Advanced Paramedics reducing hospital admissions

Data from the Welsh Ambulance Service shows that up to 70% fewer people needed to be taken to emergency departments when responded to by an Advanced Paramedic Practitioner, compared to traditional crews.

Providing a link between primary and secondary care, APPs are paramedics who also care for patients in a primary care setting through a rotational working model and are based in General Practitioner surgeries, Community care centres and on the road in Rapid Response Vehicles in the community. They have undertaken rigorous additional education to respond to 999 calls, make advanced clinical decisions, undertake medicine reviews and in some cases prescribe medication.

Common calls attended by APPs include chest pains and breathing difficulties. If an advanced assessment determines that there no clinical need for the patient to be taken to the emergency department, an APP can provide immediate treatments, working with primary care or alternative pathways to undertake, medicine reviews, social care, mental health support and other interventions.

Following a review of their role in 2017, work is underway to build on the success of the rotational model. In several Health Boards APPs are as ‘navigators’ within the integrated urgent care centres, where they provide remote consultation to 999 callers, directing them to alternative appropriate services to avoid unnecessary hospital admissions.

Increasing the number of APPs is part of the Welsh Government’s Rehabilitation Framework commitment for rehabilitation services to deliver support and care closer to home. By keeping people who have suffered a fall, are frail or who have an acute or urgent requirement for rehabilitation services out of hospital, the chance of a positive patient outcome is increased. By referring patients to rehabilitation specialists, including physiotherapists for treatment, problems such as muscle wastage which can be triggered by a hospital admission can be avoided.

The Minister for Health and Social Services, Eluned Morgan said:

“Advanced Paramedic Practitioners are just one way we are ensuring people receive the right care, in the right place, first time and as close to home as possible. Early intervention can avoid unnecessary hospital admissions for our already overstretched emergency departments and help keep people in their homes.

“This enhanced role allows paramedics to work across the whole health and care system rather than being restricted to traditional ambulance crew roles. They provide advanced life support, make emergency treatment decisions, and assess and signpost patients to the right part of the health system to deliver the care they need. Identifying peoples’ needs at first contact and ensuring appropriate care is accessed avoids duplication and provides a person-centred approach to maximise health outcomes and support people to stay and live well”.

Andy Swinburn, Director of Paramedicine at the Welsh Ambulance Services Trust said:

“WAST has worked hard to increase its ability to manage more patients closer to home. The changes in patient presentations we see within the 999 system illustrates that for many of our patients conveyance to the Emergency Department is not always the best option. Working with our Commissioners, Health Education and Improvement Wales and Welsh Government, has allowed us to grow our APPs numbers to ensure more patients can benefit from their skills. Our aspiration is to continue this growth and ensure we maximise the benefits of this key clinical role”.