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New flowchart supports care homes make the right decision about calling 999

02 February 2018

A South East Coast Ambulance Service (SECAmb) paramedic has helped develop a step-by-step flowchart to support care homes make informed decisions about when is the right time to call 999 for ambulance assistance.

Tom Pullen, a specialist paramedic from the Trust’s Clinical Development Team, developed a guidance document on how to appropriately access urgent and emergency care from SECAmb, including the easy-to-follow flowchart.

Tom worked in collaboration with First Community Health and Care, which provides community-based care services in East Surrey and the surrounding areas.

The guidance and flow-chart gives care home providers information on what service they should call if one of their residents needs medical assistance.

Tom said: "It’s a very simple idea. We’ve really engaged with care home providers to make sure that what we ended up with was fit for purpose."

The approach aims to reduce the number of calls to 999 which could be handled more efficiently elsewhere by providing appropriate signposting and optimising patient flow through urgent & emergency care systems. This in turn reduces avoidable hospital admissions. The guidance was initially trialled in a couple of local East Surrey care homes, prior to being deployed across the region.

"First Community Health Care initially drove the initiative and opened doors,” said Tom. “This allowed us to get some valuable feedback from care homes when developing the guidance ensuring that when we went live for the rest of the region we could feel confident with what had been produced.”

SECAmb Consultant Paramedic and Head of Clinical Development Andy Collen said: "We know that across the region care homes will often call 999 because they are unsure what to do, and may be concerned about doing the wrong thing. By introducing the flow chart, we are effectively giving care homes another way of providing a safety net. While not a formal decision-support tool, the flowchart can guide staff to “choose well”, which is key message in the NHS. We are not advising care homes to stop calling 999, but rather to work with us to promote the best care for patients, and avoid unnecessary risks, bearing in mind there are risks with sending older patients to hospital where this may be avoidable."

The guidance also provides some basic dos and don'ts when calling 999. It uses the same language which is found in NHS Pathways, the clinical system used by 999 and NHS111 providers in the region to triage calls. This helps care homes become more familiar with the way the system works and improves patient experience.

Tom added: "There are some very simple things in the guidance which can really make a massive difference, such as ensuring that the person delivering the care to the resident is the person who calls 999. In some cases, we may need to ask more questions about the patient so having a fuller picture as quickly as possible will ensure we get the right level of care."

With the early success of the scheme seeing the number of calls and admissions to hospital from care homes in the area falling, Tom and the Trust is keen for care homes across the  Kent, Surrey and Sussex region to make use of it.

Tom and SECAmb were recognised for their work when the team at First Community Health and Care awarded them ‘Partner of the Year’ at the community provider's annual awards in November 2017.

Care home providers can request further information by emailing

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