Scottish Ambulance Service
Cab Based Terminal Project
an overview
September 2012
Clinical Background
• In 1999, NAO investigated clinical
performance of SAS.
• Only 49% of A&E incidents had any
written record at all.
• Clinical Performance was well below
acceptable standards.
• Improvement was demanded.
Project Aim
Aim:
To implement an appropriate Mobile
Data Solution for the Emergency
Service,
that will enable the right information
to be provided to crews, at the right
time, at the right place.
Background Rules
MUST BE;
• Easy to Use - Big, bright buttons, simple flow. Never
looking cluttered. Must allow free movement across
every screen. Must be dictated to, and never dictate.
• Functional - People who see it and first use it, must
want to use it and keep using it. If they furrow their brow
– without input – it’s not right. More facilities can be
added when users are happy with the basic system of
use.
• Patient Centred - Must flow along expected treatment
path. This must make it easy to fill in at the time and
later. Must help newer staff in suggesting logical &
sequential questions or tests along the way, without
instructing or hand-holding.
Background Rules
MUST BE;
• Supportive - a) not obstructive – no daft questions,
rules, illogical or mandatory screens, or flows that divert
from what actually happens. b) Must provide all
necessary advice, guidelines, standards, formulae and
flowcharts – without insisting that you follow or read
them. It is here for you, not vice versa.
• Acceptable - People who see it and first use it, must
want to use it and keep using it. If they furrow their
brow – without input – it’s not right. More facilities can
be added when users are happy with the basic system
of use.
Background
Original Concept
ePRF
SAS ePRF Servers
Manual re-keying
A&E System
A&E Admission Staff/Clinicians
Background
Vehicle Infrastructure
ePacer
Screens
ePacer
Screens cont...
Recent Developments
Sending the details to the Hospital
•
The system has been designed to automatically send the ePRF to the hospital when
the crew selects the ‘Leave Scene’ button in the Cab. There may be very little data
within the ePRF at this time but the document will alert the A&E that an
ambulance is on its way to them.
•
During prolonged journeys, crews can use the ‘Pre-alert’ facility to send further
updates to the hospital as they enter further details of the patient’s condition.
•
A further copy of the ePRF will be sent to the hospital automatically when the crew
selects ‘Clear’ within the cab. In most cases this will be the completed document.
Benefits: Real-time information, Preparation for patient within A&E, Faster
handover from ambulance to hospital
Recent Developments
Emergency Care Summary
Ambulance Service access to the ECS will benefit patients in the following ways:
•
Medical history often unavailable at scene
•
Care pathways better informed
•
Co-morbidities discovered early
•
Pre-arrival advice available
•
Advanced directives known
•
Risk-reduction (e.g. allergies)
•
Safer clinical decisions
•
Safer referral to local care
Recent Developments
Overall System
Data Warehouse
• Provides clinical performance data
immediately
• For Service, Division, Station and
individual.
• Provides Trigger tools and CPI reports.
• Allows for simple and targeted audit.
Data Warehouse
• Allows for simple benchmarking.
• Provides data to allow local audit and
improvement.
• Supports projects aimed at improving
service.
• Shows equipment/skills needs.
• Allows for clinical appraisal.
Data Warehouse
• Provides evidence for Guidelines and
standards.
• Allows staff to view their performance.
• Supports clinical governance and CQI
• Valuable research tool.
• Simple review when exceptions are being
investigated.
2010 – EHI Best Use of Mobile
Technology and Overall UK Winners
Next Steps:
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Linkage to intranet
Greater connectivity via Ensemble
Datix incident reporting
Stock requests
Manpower organisation
Clinical Forum
Net sites (Toxbase, BNF, Medline)
Audio/video telehealth