Individualised ambulance plans for young people with functional neurological disorders

Aim

The overarching goal was to provide patient and family centred care by reducing the impact of the functional neurological disorder and to reduce acute emergency service utilisation.

Outcomes

For the young person and their family there have been numerous benefits including:

• reduced patient anxiety, and therefore events, having an established management plan
• improved earlier integration back to school due to improved school confidence in accepting a young person with functional neurological disorder
• reduced impact on family resources - young person back to school and parents can go to work

For the emergency and hospital services the benefits include:

• more efficient use of the ambulance service as they can take patient directly home
• reduced emergency department usage
• improved patient flow in the hospital
• reduced medicalisation of a mental health disorder

Background

The effects of recurrent pseudo seizures or dissociative (non-responsive) episodes can be debilitating for the young person and their family. Functional neurological disorders, however, are safe and do not require acute medical treatment.

When episodes occur in the community, and the young person cannot be physically moved, the ambulance is generally required to take the young person to emergency to recover from the event. When acute emergency services are already under significant stress and demand, this is an added burden for services. The ambulance may be waiting to be seen (ramping) and then or held up in addressing acute emergency calls. The emergency service is also then required to provide resources for a non-acute issue, impacting their flow. Finally, the patient and family, who already understand the disorder and would like to go home, are impacted with prolonged time waiting for recovery and clearance in the hospital.

Discussion

Once we developed an ambulance plan, we evaluated the number of ambulance calls that were required to take the young person home. These were counted as number of hospital avoidance episodes.

Since this approach has been implemented, we have saved 84 emergency presentations - which represents a significant cost saving to our service.

We also sort qualitative feedback from families and schools.

Families and young people reported increased confidence in going to school knowing a plan was in place. Schools were able to accept students back with functional disorders as there was a medically acceptable plan in place.

Lessons learnt

It was easy to communicate and collaborate with QAS, ensuring high quality patient care. We were surprised at the willingness to change, to meet the need of patients, rather than just sticking to standard practices. The collaboration has improved relationships between the Horizons team, QAS and the emergency department resulting in further efficiency in care.

References

Pope, D., Fernandes, C. M., Bouthillette, F., & Etherington, J. (2000). Frequent users of the emergency department: a program to improve care and reduce visits. Cmaj, 162(7), 1017-1020.c.

Spillane, L. L., Lumb, E. W., Cobaugh, D. J., Wilcox, S. R., Clark, J. S., & Schneider, S. M. (1997). Frequent users of the emergency department: can we intervene?. Academic Emergency Medicine, 4(6), 574-580.