EL VII DUQUE Y SU MECENAZGO LITERARIO
LA SUCESIÓN DEL TÍTULO
This thesis focuses on the role of the service providers, to be more specific, the North East Ambulance Service NHS Foundation Trust in England, which will be referred to throughout this thesis as NEAS. It assesses the practicality and feasi-bility of a proposed Technology-Based Solution (TBS) that can be integrated into NEAS’s current systems, and which could provide the ambulance crew, who lack reliable patient information while on scene, with ‘on-demand’ health information for the chosen group of patients with epilepsy during an incident. This information empowerment will support a crew by enabling better health decision-making, and aid with deciding if the patient needs to be conveyed to ED or not.
First of all, an explanation of the current systems at NEAS alongside the feasi-bility study will be briefly explained and defined. Figure 1.1 reflects a holistic view
The Technology- Based Solution
NEAS Database
Current System The Feasibility Project
Call Maker
Crew
Call Handler
‘On-demand’
Information Reports an incident via call.
External Databases
Dispatch a crew and inputs incident initial info manually.
Hospitals Databases
1
2
3
Figure 1.1: A Simple Outline of the Current System and the Feasibility Project
of the current system at NEAS in parallel with the proposed Technology-Based So-lution (TBS) that may enhance the performance of an ambulance crew in addition to the ambulance service and other healthcare organisations by supporting them with reliable patient health information which they already lack.
The involvement of the other human subjects, that is the call handler and the crew, in Figure 1.1 will be first triggered by a 999 call to the emergency services placed by a member of the public asking for help (1). Depending on the situation described in the 999 call, the call maker will then be connected with a call han-dler based at the call centre at NEAS. The call hanhan-dler will talk to the call maker and ask for details and information regarding the health situation of the person in need, their symptoms and location. Meanwhile, an ambulance will be dispatched to the scene within 60 seconds of receiving the call (2). The call handler will manually input all the information about the person in need, as provided from the perspec-tive of the call maker, into an electronic triage system called NHS Pathways. The triage system, based on the information inserted, will identify a suitable relevant care service (pathway) appropriate to the symptom(s). If the triage system selects a pathway where an ambulance crew is no longer necessary, the crew will be notified via the system to stand down. This chain of decision-making does not cease here, it continues when a crew is on scene, where they are faced with the task of choos-ing between the different pathways mentioned earlier. The thesis focuses only on that situation where the ambulance crew are on scene and need to make a decision between ‘See and Treat’ or ‘See and Convey’ to ED.
A crew on the ambulance vehicle will accept the dispatch instruction from the dispatch centre. Immediately after that, they will be able to pin point the location of the incident via the SatNav provided in the ambulance vehicle. Simultaneously, they will be receiving live and updated incident initial information regarding the patient on scene, which the call handler will continue to insert into the system, should this become available from the call maker. While travelling to the incident, the crew have limited information about what will be facing them. In complication-free scenarios, the crew will reach the scene with incident initial information about
the patient and the incident situation to hand, in addition to having electronic access to databases of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines and the National Poisons Information Service database (TOXBASE) di-rectly available to them if needed.
In 2014 in England, 36% of all incidents were managed on scene and the patients involved did not need to be conveyed to ED (Workforce & Facilities Team Health
& Social Care Information Centre (HSCIS), 2014). This proportion has grown to 38.3% in 2016 (NHS England, National Statistics, 2016). While on scene, the crew are usually faced with a complex decision-making situation and a lack of patient health information (patient’s health history). This study will try to fill this gap in patient health information, and supply such information ‘on-demand’ to the on-site crew by electronic means, according to their needs (3), by testing the feasibility of implementing a TBS system that transfers patient information to the crew upon request. Along side this, is an understanding of the other sociotechnical issues surrounding this implementation and most effective use.
Going back to Figure 1.1, the left hand side of the dotted red line is the current process that is employed in NEAS. Usually, the ambulance crew will, at point (2) on the figure, make a decision either to ‘See and Treat’, ‘See and Convey Elsewhere’
or ‘See and Convey’ to ED based on the current health situation gained about the patient in the incident. The right hand side of the dotted red line is what the thesis is seeking to describe, involving the provision of a TBS in addition to existing systems, in order to support the ambulance crew on scene with ‘on-demand’ health information.
In summary, the ambulance crew who work for NEAS, while on scene, will be able to electronically request additional health information about a patient who has epilepsy from the PWE database at James Cook University Hospital (JCUH) database. Therefore, this thesis will describe the investigation of the provision of
‘on-demand’ health information to an ambulance crew while on scene, and how this information transfer may assist a crew’s decision-making in treating patients locally rather than conveying them to the ED unnecessarily. Doing so involves designing and
evaluating a prototype TBS information transfer system and using this to identify sociotechnical issues surrounding this electronic information transfer.