Reducing pressure on emergency medical services

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Reducing pressure on emergency medical services

• Rapid response review
• Wroclaw, 23 July 2015

Willy Palm, Dissemination development
Officer (Anna Sagan, Erica Richardson)
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www.hspm.org

• An international network of prestigious national
  institutions
• Monitoring online health reforms and policy
  developments at national level
• Comparing key aspects of health systems

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available on www.healthobservatory.eu
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Initial observations

• Essential part of public health, comprehensive
  systems to seamlessly integrate pre-hospital care
  with stabilisation, triage, immediate care and
  in-hospital care (WHA Resolution 60.22)
• Wide variation of professional standards,
  organisational structures, coordination mechanims
  across Europe (WHO 2008)
• A relatively expensive way of providing care so
  needs to be restricted
• One of the most accessible points in the system
  universal, free of charge (uninsured!)

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Growing concern
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Common challenges (1)

• Overcrowded AE departments, frequently due to
  patient self-referral, is a common problem
  throughout Europe
• Improvements require strategies that reach far
  beyond emergency departments (Siegel, Wilson
  Sickler 2007)
• Emergency care is often impacted by deficiencies
  elsewhere in the system (primary care, social
  care, hospital care, palliative care, etc.)
• Financial or physical access
• Bottlenecks in hospital patient flows (e.g. bed
  blocking)
• Lack of integrated care and intermediary
  services
• Early discharges (emergency readmissions)
• Etc.

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Common challenges (2)

• The provision of specialist emergency services on
  a 24/7 basis requires a level of staffing that
  may only be economic at a large scale and this
  drive centralisation.
• Problem for smaller hospitals in remote or rural
  areas
• Staff shortages and attractiveness working and
  remuneration conditions, problems of violence
  against staff
• Regulation, governance, financing and
  organisation of pre- and in- hospital EMS often
  differs, impeding on the full integration of the
  EMS chain
• Emergency medicine increasingly acknowledged as
  medical speciality (in 15 EU MS)
• Improved training of paramedics (regulated
  profession in 12 MS)
• Quality indicators and targets not
  systematically evaluated ambulance response
  time, ED waiting times

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Out-of-hospital policy options (1)

• Ambulance and dispatch services
• Combined model load go stay stabilise
  through better training of paramedics,
  diversification in rescue teams and clear
  protocols and dispatch guidelines
• Concentration/centralisation with less players,
  clear targets and integration/coordination with
  other rescue services
• Single entry point and unified call/dispatch
  centers with growing role for dispatcher to
  triage patients (clinical support, triage
  protocols, computerised solutions)

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Out-of-hospital policy options (2)

• Reduce unnecessary emergency hospital admissions
  by increasing role of primary care in attending
  urgent and emergency care
• Improve access to out-of-hours primary care
  (formal obligation, centralised provision through
  GP posts, walk-in clinics, PC centers etc.
  mobile teams)
• Better coordination / cooperation / communication
  with EDs but also with other services (e.g. home
  care, palliative care, psychiatric care)
• Telephone assistance and support to advice
  patients, assess complications and direct to the
  appropriate services (e.g. GP appointment)

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In-hospital policy options

• Discourage unnecessary emergency admissions in ED
  through disincentives for self-referral,
  front-door triage by GP, cooperation with other
  local providers (GPs, nursing homes, psychiatric
  hospitals), public education and awareness
• Improved triage and patient flow management (e.g.
  nurse-led, standardised guidelines and protocols,
  computerised triage systems, fast-track streams,
  post-emergency department)
• Hospital reconfiguration and interhospital
  networking with emergency functions separated
  between types of hospitals (e.g. hub and spoke
  network model supported by technology)

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Evidence-support next steps?

• Policy summary on reducing pressure on EMS
• Policy dialogue to discuss options in Polish
  context
• ...

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Analysing HealthSystems and Policies
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