nhs 24 and the scottish ambulance service dr george crooks medical director nhs24 and sas
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NHS 24 and the
Scottish Ambulance ServiceDr George Crooks
Medical Director NHS24 and SAS
A&E - Demand
100
105
110
115
120
125
130
135
140
145
2004/05 2005/06 2006/07 2007/08
(Since introduction of Priority Based Dispatch)
414,000 incidents
332,000 incidents
+25%demand
597,118 incidents in 2008
Cat A Performance 72.3%
Ave response time 6.96 mins
Costs £145M
A&E – Cat A since PBD
A&E – Cat A
100
105
110
115
120
125
130
135
140
145
2004/05 2005/06 2006/07 2007/08
(Since introduction of Priority Based Dispatch)
100
105
110
115
120
125
130
135
140
145
2004/05 2005/06 2006/07 2007/08
Cat A
100
105
110
115
120
125
130
135
140
145
2004/05 2005/06 2006/07 2007/08
Actual Cat A jobs reached on target
64,592
92,440 +42%
86,000
Ambulance demand
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
2001/02 2002/03 2003/04 2004/05 2005/06 2006/07
Emergency Urgent and planned
Emergency ambulance demand
Emergency 2004/05 2005/06 2006/07
Public 70% 69% 69%
GP 9% 7% 5%
NHS 24 7% 11% 15%
Other 14% 14% 11%
TOTAL 332,474 354,973 397,553
Performance – Air
3500+ missions
Demand up 4.4%
EMRS – separate co-ordination
NHS24 and A + E
Performance2006/07
• Total calls handled: 1,458,464 2006/07
• 8% increase in call volume
• 1,508,597 2007/08
• 3.5% increase in call volume
Typical weekly pattern
Typical daily pattern
11.9%
9.4% 9.7%8.6%
9.3%
26.4%
24.8%
0%
5%
10%
15%
20%
25%
30%
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Typical Weekdays
Typical intraday call arrival pattern
0
50
100
150
200
250
300
350
400
00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00
Time
Monday Tuesday Wednesday Thursday Friday
Typical Saturday
Saturday 9 June intraday call demand
0
100
200
300
400
500
600
700
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Rate of Contact per 1,000 Population
0 5 10 15 20 25 30
Highland Hub
Western Isles
Shetland
GEMS
ADOC
Dum & Gall
Argyll & Clyde
Lanarkshire
Fife
Borders
Lothian
Tayside
Forth Valley
GMED
Orkney
Health Board Areas
May-07 May-06
Monthly Calls by Age Category
0%
10%
20%
30%
40%
50%
60%
0-5 17.1% 17.1%
6-12 6.3% 6.2%
13-18 5.0% 5.2%
19-65 48.6% 50.0%
Over 65 20.6% 19.6%
No Valid DOB 2.4% 1.9%
May - July 06 May - July 07
1.Monthly DispositionsSpread of Monthly Dispositions
0%
10%
20%
30%
40%
50%
60%
% of Total Dispositions
Nov-07 6.1% 6.0% 54.9% 2.2% 7.6% 1.8% 2.4% 11.1% 1.8% 6.1%
Oct-08 6.1% 5.8% 51.1% 2.1% 6.7% 2.0% 5.1% 10.2% 4.8% 6.3%
Nov-08 6.3% 5.5% 53.4% 1.9% 6.2% 1.8% 4.8% 10.1% 3.6% 6.3%
999 A&EGP within 4
hours
GP within 12
hoursGP routine Pharm. Other Prof. Self Care
Info.
ProvidedOther
NHS Lothian NHS24 Study
Dr M Crooks
• During the out of hours period, there were a total of 2,269 A&E attendances
• 1126 patients self-presented to A&E without prior contact with other out-of-hours services
• 288 had contacted NHS24 and been assigned a disposition leading to A&E attendance, 13% of activity
NHS24 NHS Lothian Study
• 288 patients were advised to attend A&E by NHS24 during this time. A compliance rate of 85%
• 4 self-presented following home care advice from NHS24
Outcome of patients self presenting to A&E (n=1,130)
Admissions Discharges
Male Female Male Female
38 27 589 476
Total = 65 (6%) Total = 1,065 (94%)
A total of 409 patients that self presented to A&E were deemed to have presenting complaints that may have been more appropriately triaged by NHS24. This represents 36% of patients self presenting to A&E during the out of hours period.
Patient Self Care Education
Evidence of Effectiveness: Staywell Empowering Patients
LTCs - National Refractory Angina Centre in Liverpool (NRAC)•First to have quantified the impact of high quality patient education and properly informed treatment choices on hospital admissions. •Study* focused on 271 chronic refractory angina sufferers between 1997 and 2002 • 26% reduction in admissions• 33% reduction in length of stay• £1337 per patient per year saved (£362,440 across their 271 patients)
*A brief Cognitive-Behavioral Intervention Reduces Hospital Admissions in Refractory Angina Patients. Journal of Pain and Symptom Management. Vol 33 No.3 March 2007
Health of the elderly - Gloucestershire Practice, creator of Staywell 75 (paper-based)
Older Persons Emergency GP Admissions
0
5
10
15
20
25
Stayw ell Surgery Average for non-Stayw ell practices in
locality
Surgery
Admissions per 000
2004/05
2005/06