PP37 Optimising the right care first time: an analysis of the integrated clinical hub ‘hear and treat’ calls in the Northern Ireland ambulance service

<h3>Background</h3> In the Northern Ireland Ambulance Service (NIAS), paramedics were first embedded within Emergency Ambulance Control (EAC) in 2017 when the Clinical Support Desk (CSD) was implemented. CSD paramedics contacted patients who had phoned 999 and who, based on their reported clinical condition, had been categorised by the Medical Priority Dispatch System (MPDS) as Category 5. The workload of CSD paramedics was therefore guided by this computerised system with limited freedom to assess calls outside of Cat 5 due to the staffing model built around this. On the 9th October 2023, a pilot of the new Integrated Clinical Hub (ICH), which aimed to replace the CSD model, was carried out. Within the ICH, staffed by paramedics and nurses, a larger team of clinicians assessed 999 calls from all call categories. This workload was directed by senior clinicians who, using their clinical experience, identified those calls they felt had a reasonable likelihood to achieve a Hear&amp;Treat (H&amp;T) outcome. This meant that the workload was no longer dictated by the computer system but was being clinically-led. As part of ‘Getting it Right First Time’, H&amp;T outcomes, where clinicians manage the patient appropriately at the point of the 999 call, forms a key part of the ambulance services’ work on this. Additionally, this approach meant that waiting 999 calls from all categories received oversight from a senior clinician improving safety for those waiting for an ambulance response. The aim of this project was to measure the impact of changing from an MPDS-led approach to a clinician-led model of H&amp;T. <h3>Methods</h3> Data was extracted from the Command and Control system and analysed using descriptive statistics. Data from the pilot day itself and after was compared with pre-intervention data to measure change. <h3>Results</h3> Data from before the pilot (1st Jan 2023 to 30th Sept 2023) showed that the average H&amp;T referrals made up 3.79% of all 999 calls. <i>Lower acuity patients</i> In lower acuity patients, H&amp;T numbers increased and continued in this trend in the months following the pilot. In October, H&amp;T referrals rose to 3.91%. The pilot was so successful that it was continued in the following months. In November, December, January and February, H&amp;T referrals were 3.80%, 4.39%, 4.53% and 4.97% respectively. In March, referrals increased to 6.5% of the total call volume. <i>Higher acuity patients</i> During the pilot and the months following, ICH staff were also identifying and appropriately upgrading five times more patients to a higher acuity response, thus increasing patient safety. <h3>Conclusion</h3> The clinically-led approach is now business as usual. The senior clinical tier and wider team has been expanded and the ability to assess a more appropriate range of patients has demonstrated a continual return in ‘Getting it Right First Time’ for 999 callers. Additionally, this clinically-led model has allowed clinicians more time to identify calls within the wider waiting 999 call ‘stack’ that warrant a higher acuity response. Under increasing health service pressures, these patients were waiting longer than ever and this new approach increases clinical oversight of these incidents.