients who were still in or around the coach. The second view the baby and the parent, have discussion with the team started to assess the remaining patients. One patient who was still in referring hospital staff, and provide on-going advice and the coach was critically unwell and once extricated and was intubated and support until the physical arrival of the team later on the ventilated with a rapid sequence induction of anaesthesia performed by the Dr Stuart Daly, Service Lead – Adults same day. forward medical team. Due to the remote location of the incident and the number of patients involved, the coordination and appropriate use of the transport assets The parent of the baby commended the use of the video on-scene, including Royal Navy and Royal Air Force Sea King helicopters, was of vital importance. conferencing facility, highlighting that this had made them The medical teams were able to ‘clear’ the cervical spines of several patients which meant they feel happier and less stressed that the transport consultant could travel to hospital without the need for full spinal precautions thereby alleviating the pressure could provide advice on the care and management of the on transport resources. After the last patients had been moved from the crash scene the Adults team baby whilst they were waiting for the team. went with other Service resources to the casualty reception centre which had been set up in a local Courtesy of Bees Nees Media / MG ALBA community centre and further assessed walking wounded patients. As a result of this experienced clinical assessment several patients were able to be ‘discharged’ from scene and no longer required all team members will be asked having an empowered workforce to be transported to hospital. 3.5.6 Staff Engagement Index to complete a short online or is key to smooth service delivery A new tool has been designed paper questionnaire and provide and efficient coordination of all The Adults team were also able to assist with the triage / distribution of patients to the most appropriate with staff in NHS Scotland to information on their experience of transfers and retrievals. Anne location and thus ensure the various hospital emergency departments involved did not become help individuals, teams and working for NHS Scotland, in their Mitchell, Neonatal Nurse Consultant overwhelmed and therefore minimise the recovery phase for these hospitals following the incident. Health Boards understand and team and their Health Board. Staff is approaching retirement in May With input from the coordinating team at base, the MIO was able to ascertain the critical care bed state improve staff experience, the Engagement Index will be reported 2015, and provides her experience of receiving hospitals so that the most serious patients were taken to a hospital which could support idea being that positive staff from 2016 onwards. of how far Neonatal care and any critical care needs that they had and to avoid the need for secondary transfer to definitive care. engagement will result in positive Neonatal transport have come: patient experience. As the tool Staff engagement has always been is rolled out, it is intended that a key priority for ScotSTAR as
30 31 3. STRATEGIC OBJECTIVES
Home 1. Welcome 2. Introduction 3. Objectives 4. Conclusions 5. Looking Ahead Appendices Prev Next
Principles have not changed – the 1920s incubator pictured here provided 2003 saw the introduction of the Scottish Neonatal Transport Service with thermal support and the ability to provide supplementary oxygen. three regions developed to ensure the safe transfer between hospitals of any infant small enough to fit in an incubator. We were to get dedicated staff just In the UK and Europe Neonatal Intensive Care units were not common for transport! The existing nurses continued their commitment to the service until the 1960s. My first experience of working in a Neonatal unit came by covering weekends and nights as an on call service. South East region about in Australia in 1984 and gave me the opportunity to spend a day started out slowly with only me initially but this was quickly followed by three with Neonatal Emergency Transport Service (NETS). From then on I middle grade experienced doctors and a nurse. Now under ScotSTAR that could not envisage working in any other speciality. team comprises 6 nurses, 3 middle grade doctors, a consultant, 2 ANNPs and a secretary providing 24/7 cover. Nationally it was estimated that the Treatments that are now considered standard were only at discussion service would move about 900 babies per annum; currently that number is point then – surfactant, maternal steroids, oscillatory ventilation, ECLS, closer to 1800 with approximately