The Queensland Ambulance Service – Clinical Hub Implementation

Overview

Initiative type

Service Improvement

Status

Deliver

Published

03 March 2022

Summary

In response to the escalating demand for ambulance services, the Queensland Ambulance Service (QAS) has recognised the need for a more agile and responsive approach to community care. Conceptualised as a coordination adjunct, the Clinical Hub offers an adaptive service model that ensures a timely, appropriate, and patient-centred ambulance response by providing secondary triage for a select cohort of patients, optimising resource allocation and improving patient outcomes.

Key dates

Jan 2021 - Feb 2022

Implementation sites

Brisbane

Partnerships

Primary health networks and hospital services (HHS). This is exemplified by the virtual Emergency Department agreement that is ongoing with the Metro North HHS, and arrangements with Residential Aged-Care Facilities outreach services – RADAR, CAREPACT an

Aim

The QAS Clinical Hub pilot was aimed at identifying Triple Zero (000) calls which were suitable for secondary triage and ultimately alternative care models rather than the dispatch of an ambulance.

Outcomes

  • The model of service provided by the clinical hub is highly malleable and is tailored to the identified severity of the patient’s ailment. Unlike the current rather regimental dispatch model, the clinical hub presents a dynamic and adaptive approach to ensuring patients receive correct and appropriate care.
  • As an adjunct of the telephone triage that occurs, clinicians in the hub have capacity to undertake telehealth if consented by the patient. This currently occurs using an encrypted digital solution ‘whisper’ that ensures patient confidentiality. This process allows the clinician to visualise the patient, allowing for a more thorough assessment. Additionally, this assists in building rapport by making the patient interaction more interactive.
  • During the telephone intervention, clinicians may identify symptomology indicative of a serious condition that requires immediate ambulance dispatch. If this occurs, the incident is reclassified and is dispatched under the standard ambulance response model. The clinical hub therefore should be viewed as an imperative safety-net that that adds an additional tier of rigor and evaluation that improves clinical quality and patient safety.

Background

Many incidents attended by Queensland Ambulance Service could have been safely managed through an alternative healthcare pathway.

Methods

Following extensive stakeholder engagement, the Clinical Hub was implemented within the Brisbane Operations Centre, located at Kedron Park. Staffed a multidisciplinary team these personnel initiate scalable healthcare pathways that can be tailored to the patient’s presenting complaint which include:

  • dispatch of an emergency ambulance
  • dispatch of a non-emergency vehicle
  • transport by private means to hospital
  • referral to a local general practitioner
  • admission of the patient into a virtual emergency department
  • provision of self-care advice.

This nuanced approach has been found to positively influence the patient journey through providing a detailed real-time telephone assessment that ensures the allocation of the right care to the right patient. Importantly, this also acts as additional safety-net ensuring high acuity patients which may have been incorrectly triaged during the initial Triple Zero (000) interaction are identified.

Discussion

Retrospective quantitative review. During a 12-month period (1 October 2020 – 30 September 2021), the Clinical Hub reviewed 46,002 Triple Zero (000) incidents. Of these 5,866 (12.7 per cent) were identified to not require the dispatch of an emergency ambulance and could be safely managed through other processes. Assuming the call cycle of an ambulance response is 120 minutes, calculated from the time paramedics arrive on scene to subsequently offloading the patient at hospital, this equates to 23,464 hours of saved time.

Key contact

Alex Thompson

Acting Director Patient Safety and Quality

Queensland Ambulance Service

Email:  QAS.Correspondence@ambulance.qld.gov.au

Last updated: March 2022

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