Early Intervention vehicles - EHCH Vanguard



Purpose:	The Early Intervention Vehicles (EiV) provide immediate response, via screened 999 calls, to residents in East and North Hertfordshire with the primary role of providing holistic assessment and a proactive approach to maintaining independent living for the over 65s. Needing an ambulance can be stressful and disorientating for elderly people and the EiV can alleviate this stress and boost wellbeing by helping them stay in their own home whether that is a private house, sheltered accommodation or nursing/care home. The benefits of the service include: 1 Preventing delays in health and social care ü Multidimensional assessments, aiding recovery from ill health or injury ü Promoting independence in the community ü Protecting older people & carers from avoidable harm ü Reducing hospital conveyances and admissions ü Enhancing quality of life and promoting independence for older people and people with long term conditions ü Improving end of life care and care for people with Dementia ü Not limited to care homes. ü Integrated health and social care practice
How it works:	EiV vehicles are dispatched to patents who are: · Over 65 · Suffering a fall, dehydration, malnutrition · Head injury, but still conscious · Dementia/delirium · Acute loss of mobility/function The vehicle does not respond to life threatening conditions or conditions with a pre-defined pathway, such as, strokes, chest complaints, and head injuries with loss of consciousness or respond to drug and alcohol cases. The vehicles are staffed by a paramedic, who is seconded to the service on a 12 week rota from East of England Ambulance Service. They provide a medical assessment and work alongside a colleague (who could be a physio/occupational therapist, social worker or nurse) to deliver treatment, support or referral to enable patients to remain in their own home. The vehicles are packed with medical equipment and mobile occupational and physio therapy equipment to provide immediate support to patients in their own homes. Therefore they cannot transfer patients to hospital. If a transfer to hospital is required an emergency ambulance will be called and the EiV team stays with the patient until it arrives. An initial medical assessment occurs, this can typically take up to an hour or more. The EiV practitioners talk to both the patient and carers to assess if a patient can remain at home with community resources and assistive equipment, including Telecare. Additional care can also be arranged if the patient is eligible under the Care Act. The staff also signpost to other services such as Crossroads, Hertfordshire Action on Disability, the Money Advice Unit, to name a few.
Success so far? i.e. what has been the outcome and impact for residents?	The first EiV went on the road in April, initially working just 9am – 5pm. It is now operational between 7.30am and 6.30pm, 365 days a year, with a second 9-5 vehicle in operation. Referrals so far are resulting in 80% of people staying in their own homes, avoiding a stressful visit to hospital and easing pressure on both ambulance and A&E services. Case study: The family of a 96-year-old lady called an ambulance because she was not eating or drinking properly and they were concerned about her deteriorating state of health. 999 call centre operators despatched the EiV team which, after medical and functional assessments, ascertained that the lady was dehydrated but not in need of hospitalisation. Their main concern was that the family was not coping well with their mother/grandmother’s deteriorating health. The lady herself was accepting of the fact that she was coming towards the end of her life, and wanted to stay in her own home, but it was clear that the family needed support to help her achieve this. The team contacted the lady’s GP and rapid response services who were able to assess her needs and put in place a care package and practical aids to help maintain her hydration and wellbeing. Altogether the team was with the patient for two hours but was able to help her achieve her wishes and ease the burden on her family – a rewarding outcome for everyone.
What has been the financial impact of this innovative idea, compared to before implementation? i.e. is this cost effective?	The service is currently being assessed, but early indications suggest that it has so far saved over £100,000 in hospital admissions. Feedback is also being gathered from patients who have used the service to discover how their health/wellbeing has progressed since the intervention of the EiV teams.
Lessons learnt:	Staff need to understand the EOC (Ambulance control room), so allow them to spend time in their room helps Spend time developing the specification and contract, prior to the vehicle going out on the road. Agree onwards referral process to other services at the start Consider the different working contracts, between Health and Social Care when planning rotas Be flexible with reporting and monitoring and let the data tell the story, don’t assume. Monitor what equipment is being used and not is needed and adapt accordingly. Having a good relationship with your equipment supplier is really important Procuring right vehicle is important and needs to happen from the very start, as this takes time. Skills mix of staff, from OT to a MDT approach Ensuring we have the staff before vehicle is operational. Go live with inter crew referrals
Key contact:	www.enhertsvanguard.uk

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