000Referral Service Presentation Secondary triage Ambulance Victoria 24 October, 2012

Referral Service Overview Established 2003, demand management strategy ensures appropriate alternate response,service or advice when ambulance dispatch is not warranted. Qualified Health professionals [RN, paramedics] 24 hour service, two technology platforms [CAD & CECC] 43 alternate pathway services Managed 271, calls [2003 to October 2012]

Auditor Generals Report Identified Ambulance Demand Strategy [ page 36 ] Capacity to influence demand for services Cases unlikely to require ambulance Refcom is a sound demand management strategy 8% of all 000 calls emergency caseload for year were referred to other health services OR Received telephone advice Service is expanding across the state

Referral Service Stakeholders All metropolitan Health Networks CAT, Spectrum, MACNI, individual Psychiatrists/psychologists Chief Psychiatrist, Chief Medical Officer and Coroner Royal Childrens Hospital & ACE Nursing & Locum Services Aged Care: ACC, leading Aged Services, VCAT [patient dementia] Federal, State agencies & regulatory authorities Divisions of GP, individual General Practitioners, AMA Shopping Centres, Schools and Universities, airports Palliative Care Victoria Justice system: Victoria Police,Thomas Embling, Bail Services Drug and Alcohol Services (Direct Line/health link) Community Care, Catholic Homes, child protection

How it works 000 to triage? 000 caller Telstra requests service required ESTA questions caller compliant with MPD PQA questioning Priority dispatch allocation actioned - technology system Low acuity fit – transferred to AV Referral Service triage Receive caller from ESTA Identifies professional status to caller Confirms details, who is the patient Obtains symptoms [at that time] Selects guideline match & acuity Rules out cardiac, stroke & specific worst case scenario test immediately Poses questions & additional clinical questions Reaches disposition [health outcome] Confirms with patient health management required Actions in real time health management referral

RS Determinants RS monitors MPDS events for triage suitability Key is high cancellation rate Transport no treatment outcome Fits given skill set of service provider/s Gap analysis – 24 alternate referral management capability Locate services, match their process to secondary triage Broker same interest relationship Grid review – systematic & mathematical process of event assessment Considerations – risk mitigation Confirm low acuity - triage suitability Detailed briefing to AV medical standards committee Endorsement for secondary triage Technology alignment to direct event [000 caller] to RS triage Monitoring program - outcomes

000 RS triage specialist Does this need pre hospital emergency care? Its low acuity but needs to attend ED? Is this a same day non acute health crisis management need? Is this a community service need? I will refer but firstly discuss the health crisis management with the 000 caller. Is it safe for the provider? Dispatch emergency ambulance Pathology, emergency diagnosis, or delayed specialist medical need Locum or nurse assessment, CATT Alternate ASP or GP Rational for the decision Provider is matched to their need CAD/LOI risk check Environment evaluated Persons expectation CECC Disposition

1. Triage 2. Add Keywords 3. Select Guideline

Alternate Pathway Provider its a 000 ambulance caller Will they need care beyond your skill set/ability? What are they expecting of ME Is this safe? I find an emergency? screened for an emergency state by 2 international systems [MPDS & CECC] Completed 20 minutes verbal questioning [ESTA (5), RS (15)] Referral triage confirmed low acuity disposition [see HP 4 hrs or greater] only patients referred that are within your registered capability Face to face assessment, diagnosis & management LOI system check RS question on environment [access & pets], acceptance & advise on expectation Ring 000 follow prompts. There have been no occurrences for provider services to date.

Expectations - patient Same day contact & managed outcome They believe an emergency – RS confirms a health crisis At time of referral to a provider the patient is: given care advice while awaiting provider consult advised to contact 000 – if a deterioration expect telephone contact within 1 hour [if no warm transfer] health professional attends their home within 4 hours patient assessment conducted & advice or care administered [compliant with providers business rules] redirection [continue self care, see GP/HP/other referral] treatment within scope of practice [registration]

Expectations – Referral Service Same day contact [365 days] telephone contact in 1 hr [ ensure status unchanged] Face to face patient home consult & assessment [within professional scope of practice] Provide rational for findings to reinforce positive behaviour [e.g. taking pain medication, progressing to next phase of care] redirection [other community services or within hospital system] treatment within scope of practice [medical authorising regime] Maintain patient continuum of care

Point of Difference Nurse on call, GP line Medibank health solutions Fee service telephone provider Same technology CECCv5 Registered nurses Conducts call back [patient administer medication – checks effect] Applies verbatim guideline questions Reaches disposition Provides advice Patient assumed to comply with disposition 000 Referral Service Ambulance Victoria Not publicised & no fee Same technology CECCv4 Registered nurses & paramedics Applies guideline questions & additional clinical questioning Guidelines customised/developed for emergency states Reaches disposition, actions patient management [including referral]. Monitors patient outcome & care Frequent caller management [256 professionally consulted care plans] Contracts, business operations documentation provider agreements Active partner on strategic development programs Escalation management –communication link with patient during high demand periods