Introduction BTS Guidelines recommend that admission avoidance schemes should be available for patients with exacerbations of COPD. The Suffolk COPD Service was established in 2009, operating 365 days/year. One strand of the service aims to avoid inappropriate hospital admission by encouraging GPs to refer to the service rather than sending patients into hospital. However, despite wide publicity hospital admission rates remained high. Review of 24 COPD hospital admissions suggested that 50% would have been suitable for admission avoidance through Suffolk COPD Services. 95% of these patients had been brought in to A&E by ambulance. Feasibility of direct ambulance referral into Suffolk COPD Services was discussed with ambulance personnel.
Method A business case, working protocol and pathway were developed jointly, along with a robust clinical governance system. It was planned that a member of the Suffolk COPD Nursing team would visit the patient within 4 h of referral. Approval was gained from the Local Medical Council and Expert Clinical Steering Group. The system was launched following wide publicity and training of both ambulance and nursing staff.
Results The first successful referral was received 40 min after the launch. In the first year 83 referrals were received, of which only eight were inappropriate and requiring redirection to other services or hospital admission.
Advantages of ambulance referral system:
Reduction in ambulance call cycle time by up to 30 min
Increased ambulance personnel COPD knowledge
Development of patient group directives
Improved team working/collaboration across services
Ability to discharge duty of care to a specialist community service
Increased admission avoidance
People cared for in own home
“Self supported” care encouraged
Conclusion 73% were admissions avoided compared to the 50% which had been predicted. The collaboration was a successful model of service delivery, reducing hospital admissions by the seamless transition of the duty of care from the ambulance service to the Suffolk COPD Services, who supported the patient at home.
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