a third being classed as emergencies. nitric oxide and cooling. Even the age of viability was 28 weeks rather than the current 24 weeks gestation. My current role of nurse practitioner My role as advanced Neonatal nurse practitioner on transport and lead did not exist outside the USA then. 10 years later I went on to become the for this area has been the best job in the world and is definitely a case of first ANNP in Scotland. having my cake and eating it. In this role I have clinical commitment and education provision as well as managerial responsibilities. We have Mrs Anne Mitchell, ANNP – Neonates I returned to Edinburgh in 1987 but despite several years experience had to undertake midwifery training in order worked with NES to ensure standardised training for the staff in smaller to work in the Neonatal unit in the Simpson, but since qualifying in 1989 I have not moved. Recruitment to the units as they come across Neonatal problems far less often than their counterparts in larger units. NNU is now generally limited to general and Paediatric nurses. Nowhere else could I have worked with such fantastic people – the team functions like a family supporting each Neonatal transport happened at this time but babies were moved between hospitals in a very ad hoc manner. other when things outside are tough and celebrating when they are going well. Being able to walk into any unit in Every special care unit in Scotland had a transport incubator and while the tertiary units would go to retrieve the area and feel welcome and known is a real privilege. Being part of a family’s life at this terrible time is humbling. most sick or very preterm babies this was not always the case. Nursing staff had intensive care experience but Sometimes the A&E crews that join us on a job feel that they are just there to drive but knowing them as people were in the unit looking after two sick babies already and medical staff were middle grade but already on duty. and knowing that they are there to back us up in an emergency is so important to the team – you are appreciated! This combination of staff would be very unlikely to have worked together in a transport setting before and for the medical staff it may have been their only experience of retrieval. Mobile phones, fully charged dedicated ScotSTAR is the opportunity to see the service grow along with the other retrieval services and I am sure there equipment, knowledge of gas usage, battery life and awareness of ambulance equipment were still a dream will be a lot of progress in the next few years. away. Back transfers were done by the baby’s nurse as long as she was fairly experienced.
Ambulances in the early 1990s did not have ramps included so the transport system was regularly lifted into the Anne Mitchell, ambulance and secured using the existing York fitting on the ambulance wall. Following an accident in the North Neonatal Nurse Consultant of England, I worked with the Ambulance Service to develop ramps for loading in 1995 and identified that four wheelchair clamps would be safer than the existing York fitting. Unfortunately we then discovered that the floor tracking of ambulances was anything but straight and not every vehicle allowed securing with the wheel chair clamps and the ramps were so heavy that fingers were at serious risk! Sturdier clamps were developed over time, however, With a look at the pictures below showing how Neonatal transport has advanced over the years, we thank Anne for the most difference was noted when our wonderful dedicated vehicle came on scene in 2005, incubators were her years of dedicated hard work and wish her the very best for the future: securely kept in place with crash tested clamps. Although it should retire with me it still works with a lot of TLC.
Having every piece of intensive care equipment in the vehicle that we could ever need for any baby is so much 1968 1974 1980s - 2002 2015 safer than relying on other units to provide extras. Our only request for the next model is noise dampening and vibration limitation!
Within the Simpson there was a group of staff who were interested in transport and wanted to improve things for our patients by having a cohort of nursing staff who would be identified in advance as the person who would go on transfers. This team was formalised in 2000 and made massive improvements for the babies in and around Edinburgh. This included purchasing dedicated equipment checked by a small group of staff and designing a new transport system with the help of Blue Peter and Simpsons Special Care Babies’ charities, which we took proud ownership of in 2002. This involved a lot of work as we met every month, reviewed guidelines, discussed cases and reviewed equipment.
