Welsh Ambulance Service NHS Trust
NHS / Health Body
Action Planned
The Welsh Ambulance Service is reviewing and changing its Emergency Medical Dispatcher call script to ensure callers are appropriately advised on when to call back. A support role for dispatch will be created to undertake welfare calls and technology is being explored to ensure provision of welfare calls to patients waiting in the community. (AI summary)
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Dear Ms Morgan
Re: Mr Brian James
I am writing in response to the Prevention of Future Deaths Report issued to this Trust on 7 February 2024, following the Inquest.
The matters of concern that you have asked the Trust to consider are:-
1. A script used by Operators within WAST as part of the Clinical Safety Plan inform callers not to call back for an estimated time of arrival of the ambulance. They are told to only call back if there is a deterioration in the patient’s condition.
The current Emergency Medical Dispatcher call script within the Clinical Safety Plan (in escalation) informs the patient/caller not to call back to check the estimated arrival time of the ambulance. Prior to this and as part of Medical Priority Dispatch System, a first party caller (a patient caller) is informed ‘If anything changes, call us back immediately for further instructions’ and a second party caller (not a patient caller) is instructed ‘if s/he gets worse in any way, call us back immediately for further instructions.
2
The Clinical Safety Plan is currently being reviewed. As part of this review, the Emergency Medical Dispatcher call script in escalation is being changed and the instruction not to call back to check the estimated arrival time of the ambulance is being removed. Instead, the caller will be reminded to call back if anything changes/they get worse. The review is currently in progress and the document needs to go through the relevant governance for internal approvals.
2. During periods of a delayed response from an ambulance, WAST best practice is for an Operator to maintain regular contact with callers to assess any change in their condition. During periods of excessive demand, it is considered that this is not always achievable, and therefore Welfare calls are prioritised to callers considered vulnerable.
The Managing Delayed Response Standard Operating Procedure sets out a process to undertake welfare calls for those patients who are waiting a prolonged time for a response due to high demand. It is identified that it is best practice to maintain regular contact with patients who are experiencing a protracted response, but it is recognised that there may be limited capacity to undertake welfare calls due to high demand. Call takers’ priority is to take incoming emergency calls to identify patients who are sickest to ensure an appropriate response. Where capacity issues mean that a welfare call cannot be undertaken, this is documented within the incident. Callers are instructed to call back if anything changes/they get worse as covered in the above point.
Emergency Medical Service Coordination is currently in the process of undergoing a restructure which will include a support role for dispatch. Whilst job descriptions, roles and responsibilities are yet to be confirmed, undertaking welfare calls will form part of the day-to-day responsibilities of this role. Additionally, the Trust is exploring new ways using technology to ensure the provision of welfare calls to patients waiting in the community and is liaising with other UK ambulance trusts to understand if there are any different processes in place which would be suitable for this Trust’s development and use.
3. There may be a risk that callers do not understand the instruction to only call back if there is a deterioration, and/or may not recognise a deterioration, and feel they cannot call WAST again. There is a further risk that unless regular welfare calls are made during periods of delayed response, there is a missed opportunity to properly re-assess and re- grade the response to a call by WAST.
Please see the responses above
I hope that the above responses fully address the concerns that you have raised, please do not hesitate to contact me should you require any further clarity.
3 May I also take this opportunity to again offer my sincere condolences to Mr James’s family on their sad loss.
Re: Mr Brian James
I am writing in response to the Prevention of Future Deaths Report issued to this Trust on 7 February 2024, following the Inquest.
The matters of concern that you have asked the Trust to consider are:-
1. A script used by Operators within WAST as part of the Clinical Safety Plan inform callers not to call back for an estimated time of arrival of the ambulance. They are told to only call back if there is a deterioration in the patient’s condition.
The current Emergency Medical Dispatcher call script within the Clinical Safety Plan (in escalation) informs the patient/caller not to call back to check the estimated arrival time of the ambulance. Prior to this and as part of Medical Priority Dispatch System, a first party caller (a patient caller) is informed ‘If anything changes, call us back immediately for further instructions’ and a second party caller (not a patient caller) is instructed ‘if s/he gets worse in any way, call us back immediately for further instructions.
2
The Clinical Safety Plan is currently being reviewed. As part of this review, the Emergency Medical Dispatcher call script in escalation is being changed and the instruction not to call back to check the estimated arrival time of the ambulance is being removed. Instead, the caller will be reminded to call back if anything changes/they get worse. The review is currently in progress and the document needs to go through the relevant governance for internal approvals.
2. During periods of a delayed response from an ambulance, WAST best practice is for an Operator to maintain regular contact with callers to assess any change in their condition. During periods of excessive demand, it is considered that this is not always achievable, and therefore Welfare calls are prioritised to callers considered vulnerable.
The Managing Delayed Response Standard Operating Procedure sets out a process to undertake welfare calls for those patients who are waiting a prolonged time for a response due to high demand. It is identified that it is best practice to maintain regular contact with patients who are experiencing a protracted response, but it is recognised that there may be limited capacity to undertake welfare calls due to high demand. Call takers’ priority is to take incoming emergency calls to identify patients who are sickest to ensure an appropriate response. Where capacity issues mean that a welfare call cannot be undertaken, this is documented within the incident. Callers are instructed to call back if anything changes/they get worse as covered in the above point.
Emergency Medical Service Coordination is currently in the process of undergoing a restructure which will include a support role for dispatch. Whilst job descriptions, roles and responsibilities are yet to be confirmed, undertaking welfare calls will form part of the day-to-day responsibilities of this role. Additionally, the Trust is exploring new ways using technology to ensure the provision of welfare calls to patients waiting in the community and is liaising with other UK ambulance trusts to understand if there are any different processes in place which would be suitable for this Trust’s development and use.
3. There may be a risk that callers do not understand the instruction to only call back if there is a deterioration, and/or may not recognise a deterioration, and feel they cannot call WAST again. There is a further risk that unless regular welfare calls are made during periods of delayed response, there is a missed opportunity to properly re-assess and re- grade the response to a call by WAST.
Please see the responses above
I hope that the above responses fully address the concerns that you have raised, please do not hesitate to contact me should you require any further clarity.
3 May I also take this opportunity to again offer my sincere condolences to Mr James’s family on their sad loss.