The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions (SPRAINED) study: a controlled interrupted time series analysis

Abstract

AbstractIntroductionNHS ambulance service conveyance rates in the UK are almost 70%, despite an increase in non-emergency cases. This is increasing the demands on crowded emergency departments (ED) and contributes to increased ambulance turnaround times. Yorkshire Ambulance Service introduced a specialist paramedic (SP) role to try and address this, but non-conveyance rates in this group have not been as high as expected.MethodsWe conducted a controlled interrupted time series analysis using data from incidents between June 2017 and December 2019, to study appropriate non-conveyance rates before and after a GP placement. A costing analysis examined the average cost per appropriate non-conveyance achieved for patients receiving care from intervention group SPs pre- and post-placement was also conducted.Results7349 incidents attended by intervention group SPs were eligible for inclusion. Following removal of cases with missing data, 5537/7349 (75.3%) cases remained. Post-placement, the intervention group demonstrated an increase in appropriate non-conveyance rate of 35.0% (95%CI 23.8–46.2%, p<0.001), and a reduction in the trend of appropriate non-conveyance of −1.2% (95%CI −2.8–0.5%, p=0.156), relative to the control group.Post-placement, the cost per appropriate non-conveyance for intervention group SPs was a mean of £509.38 (95% bootstrapped CI £455.32–£564.59) versus £1258.04 (95% bootstrapped CI £1232.64–£1284.04) for the same group in the pre-placement phase. This represents a mean saving of £748.66 per appropriate non-conveyance (95% bootstrapped CI £719.45–£777.32) and a cost-effectiveness ratio of £2141.15 per percentage increase in appropriate non-conveyance (95% bootstrapped CI £2057.62–£2223.12).ConclusionIn this single UK NHS ambulance service study, we found a clinically important and statistically significant increase in appropriate non-conveyance rates by specialist paramedics who had completed a 10-week GP placement. This improvement persisted for the 12-month period following the placement and demonstrated cost savings compared to usual care.What this study addsWhat is known about this subjectUK ambulance service conveyance rates are almost 70% despite an increase in the number of non-emergency casesHealth Education England funded a pilot in 2018 to rotate paramedics into a range of health settings to improve patient care and relieve pressures on primary care services.What this study addsClinically important and statistically significant increases in appropriate non-conveyance rates can be achieved by specialist paramedics who complete a 10-week primary care placement.This improvement is sustained for at least 12-months following the placement cost-effective.