The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions: a controlled interrupted time series analysis

Abstract Introduction NHS ambulance service conveyance rates in the UK are almost 70%, despite an increase in non-emergency cases. This is increasing the demands on crowded emergency departments (ED) and contributes to increased ambulance turnaround times. Yorkshire Ambulance Service introduced a specialist paramedic (SP) role to try and address this, but non-conveyance rates in this group have not been as high as expected.Methods We conducted a controlled interrupted time series analysis of appropriate non-conveyance rates in the 12 months before and after an SP primary care placement, using matched groups of patients cared for by SPs and control paramedics. A costing analysis examined the average cost per appropriate non-conveyance and the cost-effectiveness ratio between groups.Results Between June 2017 and December 2019 there were 7349 incidents attended by intervention group SPs and eligible for inclusion. Following removal of cases with missing data, 5537/7349 (75.3%) cases remained. Post-placement, the intervention group demonstrated an increase in appropriate non-conveyance rate by 35.0% (95%CI 23.8-46.2%, p<0.001) and a reduction in the trend of appropriate non-conveyance relative to the control group of −1.2% (95%CI −2.8-0.5%, p=0.156).Post-placement, the cost per appropriate non-conveyance for intervention paramedics was a mean of £509.42 (95% bootstrapped CI £485.94-£535.41) versus £1124.41 (95% bootstrapped CI £1041.89-£1218.31) for the control group. This represents a mean saving of £615 per appropriate non-conveyance (95% bootstrapped CI £545.31-£686.69) for SPs compared to the control group, and a cost-effectiveness ratio of £1758.89 per percentage increase in appropriate non-conveyance (95% bootstrapped CI £1477-76-£2133.08).Conclusion In this single UK NHS ambulance service study, we found a clinically important and statistically significant increase in appropriate non-conveyance rates by specialist paramedics who had completed a 10-week GP placement. This improvement persisted for the 12-month period following the placement and demonstrated cost savings compared to usual care..

Medienart:	Preprint

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	bioRxiv.org - (2021) vom: 02. Feb. Zur Gesamtaufnahme - year:2021

Sprache:	Englisch

Beteiligte Personen:	Pilbery, Richard [VerfasserIn] Young, Tracey [VerfasserIn] Hodge, Andrew [VerfasserIn]

Links:	Volltext [kostenfrei]

doi:	10.1101/2020.08.06.20169334

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	XBI018607217