How to support Treat & Leave and Treat & Refer

The ambulance service and its role within the pre-hospital care are changing. Initially it was a pure transport service for injured or sick people. Then slowly the treatment became more sophisticated, and in the next phase the co-operation with other care-providers like hospitals increased. The latter in most cases backed up by increasing use of telecommunication and IT. Now we see a new trend coming up where the ambulance takes a more active frontline role in treating people at site, transferring them to “right care-provider”, i.e. to less extent A&E, and referring them to other more appropriate care providers than the emergency service and department. This new role is often referred to as Treat & Leave and Treat & Refer, and the process of not always bringing the patient to A&E as “Admittance Avoidance.

Many of these concepts originate from the ambulance service in UK, but the trends as well as the problems to handle are seen in most European countries. One of the bearing facts behind the ideas is that it has been found that many patients are taken to A&E which should not be taken there at all; because it is not where they get the most appropriate care. Instead they should have been treated at home or referred to some other care provider or department like primary care, GP or geriatric department. Furthermore, bringing unnecessary patient to A&E increase the load on these departments which results in patient overload, not efficient staffing and in the end inappropriate use of all resources; personnel as well as money.

In the report “NHS Ambulance services – more than just patient transport” it is stated that 77% of the patients today treated by the ambulance service are transported to A&E. This figure is the result of strong efforts to bring the number of what is considered as unnecessary transports down. Still it is estimated that 50% of these 77%  should not be taken there anyhow; they should have been treated at the scene or by the community (Taking Healthcare to the Patient, DoH, 2005). 

A way to handle the situation is to support the ambulance service personnel making the right decisions on transport and care already at scene. If the patient shall be treated and left at scene, transported somewhere else than the “default” location A&E, or handed over to the GP, the personnel needs tools to carry out these tasks. It is necessary to be able to bring up information from various sources like patient records or social records. The actions taken at scene need to be documented, and sometimes a telemedicine consultation including measurement of vital signs needs to be performed. Also information exchange with other care stakeholders as well as patient hand-over has to be possible and secure in all aspects.

Ortivus MobiMed constitutes the perfect platform for applying Treat & Leave and Treat & Refer protocols and processes. It is designed to handle measurement and analysis of vitals, utilize telemedicine, handle communication using various networks, exchange information in a secure way with various stakeholders and information sources, handle all necessary documentation and be adopted to the care processes being deployed on for instance a regional base. Finally it is scalable and modularized thereby making it possible to start at the “right” implementation level; i.e. you don’t need to do all at once with everyone.

Core Messages:
• Care at correct care level and by right care provider saves money
• Care at correct care level and by right care provider is more beneficial for the patient
• MobiMed offers a platform for applying T&L and T&R

Links/Downloads:

Vård på plats, Press release VGR

Gepard projektet, Stockholm Prehospital Centre (How to re-direct the geriatric patient to an adequate level of care)

Not just a Matter of Time, Healthcare Commission 2008
 
NHS ambulance services – more than just patient transport, The NHS confederation 2006

Taking Healthcare to the patient, Department of Health 2005
 
Changing Times, Department of Health 2008