Kathryn Eastwood Presents on Ambulance Management of Low-Acuity Patients

PhD student, Kathryn Eastwood, recently presented an epidemiological review on the Ambulance Victoria (AV) management of low acuity patients at the European Health Management Association conference in Milan, Italy. Demand for increasingly sophisticated and costly ambulance services grows at near 5% per annum and is expected to increase with an ageing population. For the many low-acuity patients (up to 38% of the caseload), ambulance transport to hospital is not necessarily the most appropriate care. As an alternative, AV has implemented a secondary telephone triage service, called the Referral Service (RS), for selected low-acuity patients who ring 000.

Through this service, nurses or paramedics further assess low acuity patients and provide a range of care pathways resulting in self-care advice, arranging home-based medical assessment and treatment by doctors, nurses or psychiatric services, non-emergency ambulance transport, or returning the patient back to the emergency ambulance system. 

In 2011-2012 the RS handled 14% of the AV workload.  Since 2009-2010 75% of the calls handled by the RS have been diverted away from ambulance dispatch and to more appropriate healthcare professionals, not only reducing workload on the ambulance service, but the receiving emergency departments also.  The service also identified 1% of patients as high acuity, that would otherwise have been left inappropriately as low-acuity.

The RS has proven to be a significant cost saving to AV of over $A160m since its inception, compared to the traditional ambulance transport model. The RS provides a demand management solution via a range of alternative patient care pathways that provide direct access to healthcare, bypassing the expensive and time consuming intermediate step of hospital emergency department assessment. Other benefits include increased emergency ambulance availability to respond to urgent calls and decreasing low-acuity cases entering the emergency department. This was also found to be acceptable to patients seeking assistance.