32 33 3. STRATEGIC OBJECTIVES
Home 1. Welcome 2. Introduction 3. Objectives 4. Conclusions 5. Looking Ahead Appendices Prev Next
3.5.7 Fair for all: Equality & are being met – this will also be Diversity guided to an extent by the linkage of Adults data to the outcomes An Equality Impact Assessment data held by Information Services ScotSTAR Referrals by Referring Unit (EQIA) was carried out by the Division (ISD) to monitor if the ScotSTAR Management Team in rurality of the population served by Shetland conjunction with Scottish Ambulance the service has changed. Service Equalities Manager in early 2014 prior to the formal launch of It is envisioned that the EQIA will be ScotSTAR. A number of positive reviewed periodically. impacts were noted as a direct Western Isles result of the services provided by 3.5.8 Equity: Geographical Access the three teams: Orkney ScotSTAR is committed to enhancing The minority ethnic groups are the equitability of our services as provided support to access the far as possible. Data on referring Service, with an interpretation hospitals and Health Boards of service being available to meet referral and treatment are collected communication needs. and monitored for the three teams. A Highland Families of children and study to link the Adults, Paediatrics neonates from all population and Neonatal activity data to Grampian groups that are retrieved and outcomes related data including admitted are given priority for deprivation and rurality is currently hospital accommodation. underway and will allow ScotSTAR to Retrieval services provide support take any steps necessary to ensure to referring hospitals through the service remains equitable across Tayside direct access to clinicians’ advice different areas in Scotland. as well as outreach education sessions, thereby reducing Specific steps to ensure equitable stressful situations for the access are in place within the teams, Fife Forth Valley referring services. for example, within the Neonatal transport team, all regions have ScotSTAR has also made their point of contact that can be GG&C Lothian progress in implementing the accessed to arrange a transfer. This Lanarkshire recommendations put forward by will be streamlined with one national the EQIA, such as data sharing contact number under ScotSTAR. Legend Ayrshire & Borders to allow effective performance PAS is a dedicated line in the West, Arran management and quality and it is planned to roll this out to the Neonates improvement. Work has been other two regions. The teams hold Dumfries and Galloway initiated to improve the joint sharing twice daily teleconference at 8:15 Paediatrics of Datix between the services and and 12:30 to discuss and prioritise Scale the Scottish Ambulance Service workload and cot availability. Adults 0−20 20−40 40−100100−200>400 >700 to ensure greater shared learning. One area the service wishes to The map opposite shows referrals progress further is consulting with by Health Board of referring units. the Remote and Rural stakeholders in the future to ensure local needs
34 35 4. Conclusions: celebration & risk
Home 1. Welcome 2. Introduction 3. Objectives 4. Conclusions 5. Looking Ahead Appendices Prev Next
The first year of operation for Ever increasing demand for ScotSTAR has seen approximately Neonatal transfers, and winter 2,600 successful retrievals with pressures within the Paediatrics patient care at the heart of the team. Working closely with clinical decision making. The last Scottish Government and the year has brought together the Neonatal Managed Clinical reporting structure for ScotSTAR, Networks (MCNs) regarding including the establishment national cot capacity and as of Advisory, Divisional and noted above the evolvement of a Management Groups. In addition, separate paediatric rota should the following have been developed support winter pressures, to support effective service delivery: Memorandums of Understandings (MOU) for monthly activity reports for the 2016/16 are being agreed three teams, full sign off with the Boards provisional QPIs, and involved to ensure due control as Ms Carole Morton, Head of Service – ScotSTAR close liaison and working on joint maintained on the budget. arrangements with the finance The need for further engagement and management teams within across the teams towards the the territorial boards involved. vision for ScotSTAR and the requirement