LAS TRANSFERENCIAS DE LOS EMPANELADOS A LOS CUARTOS DE MARÍA LUISA Y DE ISABEL II

Although policies and guidelines are being set by the NHS, yet firm actions and commitment to those are still lacking (Besag, 2004; Epilepsy Action, 2009).

More emphasis should be focused on prevention, patient empowerment, service in-teractions, systems and networks of care; supporting end-line workforce skills, ed-ucation; applying different approaches to health information transfer; expanding

out-of-hospital care; and integrating services around the patient. A large propor-tion of PWE are conveyed to hospital after a seizure unnecessarily, when their need can be managed locally. However, there is little research regarding alternative care pathways or criteria that could assist the ambulance crew to avoid conveyance to hospital. Further, more studies are needed to improve care for such group after a seizure (Osborne et al., 2015).

Alternative pathways and channels of access of support, for PWE should be improved in the community to alleviate the unnecessary usage of the ambulance services and ED in hospitals (Dixon et al., 2015). More attention should be paid to intra-organizational communication and collaboration in regards to services pro-vided to PEW, as available collaborations are poor among services and healthcare providers. Clear guidelines for PWE should be targeted in clinical pathways to be followed by crew on scene (Gray and Wardrope,2007).

PWE widely lack structured care and poor self-management of their condition.

They also lack follow up and adequate review (Jones, 1980; Minshall and Smith, 2006), and there is a lack of intra- and inter-communication between healthcare services and clinical staff (Elwyn et al.,2003;Minshall and Smith,2008;The Clinical Standards Advisory Group,2000). PWE lack information about which health service provider to contact for follow up, for urgent help, for guidance and/or support.

There is a need for a patient-centric approach to be applied to the whole system where clinical staff can collaborate and communicate around the patient’s health.

As noted above, some PWE/carers will call the ambulance service unnecessary even when experiencing their normal pattern of seizures. This results is an ambulance being dispatched to an non-urgent incident, only because they share the same symp-toms with life threatening conditions. Therefore the ambulance crew will convey them to ED unnecessarily adding more financial and resource expenditure on the ambulance service.

A study conducted by Stiell et al.(2003) supports the argument about the lack of information (information gaps) for those who are conveyed to the ED. One-third

of visits to ED were identified as having information gaps, 34% of those presented to the ED with information gaps were brought by an ambulance. The most common types of gaps identified were medical history accounting for 57.9%, then laboratory information which was 23.3%. People with serious chronic conditions, who arrived by ambulance, the elderly, and those who have been recently hospitalized or visited the ED, were more likely than others to have information gaps. Alleviating a little of this problem could be achieved by supporting the ambulance crew, who lack patients information and find themselves with no choice but to convey to ED, with patients health information provision (i.e. filling the information gap) on scene in order to reduce unnecessary conveyance to ED. As providing information does not just benefit the ambulance crew, but also may offer potential benefit ED staff as well.

Finally, it is important to note that there has been another analysis that was performed while doing this main one, regarding the handover process between the ambulance crew and ED staff. This will be discussed in more detail in the Chapter 9.

2.6 Summary

To sum up, ambulance services are faced with an increasing demand by the public; with an average annual increase rate of 5.2% (National Audit Office (NAO), 2017). This inflicts difficulty and resourcing challenges on them, especially when funding does not keep up with the imposed rising demand. Ambulance services need to identify barriers in the use of Health Information Systems (HIS), Health Information Technology (HIT) and related fields in the sociotechnical aspects etc.;

and try to resolve and overcome those impediments to increase benefits and save resources, including designing collaborative systems based on Computer-Supported Cooperative Work (CSCW) in healthcare (Fitzpatrick and Ellingsen, 2013).

Therefore, it is important to develop and implement simple HIT solutions in

ambulance services not just to save resources, meet national targets, and support communication and collaboration, but also to meet the requirements of other stake-holders, each with different needs to be met by the ambulance system. For example, one stakeholder, PWE/carers, do not want to be taken to ED unless it is neces-sary. They would rather be treated on site, then released with minimum disruption to their lifestyle routine and independence. Ambulance crew, another stakeholder, would like to have more reliable patient information, regarding the PWE, while on scene, in order to support them in their decision-making when selecting the most suitable care pathway, therefore saving financial and time resources by reducing un-necessary conveyance to ED and satisfying the preference of the patient. Of course, the lack of information may incur financial cost and total time lost to the ambulance services. Thus, developing a simple Technology Based Solution, like the Informa-tion Broker (IB), to meet the demands of stakeholders carries potentials benefits, not just to those directly involved, but also reducing financial costs of unnecessary convenience to ED and time lost on scene due to lack of patient information, and consequently, on the three different healthcare system levels (macro, meso, micro).