Evaluation of the emergency medical retrieval service - Scottish ...

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• Section 6 outlines the option development and short-listing process • Section 7 is our cost and value for money assessment • Section 8 is our risk assessment • Section 9 presents our final conclusions and recommendations. 2.10 Due to the length and complexity of the report, box summaries are presented at the start of each section, which outlines the work in a particular section and its key findings. 10
3 BACKGROUND TO EMRS • EMRS is designed to improve care and survival of acutely ill and injured patients in remote and rural Scotland. • The Service was set-up as a voluntary service covering Argyll & Bute in 2004 and has been run as a pilot, covering the West of Scotland, since June 2008. • The Service is consultant led and delivered, and focuses on ‘secondary retrievals’, i.e. retrieving patients from a referring rural medical facility to a place of definitive care. 3.1 This section sets EMRS in context. More details on the Service’s development are provided in Section 3 after the discussion of other models in the literature review. 3.2 EMRS is a consultant led, consultant delivered, air retrieval service that aims to improve the care and survival of seriously ill and injured patients in remote and rural areas of Scotland. 3.3 The EMRS Team provides an advisory service if requested by the local medical professional, assessing the appropriate care model and need for subsequent transfer or retrieval. If required, the EMRS Team then undertakes retrieval of these patients from rural facilities to urban centres with definitive care capabilities. This represents a ‘secondary retrieval’ accompanied by an EMRS consultant. 3.4 The key milestones in the development of the Service are provided below. • Oct 2004 – EMRS set up by a group of clinicians as a service in Argyll & Bute Health Board collaboratively with SAS. • Oct 2004 to Sept 2005 – Initial pre-pilot in the Argyll & Bute Health Board Area. • 2005 – Delivering for Health identified the need to develop safe and sustainable health services for remote and rural Scotland, and to review and, if necessary, enhance EMRS. The then Scottish Executive established the Remote and Rural Steering Group (RRSG) to produce a report on sustainable remote and rural health services. • 2007 - The final report of the RRSG Delivering for Remote and Rural Healthcare, identified the need for patients with a health emergency or crisis to have access to the appropriate response, i.e. the appropriate form of emergency care as quickly as possible. The EMRS sub-group of the RRSG review reached the following conclusions. o NHS Scotland should establish an EMRS to support the care of seriously ill and injured people in remote and rural Scotland. 11
Page 1 and 2: Health and Community Care Evaluatio
Page 3 and 4: This report is available on the Sco
Page 5 and 6: Value for Money Assessment 103 Conc
Page 7 and 8: 1 EXECUTIVE SUMMARY Introduction 1.
Page 9 and 10: 1.14 Patients are referred from acr
Page 11 and 12: 1.33 We assumed the following numbe
Page 13 and 14: 1.46 This leaves us with the remain
Page 15: 2.6 There were three core elements
Page 19 and 20: • Consultant led retrieval allows
Page 21 and 22: Figure 3.1 Map of EMRS coverage and
Page 23 and 24: A note on primary retrievals 3.14 D
Page 25 and 26: 4 LITERATURE REVIEW • Air-based e
Page 27 and 28: The Red Cross Flying Doctors Servic
Page 29 and 30: Retrieval times 4.21 The Associatio
Page 31 and 32: setting and study design. Again, th
Page 33 and 34: difficult to prove this from existi
Page 35 and 36: cover (of both ambulance resources
Page 37 and 38: hospitals keen to provide the servi
Page 39 and 40: • Improved training and empowerme
Page 41 and 42: • Deliver a strategy for sustaina
Page 43 and 44: 5 PERFORMANCE OF THE WEST OF SCOTLA
Page 45 and 46: Figure 5.1 Summary of total mission
Page 47 and 48: 5.13 Figure 5.4 shows the location
Page 49 and 50: Figure 5.6 Location of referrals So
Page 51 and 52: Figure 5.9 Final destinations for E
Page 53 and 54: Table 5.2 Average (median) retrieva
Page 55 and 56: Figure 5.12 Clinical indication for
Page 57 and 58: • ISS score - The Injury Severity
Page 59 and 60: • SAPS II - 156 patients were giv
Page 61 and 62: Qualitative assessment 5.49 This se
Page 63 and 64: 5.56 However, a number of patient r
Page 65 and 66: “Without EMRS, we would struggle
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5.75 This view was supported by one
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5.87 Generally, there was support f
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• The literature review highlight
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Table 5.8 QALYs under Estimate 1 As
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epresenting an improvement in EMRS
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always err on the side of caution.
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6.4 The demand estimates presented
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• High estimate - 345 cases per a
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day time admission is at their plac
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7 OPTIONS DEVELOPMENT AND SHORT LIS
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Option / option Overview Key driver
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7.6 This exercise provided us with
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Table 7.5 Guidance notes for scorin
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Table 7.6 Scoring of the options Cr
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• Option 2 - revert back to Argyl
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8 COST AND VALUE FOR MONEY ASSESSME
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8.10 For Option B, therefore, the s
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Staff costs 8.17 The following assu
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staff rota. To err on the side of c
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Aircraft 8.28 It was clear during t
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• In addition, it has been estima
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Value for Money Assessment Cost per
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8.49 The final column of this table
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8.59 Option C, regardless of which
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Table 9.1 Risk matrix of key risks
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Table 9.2 Health boards involved in
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10 ADDITIONAL DATA 10.1 Since the e
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10.11 This model is not sufficientl
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Appraisal audited afterwards, perha
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covering other rural parts of Scotl
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K S Berns, DG Hankins and S P Zietl
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Appendix B - Secondary Retrieval Li
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Author Title Journal (if applicable
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Other EMRS Literature Author Title
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Page 137 and 138:
Author Title Patients Journal (if a
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Page 141 and 142:
Page 143 and 144:
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Appendix C - Risk Matrices Option A
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that a number of transfers were avo
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Increase in additional air transfer
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Table C.3 Risk matrix for Option C
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EMRS may lead to less ICU admission
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Increase in case workload Simultane
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Table C.5 Risk matrix for Option E
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Adverse weather May prevent SAS air
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RRIG Membership (as of 16 December
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APPENDIX E - GLOSSARY Acronym Full
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ISSN 0950 2254 ISBN 978 0 7559 7841
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