for significant input There have been regular meetings from the Management Group to with the service and medical leads ensure the vision and plans are to work towards the vision as set out communicated widely to all staff in the Full Business Case. The new and stakeholders. base will provide great opportunity for joint working which has already In summary, the first year has been taken forward by the neonatal provided an expected mix of and paediatric teams, supporting achievement and ongoing risks and each other when demand is high. The challenges, but all risks are being successful employment of a Paediatric addressed and mitigating actions Nurse Consultant to ScotSTAR will are in place. The second year of provide the foundation for establishing ScotSTAR will deliver a central a specialist paediatric response that base, central co-ordination and ensures the PICUs in the East and the an ongoing commitment by all the West remain daily staffed. teams to provide the most effective and safe retrieval and transfer for In addition to the achievements there patients across NHS Scotland and have been a number of challenges in out with when required. the first year including:
Workforce recruitment and succession planning especially for Neonatal and Paediatric teams, this is an ongoing risk currently being addressed with the territorial Boards involved, Courtesy of Carol McCabe
36 37 5. looking ahead
Home 1. Welcome 2. Introduction 3. Objectives 4. Conclusions 5. Looking Ahead Appendices Prev Next
The establishment of ScotSTAR As the service beds in, relationships within the Scottish Ambulance develop and the opportunities Appendix 1 ScotSTAR Financial Performance 2014/15 Service has presented an exciting emerge, we will create a system that opportunity to maximise the synergy saves more lives and protects the Forecast Revised between highly performing acute health and wellbeing of the citizens Budget Budget Actual Variance % care retrieval teams, within the of Scotland. In addition, there are 2014/15 2014/15 2014/15 2014/15 Variance £ £ £ £ 2014/15 national organisation responsible a number of additional areas of for co-ordinating, responding to and work that the stakeholders are keen ScotSTAR Total 9,741,000 9,360,701 9,360,517 184 0% delivering pre hospital emergency that ScotSTAR could take on in care in Scotland. The future is one the future: Total Managerial 1,050,000 604,102 686,597 (82,495) -14% of expected change with several developments anticipated by 2020 Inter Hospital Transfer of Total Adults 1,800,000 1,798,818 1,775,128 23,690 1% such as: critically ill Adults Total Paediatrics 1,117,000 1,147,481 1,131,369 16,112 1% Inter Hospital Transfers of A well integrated co-located Paediatric patients Total Neonates 2,952,000 2,988,300 2,945,391 42,909 1% service embedded at the ECMO provision Dr James Ward, Medical Director, Scottish Ambulance Service Central Glasgow Airport base Pre hospital critical care Total Transport (Scottish Ambulance Service) 2,822,000 2,822,000 2,822,032 (32) 0% with a significant portion of the Psychiatric Retrievals ScotSTAR Total 9,741,000 9,360,701 9,360,517 184 0% workforce trained to support Major Incident response more than one specialty Allocation Refund 300,000 Potential for North team to be In addition developments are established including Paediatric planned within the services as Income Reduction 80,299 with Adult capacity well, such as further collaborative Single back office function with working of the Paediatric Retrieval Forecast Budget 2014/15 9,741,000 clear lines to Scottish Ambulance service with the Adult and Neonatal Service including Administration, transport services, and updating procurement, medical physics, and streamlining of SOPs. Sharing fleet, HR & ICT governance, developing aligned Permanent model of finance R&D, utilising technology and arrangements with Scottish developing our workforce will allow Ambulance Service accountability us to make ScotSTAR a truly world with the budget for ScotSTAR class organisation. being managed transparency Daren J Mochrie, QAM, MBA, Dip IMC RCSEd, MC Para Director of Service Delivery, Scottish Ambulance Service Quality indicators and standards established with annual publication and regular review process in place Incident collation and learning process well established Central repository and system for all SOPs including specialty SOPs.
