The new Integrated Care Coordination (ICC) Hub is an innovative approach being rolled out nationally.
The service is designed to reduce avoidable ambulance dispatches and conveyances to the emergency department, by supporting 999 and ambulance crews.
The hub offers London Ambulance clinicians on the ground rapid access to remote clinical consultations from a team of experienced clinical decision makers, giving expert advice and guidance to support onward referral.
This page covers the details of the service:
Testing the concept:
Over a two-month period during the pilot phase, the ICC Hub supported over 1700 patients, positively impacting ambulance clinician decision making, to enable 195 patients (that previously would have been conveyed to an emergency department) to be managed through advice and guidance or onward referral to the most appropriate service for them.
Aims and objectives of the ICC Hub
A single hub operating across NWL to co-ordinate urgent and emergency care, driven by the patient’s condition, whereby the hub identifies the most appropriate service to meet the patient’s need, sharing information and clinical responsibility across professional and service boundaries.
Simplifies access to services by offering clinicians rapid access to a remote clinical consultation from an MDT of senior clinical decision makers, delivering expert advice and guidance to support onward referral
A partnership between community, ambulance, primary care, acute services and social care that brings together a multidisciplinary team supported by a Single Point of Access approach
Aims:
- Improved patient experience and equity of access - reduce touchpoints for patients, right service first time
- Optimise community and out of hospital pathways and in-hospital pathways
- Reduced ambulance conveyance to acute hospitals - reducing admissions, reducing handover delays, supporting ED flow and reducing pressure on A&E waiting times
- Reducing ambulance dispatch, improving ambulance capacity to meet ambulance response times, in particular Category 2
- Supporting community and primary care services to manage the escalation of patients with urgent and complex needs including, complex frail elderly patients and high intensity users.
- Operating hours:
- 7 days a week, 12 hours a day
- the Hub will run from 8am - 8pm
- Base:
- Pinner ambulance station
- Workforce:
- two senior clinical decision makers – consultants and GPs
- advanced paramedic in urgent care
- clinical support manager – paramedic
- care coordinator
- ICC Hub clinical operational manager
- Intervention:
- identifying patients pre-ambulance dispatch or pre conveyance, adopting an MDT approach to remote and virtual consultation. Case closed or onward referral
- case management of patients and support of the management of UEC demand, capacity and flow across NW London.
- Criteria:
Exclusion criteria are as follows:
- children <1 years of age or aged 1- 5yrs with red flag criteria or red/amber risk factors from NICE paediatric traffic light guidance. (APPUC to follow own guidance)
- patients requiring a pre-alert to ED and acute specialist pathways (except care home (nursing / residential residents)
- patients under police or prison service custody, and those detained under the Mental Health Act
- pregnant or suspected pregnant over 20 weeks gestation (follow current JRCALC + guideline).
- Clinical responsibility:
- transfers to the ICC Hub who maintain clinical responsibility for the patient
- Pathways into the ICC HUbs:
- 999 Crews on scene referring patients into the ICC Hub
- clinical safety managers and senior clinical decision makers pulling patients from the 999 ambulance call stack
- clinical advisors in the LAS Clinical Hub referring into ICC
- healthcare professional calls via 999
- care homes via the 111 *6 line or 999
- further pathways will be developed in future
- Pathway outputs from the ICC Hub:
- case closed and no onward referral, clinical advice and signposting
- onward referral to community, mental Health or in hospital pathways
- ambulance or specialist resource dispatch, including alternative transport options
- advice to attend an ED or UTC either though make own way or conveyance in ambulance
- referral to the right specialty teams for admission or urgent outpatient review
- referral to hospital discharge teams
- case management by the ICC Hub
- continual development and expansion of pathways.
London Ambulance Service hosts the North West London ICC Hub but it is a system wide initiative, delivered collaboratively with system partners.