Admission avoidance

Admission avoidance in Dorset

Amy Hassan was seconded to Dorset Health Care in January 2020 to project lead Integrated Conveyance Avoidance Scheme (ICAS), an innovative approach, looking at therapist and paramedics working together to reduce conveyances to emergency department (ED) and to provide the right care, in the right place and that right time. Key to the project was to develop a holistic centred approach to patient care with a view to scale up the service, pan Dorset wide.

Due to the onset of Covid-19, the project was put on hold, due to the unpredictability of the pressures on South West Ambulance Service and therapy teams. However, Amy was able to run a 5 day service over 10 weeks from April 2020 to trial an alternative concept for East Dorset locality.
Amy took this opportunity to look at an alternative way of providing the planned service and enlisted support from a consultant nurse currently working in primary care but who had a background in acute intensive care setting. Amy managed to get support from integrated urgent care service from Dorset and were offered use of one of their urgent response cars and filled it with basic therapy equipment, medication, medical equipment and raizer chair to assist patients off floor.
Amy and her team effectively utilised the 111 CAS (clinical assessment service) and SPoA (Single Point of Access), making direct links with the paramedics who could call her and her team for advice or request joint visit. This enable shared practice and learning and support to the paramedics in clinical decision making but also to enable them to leave the scene earlier to respond to other calls.

They worked closely with the 111/SPoA clinicians to refer patients to the service but also proactively screened throughout the day to pull off the triage list. This also identified a future need to have direct access to 999 lists to support reducing ED conveyances and offering an alternative pathway.

Over 10 weeks the service achieved 95.7% non-conveyance to ED. 85% of the cases seen were due to falls, but often presenting with very complex acute medical issues or complex therapy social issues. Out of those falls cases 80 % of those avoided a conveyance to ED. A wide range of patients were seen including patients presenting with COPD, SOB, Chest pain, HF, Falls Dementia.

Patients received a holistic assessment looking at the social, psychological and physical needs of the individual, with direct access to medication, access to care, community therapy, provision of equipment to enable the person to remain in their own homes.
Since then the service has now been commissioned by Christchurch Primary Care Network, providing a urgent response service to patients with in the Christchurch locality. Direct links with Christchurch ambulance station, GP practices, Community teams, voluntary services and care homes have been made to provide integrated timely, holistic care to patients. We have our own urgent response car as well with the same therapy and medical equipment used in the pilot.


“I was so fortunate to be given the opportunity by Dorset Health Care to pilot an urgent response service during Covid-19 and prove the concept of a holistic approach to patient centred care to reduce number of conveyances to ED. It has been so well received by everyone and really proved how to fully integrate across all the different services to provide the right care. I am really lucky to now continue this work as an OT/Clinical manager for Christchurch Primary Care Network”