38 39 Home 1. Welcome 2. Introduction 3. Objectives 4. Conclusions 5. Looking Ahead Appendices Prev Next
Appendix 2 Glossary Equality and Diversity A&E Accident and Emergency NHS National Health Service ACC Ambulance Control Centre NICU Neonatal Intensive Care Unit A full Annual Report is also available on our 我們於網站刊登了一份完整的年度報告。如 ANNP Advanced Neonatal Nurse Practitioner NIRS Near-infrared Spectroscopy website. A summary is available in other 有需要，我們可為您使用其他語言及格式提 ANP Advanced Nurse Practitioner PAS Perinatal Advisory Service languages and formats on request. Please 供報告摘要，請致電0131-242 8181向傳 BAPM British Association of Perinatal Medicine PAs Programmed Activities telephone the Interpretation and Translation 譯及翻譯部提出要求，並引述參考編號13- BBC British Broadcasting Corporation PHEM Pre-Hospital Emergency Medicine Service on 0131 242 8181 and quote reference CCP Critical Care Practitioner PIC Paediatric Intensive Care 1304 CFM Cerebral Function Monitoring number 13-1304. PICANet Paediatric Intensive Care Audit Network 我们的网站提供了一份完整的年度报告。若 CMU Community Maternity Unit PICS Paediatric Intensive Care Society Gheibhear làn-Aithisg Bhliadhnail cuideachd CPD Continuing Professional Development 有需要，我们可以提供其他语言和格式的报 PICU Paediatric Intensive Care Unit CSMEN Clinical Skills Managed Educational Network air an làrach-lìn againn. Tha geàrr-chunntas ri 告摘要。请致电 0131 242 8181 联系口译和 QF Quality Framework ECMO Extra Corporeal Membrane Oxygenation fhaighinn ann an cànanan agus cruthan eile le 笔译服务部，并告知参考号13-1304。 QPI Quality Performance Indicators EQIA Equality Impact Assessment iarratas. Feuch an cuir thu fòn dhan t-Seirbheis R&D Research and Development HEAT Health Efficiency Access and Treatment Eadar-mhìneachaidh is Eadar-theangachaidh С полной версией годового отчета можно SAP Service Administrative Policies HEMS Helicopter Emergency Medical Service air 0131 242 8181 agus ainmich àireamh- ознакомиться на нашем сайте. Краткий SAS Scottish Ambulance Service HFOV High Frequency Oscillatory Ventilation clàraidh 13-1304. обзор на других языках и в других HIS Healthcare Improvement Scotland ScotSTAR Scottish Specialist Transport and Retrieval форматах предоставляется по требованию. HR Human Resources SFRS Scottish Fire and Rescue Service Visą metinę ataskaitą taip pat galite rasti Пожалуйста, обращайтесь в Переводческую ICT Information and Communication Technology SNBTS Scottish National Blood Transfusion Service mūsų internetiniame puslapyje. Pagal Службу ITS по телефону 0131 2428181, SOP Standard Operating Procedures ISD Information Services Division pageidavimus, suvestinę galime pateikti назвав исходящий номер 13-1304. MCN Managed Clinical Network SORT Special Operations Response Team išverstą į kitas kalbas ir kitokiu formatu. SWMMNN Southern West Midlands Maternity and MD Doctor of Medicine Prašome skambinti į Vertimo žodžiu ir raštu MedSTAR Medical Specialist Transport and Retrieval Newborn Network MOU Memorandum of Understanding TIG Transport Interest Group tarnybą telefonu 0131 242 8181 ir nurodyti NES NHS Education for Scotland TRM Trauma Resiliency Model numerį 13-1304. Le rapport annuel complet est également disponible en ligne sur notre site Web. Un résumé est disponible en d’autres langues আমাদের ওয়েবসাইট থেকেও একটি সম্পূর্ণ বার্ষিক et formats sur demande. Téléphonez au রিপোর্ট পাওয়া যা붼। অনুরোধ করলে, অন্যান্য service de traduction et d’interprétation ভাষা ও রূপেও একটি সারাংশ পাওয়া যাবে। দয়া করে au 0131 242 8181 et citez le numéro de দোভাষী ও অনুবাদ পরিষেবাকে 0131 242 8181 référence 13-1304. নম্বরে টেলিফোন করুন এবং 13-1304 রেফারেন্স Pełny raport roczny dostępny jest również নম্বর উল্লেখ করুন। na naszej stronie internetowej. Na żądanie एक पूर्ण वार्षिक रिपोर्ट हमारी वेबसाइट पर dostępna jest skrócona wersja raportu w innych भी उपलब्ध है. अनुरोध पर एक सारांश अन्य językach oraz formatach. Prosimy zadzwonić भाषाओं और स्वरूपों में उपलब्ध है. कृपया do Biura Tłumaczeń (ang. Interpretation and Interpretation और Translation सेवा को Translation Service) pod nr tel. 0131 242 8181 i संदर्भ संख्या 13-1304 का हवाला देकर 0131 podać nr referencyjny 13-1304. 242 8181 पर टेलिफोन करें.
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