Dr Fenella Wrigley urges much greater use of patient care plans to help pressured frontline crews make the right decisions when attending 999 calls

Life or death decisions

The scene of an emergency 999 call can be highly pressured and stressful for patients, their families and the clinicians who attend them. Ambulance crews need to provide urgent, emergency or end of life care for patients they will have, almost certainly, never met before. Within minutes, they may be making difficult, life or death decisions.

Crews find it particularly challenging treating patients who have collapsed and may not be breathing, especially when there is no readily accessible end of life plan for patients on such a pathway. This means they do not have information about whether a patient should be resuscitated or not. At that crisis point, families can often be confused, and they may not recall the patient’s wishes.

How London has started to react

In London, the NHS Coordinate My Care clinical service has started to provide the critical information needed to provide the right care for the patient – this is given in the form of a patient care plan which quickly informs the crew about the patient’s wishes.

The electronic plans may include the individual’s preferred place of death or care, helping to ensure they are not taken to busy and stressful hospital environments, when they don’t need to be, particularly when they have a community team ready to support them at home.

Advance insight into the care needed at a patient’s home can help to ensure the ambulance service sends the appropriate resources to provide the right care for the patients and their families.

The electronic plans may include the individual’s preferred place of death or care, helping to ensure they are not taken to busy and stressful hospital environments, when they don’t need to be

Advances in technology, such as personal iPads, will give crews access to more and more patient care plans and clinicians the ability to provide the most dignified care for patients in accordance with their wishes.

But London urgently needs many more plans to have a much bigger impact and improve the quality of care we provide for patients. The previously used system of holding patient records on paper needs to be seen as something in the past.

An urgent call for action

So far only 50,000 CMC plans have been created: this only scratches the surface for London’s 8.6 million population. We need to change the perception of what CMC is for. It has the potential to coordinate care for every single one of us.

CMC was originally set up for end of life plans – and has led to fewer than 19 per cent of patients with a plan spending their final hours in hospital, compared to 47 per cent nationally and this means more planning for patients on end of life pathways.

Anyone with an urgent health need should have a care plan so bespoke care can be provided. It enables ambulance crews, GPs, out of hours services, urgent care centres and emergency departments to know that someone is allergic to a drug or if someone has a respiratory nurse who can come out if they are unwell during the winter.

Anyone with an urgent health need should have a care plan so bespoke care can be provided

For patients with chronic conditions, having a CMC plan in place can give them the confidence to call for help before they become more unwell and end up with an unwanted hospital admission. Without this assurance, they may avoid contacting urgent and emergency care providers for fear of being taken to hospital.

For mental health patients, it provides us with access to their crisis team, so that they don’t get taken to the busy, noisy emergency department – which is not the right environment for somebody suffering a mental health crisis. It is another step to safer and higher quality care for all patients and has the added benefit of efficient paper-free working.

More than alleviating winter pressures

Plans like this give our crews the ability to treat each patient as an individual. Without doubt, access to patient care plans will help to reduce the number of people taken to overcrowded emergency departments; support a dignified death in their preferred end of life place; and ensure referral to the right healthcare team for patients with worsening of chronic conditions who can be supported at home.

As we roll CMC out on handheld devices across the London Ambulance Service, and as we see greater uptake of entering patient care plans onto CMC by clinicians across London, we will undoubtedly see a significant change in benefits for patients, and an important development in helping to reduce pressures on the health system.