The Scottish Ambulance Service New Clinical Response Model Evaluation Report Authors: Dr Kathleen Stoddart (Principal Investigator) Dr Julie Cowie Dr Tony Robertson Associate Professor Dr Carol Bugge Professor Jayne Donaldson Dr Federico Andreis Date Published: February 2019 Table of Contents Table of Contents ................................................................................................................... 1 Acknowledgements ................................................................................................................ 3 Glossary of key terms ........................................................................................................... 3 Executive Summary .................................................................................................................... 4 Methods ................................................................................................................................. 4 Key Findings ........................................................................................................................... 5 Interpreting this data ......................................................................................................... 5 Speed ................................................................................................................................. 5 Accuracy ............................................................................................................................. 6 Conclusions ............................................................................................................................ 8 Chapter 1: Background and context in Scotland ....................................................................... 9 Response categories ............................................................................................................ 10 Medical Priority Dispatch System ........................................................................................ 13 Aims of NCRM ...................................................................................................................... 14 Whole System Approach ...................................................................................................... 14 Chapter 2: Approach to Independent Evaluation .................................................................... 17 Chapter 3: Analyses ................................................................................................................. 19 3.1 Descriptive Analyses ...................................................................................................... 20 3.1.1 Overall Incidents ..................................................................................................... 20 3.1.2 Purple Incidents ...................................................................................................... 22 3.1.3 Red Incidents........................................................................................................... 24 3.1.4 Amber Incidents ...................................................................................................... 25 3.2 Are patients with Immediately Life Threatening (ILT) conditions more quickly and accurately identified? .......................................................................................................... 28 3.2.1 Category level results – comparison of means (‘more quickly identified’) ............ 28 Category level results summary ....................................................................................... 30 3.2.2 Condition level results – comparison of means (‘more quickly identified’) ........... 33 Condition level results summary ..................................................................................... 35 3.2.3 Category level results – comparison of count data (‘more accurately identified’) 36 3.2.4 Condition level results – comparison of count data (‘more accurately identified’) .......................................................................................................................................... 39 1 3.3 Are more lives saved as a consequence of the best available resources being dispatched to the patient?................................................................................................... 42 3.3.1 Category level results .............................................................................................. 42 3.3.2 Condition level results ............................................................................................ 45 3.4 Are improved clinical outcomes achieved if the matched resources are sent first time for patients with non-ILT conditions? .................................................................................. 48 Chapter 4: Key Findings........................................................................................................... 49 Context Results .................................................................................................................... 49 Interpreting this data ........................................................................................................... 49 Are patients with Immediately Life Threatening (ILT) conditions more quickly and accurately identified? .......................................................................................................... 50 Speed ............................................................................................................................... 50 Accuracy ........................................................................................................................... 50 Are more lives saved as a consequence of the best available resources being dispatched to the patient? ..................................................................................................................... 51 Are improved clinical outcomes achieved if the matched resources are sent first time for patients with non-ILT conditions? ....................................................................................... 52 Chapter 5: Discussion ............................................................................................................... 53 Comparison to Other Studies .............................................................................................. 53 Strengths and Weaknesses of the evaluation ................................................................... 54 Interpretation of Results .................................................................................................... 55 Recommendations for Further Research ............................................................................. 57 Conclusions .......................................................................................................................... 59 References ........................................................................................................................... 60 (provided by the Scottish Ambulance Service and included verbatim) .............................. 62 An addendum provided by the Scottish Ambulance Service is included verbatim (page 62) 2 Acknowledgements The Scottish Ambulance Service Information Services for collating and providing summary data. Richard Dobbie and his team at NHS Information Services Division who collated data and contributed to analysis have also supported the evaluation. Glossary of key terms AMPDS AMPDS Advanced Medical Priority Dispatch System CAD Computer-Aided Dispatch DCR Dispatch Code Reference CI Confidence Interval ED Emergency Department GROS General Register Office for Scotland ILT Immediately Life Threatening ICD International Classification of Disease ISD NHS Information Services Division MPDS Medical Priority Dispatch System NCRM New Clinical Response Model NRS National Records for Scotland PDA Pre-Determined Attendance SAS Scottish Ambulance Service SD Standard Deviation UCDM Unscheduled Care Data Mart 3 Executive Summary The Scottish Ambulance Service (SAS) responds to around 1.8 million calls per year, including responses to 700,000 emergency and unscheduled incidents. Of these responses, over 500,000 are received through the 999 call service. SAS transfers around 90,000 patients between hospitals each year and responds to over 150,000 urgent requests for admission, transfer and discharge from GPs and hospitals (SAS, 2015). In 2017 SAS began to implement a new clinical response model (NCRM). The aims of the NCRM are to: . Save more lives by more accurately identifying patients with immediately life- threatening conditions, such as cardiac arrest; . Safely and more effectively send a matched resource first time to all patients based on their clinical need. The University of Stirling, commissioned to carry out an independent evaluation of the NCRM using data provided by SAS and NHS Information Services Division (ISD), considered the following questions: 1. Are patients with Immediately Life Threatening (ILT) conditions more quickly and accurately identified? 2. Are more lives saved as a consequence of the best available resources being dispatched to the patient? 3. Are improved clinical outcomes achieved if the matched resources are sent first time for patients with non-ILT conditions? Methods A quantitative analysis was conducted comparing SAS data on response to 999 calls from a pre-NCRM implementation time-period (January 2016) and a post-implementation time- period (January 2017 and January