Paramedic case study: rapid shared care for dementia patient

Jonathon Will is the Clinical Effectiveness Lead and a Specialist Paramedic & Tayside Mountain Rescue Officer at the Scottish Ambulance Service. He describes how using a prof-to-prof service enabled the best outcome for a dementia patient.

“Utilising multidisciplinary prof-to-prof conversation along with shared decision making, resulted in the police being reassured about their duty of care, it provided more efficient use of NHS resources, and most importantly, we absolutely got the right care for our patient.”

Paramedic case study: rapid shared care for dementia patient

Jonathon Will is the Clinical Effectiveness Lead, and a Specialist Paramedic & Tayside Mountain Rescue Officer at the Scottish Ambulance Service.

Like other members of the Scottish Ambulance Service, he has had access to Telephone Advice & Guidance and IG secure safe clinical photography since September 2018. The service allows paramedics and GPs to speak rapidly to local clinicians. In fact, on average calls are connected within 25 seconds.

We asked Jonathon to provide an example of a recent clinical issue that prompted him to use Telephone Advice & Guidance to benefit a patient:

 

“One example of prof-to-prof conversations working incredibly well was a 74-year-old gentleman I attended earlier this year. He had been reported to the police as a ‘wandering dementia patient’, and when they found him, it was clear he was somewhat unstable on his feet; in fact, he already had some minor injuries consistent with a fall.

Despite the patient being somewhat confused, they managed to find out where he lived, and got him home. At home, he was in a place of safety, but the Police were concerned about the likelihood of repeat wandering, and possible subsequent fall. From a duty of care they felt forced to call the Scottish Ambulance Service.

We attended the scene and discovered that the police had managed to contact the patient’s brother who also arrived. Unfortunately, the brother was a poor historian, and was also displaying early signs of cognitive decline; he was also the sole carer for his wife which meant he couldn’t stay and look after his brother – it was a really complex situation.

The brother shared a muddled conversation about the patient having a urinary tract infection and recent hospital admission. The patient really didn’t want to go back to hospital, but also recognised that he wasn’t able to look after himself.

We called the prof-to-prof line and the Senior Clinical Decision Support who informed us that he had indeed been in hospital for two days being treated for acute confusion and a UTI. There were also notes to the effect that the confusion was suspected to be more chronic in nature.

On the advice of the consultant, we then contacted the patient’s own GP for a further prof-to-prof conversation. It turned out that the patient was booked for a five-day residential dementia assessment the following week. Given the history and our observations, the GP completed a remote consultation and prescribed further antibiotics. A prescription was sent to the local pharmacy, and we arranged for this to be collected by the patient’s own care company. The GP also managed to provide details of the assessment centre and the patient’s social worker.

A conversation with the assessment centre highlighted that they could not accept the patient early, but a further conversation with his social worker enabled us to arrange emergency rest bite at a nearby care home to bridge the gap until his assessment.

Although we were on scene for a long time, our overall service time was not increased because we avoided a long convey and hand over at hospital.

The patient had been quite anxious about the prospect of returning to hospital, and so he was very grateful for this alternative plan.

“We avoided an unnecessary ED attendance and a probable hospital admission, we reduced our travel impact, and we collaborated with our Primary Care, Hospital, and Health and Social Care colleagues to provide a very patient centred plan.”

In summary then, utilising multidisciplinary prof-to-prof conversation along with shared decision making, resulted in the police being reassured about their duty of care, it provided a more efficient use of NHS resources, and most importantly, we absolutely got the right care for our patient. It was a great outcome for everybody.”

 

You can also read Jonathon’s guest blog: Why joint decision making is so important for paramedics

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