111 Clinical Hub now reducing hospital presentations New Zealand wide

Elliot Steel |

Improvements to the St John 111 ambulance call system are now fully embedded throughout New Zealand, having been rolled out in the remaining South Island DHB areas at the end of last year.

If a caller is assessed as needing an ambulance urgently, St John will send one as soon as possible. If an urgent ambulance response is not required, St John registered nurses and paramedics will determine the best treatment for the patient by using a phone triage system.

This is a proven, internationally recognised system known as the 111 Clinical Hub in New Zealand.

St John National Patient Pathways Manager Kris Gagliardi says the evidence of improved patient care is clear.

“It provides patients who have non-urgent illnesses and injuries with appropriate advice and treatment care closer to home by having an experienced nurse or paramedic call the patient back and undertake a detailed assessment,” Gagliardi says.

St John receives more than 500,000 emergency 111 calls for an ambulance each year. St John’s priority is always to send emergency ambulances as quickly as possible to those in most urgent need.

“Over 25 percent of 111 calls are for issues like strains and sprains, cramps or ear ache and could potentially divert ambulance resources away from someone in more urgent need.

“What’s more, there are better, often faster, ways of managing these calls over the phone, finding more appropriate care, thereby freeing up ambulances to focus on the increasing number of ‘high acuity’ or life-threatening incidents.

“This can also help reduce the more than 281,000 presentations to hospital emergency departments throughout New Zealand every year,” Gagliardi says.

As with all emergency care departments, the staff at Middlemore Hospital need to spend their time on cases threatening life or limb. Acting Chief Medical Officer, Vanessa Thornton says that by triaging and helping assess patients before they arrive at Middlemore, St John helps ensure ED staff are providing urgent care to those who need it the most.

“One of our biggest challenges is the number of people to come to the Emergency Care Department who should be accessing other medical help, including their own GPs. St John is helping make sure the patients with the most need, get seen in the right place,” Dr Thornton says.

As part of its commitment to improved patient care, St John regularly monitors customer feedback through a monthly customer experience survey to inform what is being done well and what to improve, from the patients’ perspective.

While efforts to increase awareness of Clinical Hub continue, the latest Clinical Hub User Satisfaction results for January 2018 shows overall satisfaction with the service is over 82 percent.

The countrywide roll out has also seen a significant impact on the number of ambulance presentations to hospital Emergency Departments (EDs).

December 2017 was the lowest ever percentage of 111 calls transported to EDs in New Zealand since records began.

In the last 12 months, about 41,000 incidents (or 9.4 percent of all incidents) went through the Clinical Hub triage process, and 40.8 percent of those incidents were clinically managed in the community without the patient being transported to an ED.

The Chief Medical Officer of Southern DHB, Dr Nigel Millar, says the goal is always to provide the best patient care possible where and when it is required, and the St John 111 Clinical Hub supports this by helping to ensure that patients get the care they need as quickly as possible which can be in services outside the Emergency Department.

“This is particularly important for urgent or life-threatening calls to the 111 service because it means that there will be a faster response and patients get the acute care they need more immediately,” Dr Millar says.

All 111 emergency ambulance calls are triaged by a call handler while St John paramedics and/or Homecare Medical nurses, conduct enhanced clinical assessment of low acuity calls.

To ensure that patients provide all the important information during a Clinical Hub call back, Homecare Medical nurses and St John paramedics who have extensive experience in telehealth are supported by a clinical triage tool which prompts the clinician to obtain essential information for each condition.

The Clinical Hub connects patients to the right care at the right time, finding the most appropriate health pathway for that caller. That could include self-care, referral to a general practitioner or urgent care clinic, or a St John response.  This could be with an emergency ambulance or alternative vehicle to treat the patient at the scene, without the patient being transported to an emergency department unless required. 

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