Devon Air Ambulance celebrates a year of being an independent healthcare provider

It’s been a year since Devon Air Ambulance successfully registered with the Care Quality Commission (CQC) and since then we have been delivering our clinical service as an independent healthcare provider.

The process of becoming ‘clinically independent’ has involved building a new Patient Services team and structure that combines various functions including leadership, research, education and training, clinical governance, patient auditing and a Patient Support service. Whilst most of this work was already being carried out, in one form or another, through the process of becoming an independent healthcare provider, we were able to bring together and shape these elements into an integrated Patient Services team who are now responsible for all the aspects that relate to treating and helping our patients. The Patient Services team now sits alongside the Helicopter Services team within the Devon Air Ambulance Trading Company Limited, the operational arm of our organisation.

All of the continuing hard work and investment involved with being an independent healthcare provider underlines our commitment to achieving the best clinical outcomes for our patients. In this Blog we wanted to explain a bit more about what it means to be clinically independent and illustrate how this has already provided significant benefits to our patients.

What is ‘clinically independent’?

Devon Air Ambulance is now a stand-alone healthcare provider just in the same way a nursing home, private hospital or GP surgeries are. We now directly employ our 23 Critical Care Paramedics and either employ or directly contract our 15 part time Critical care Doctors and we are now wholly accountable for the safety and care of our patients. We are one of only 8 Air Ambulances throughout the UK to have secured this independent status.

The application process to become an independent healthcare provider is, as you would imagine, a rigorous one. It requires an organisation to fully examine and evaluate the efficacy of their service and the key staff that lead their organisation and it must be confident that all aspects will stand up to careful scrutiny by the CQC who are the independent regulator of health and adult social care in England.

Once successfully registered, an independent healthcare provider needs to demonstrate to the CQC that their service never fails to deliver 13 Fundamental Standards in a way which are safe, effective, caring, responsive and well-led. These five ‘key questions’ or Quality Indicators inform the way in which Devon Air Ambulance (DAA) plans, delivers, evaluates and evidences its clinical practice. In effect, by becoming an independent healthcare provider, DAA is now accountable for the care of our patients but also responsible to them to ensure they are treated safely. This includes not only the treatment we provide at the scene, but also reviewing that care, following up on our patient’s outcomes and seeking to learn of and from their experience of our care to them.

Our clinical practice, in our hands, for your benefit

The main driver for DAA becoming clinically independent is that we can develop our service in the way that best meets our patients’ needs. Over the past year some of those new developments, such as our new Patient Support service, provided by our Patient Liaison Clinicians, will be more visible to our patients and their families. Others, like the introduction of LyoPlas (freeze dried plasma) or the clinical governance framework we operate within to safeguard our patients both now and in the future, may be less obvious to those we have treated. These more recent changes to how we now work are all good examples of clinical independence, which is already greatly helping our patients.

Patients benefit from changes in practice

We have established a Research Committee and Research Lead Paramedic who review newly emerging evidence and can enable Devon Air Ambulance to support research being undertaken elsewhere within the healthcare community.

One aspect of newly emerging evidence indicated how an extended package of care could provide our patients who were suffering from significant bleeding (e.g. from a traumatic injury), with a greater chance of survival. This led to us being able to integrate LyoPlas, which is freeze dried plasma that supports the body to form and maintain blood clots at the site of a wound helping to stem the loss of blood.

The arrangements and compliance aspects to carrying and delivering blood products are quite complex. LyoPlas needs to be stored at a Transfusion laboratory at a hospital, then transported to the airbase, all while being kept refrigerated. Once on board a helicopter or critical care car it needs to be kept cold, right up until the moment it about to be administered to a patient, at which point it needs to be warmed up to body temperature.

Alongside the other treatments we can deliver to patients who are who suffering from serious bleeding, the introduction of LyoPlas is helping us to save even more lives. More on our decision to start using LyoPlas can be found here. The introduction of LyoPlas is a great example of how, by being clinically independent, Devon Air Ambulance is now more ‘light-footed’ and able to respond to patient needs quickly. Once we had identified a clear benefit of LyoPlas much of the process could be driven by us, speeding up the timeframe from concept through to application by our clinicians.

As an independent healthcare provider we have been able to work much more collaboratively with other healthcare organisations, such as the Royal Devon & Exeter NHS Foundation Trust who support our LyoPlas provision through their Blood Transfusion Laboratory, Devon Freewheelers whose volunteers transport our LyoPlas to us from the hospital, Northern Devon NHS Trust who support us with pharmacy provision and professional advice and University Hospitals Plymouth who are supporting us with clinical placements for our Critical Care Paramedics so we can learn new skills that will benefit our patients.

Clinical Governance

The term ‘clinical governance’ incorporates all that DAA does to keep our patients safe through the delivery of high quality evidence led care. We continually reflect on our practice and improve the quality of the care we provide and seek to take advantage of new technologies, drugs and interventions that might further improve the chances of our patients having a successful outcome.

One example of DAA’s drive to improve patient care is our Clinical Governance days. These group sessions are a great mechanism to increase joint learning and sharing to improve our practice. Every month the whole team of critical care paramedics and doctors meet to reflect on the care we have given, especially for those patients who have received an enhanced intervention or those who have been involved in a particularly dramatic set of events. Because we work closely with colleagues in South Western Ambulance Service NHS Foundation Trust and the other emergency services, we extend an invitation to staff from these organisations to join us, so when we review the care we provided, we can incorporate the elements that other emergency service personnel were involved in, either before we arrived or as they supported us ready to transport the patient to hospital. Bringing together the multi-disciplinary team who responded to help a patient enables a more holistic learning experience which mean we can all reflect upon and develop our practice to enable to ensure the ‘next’ patient receives the best care possible.

Patient Support service

The support a patient and their family receive in the days, weeks and months after their illness or injury can make a significant difference to their recovery. DAA now offers our Patient Support service and our three Patient Liaison Clinicians are doing a great job helping our patients recover after what might have been a very traumatic event.

Patient Liaison Clinicians (PLCs) can help patients fill in any ‘gaps’ they might have whilst they were receiving care, answer any questions about their incident and the care they received and can sign-post patients to a whole range of other specialist charities and support services who can help patients in their recovery or rehabilitation. The PLCs also play an important role in gathering feedback from patients. The experience of our patients is in turn incorporated into our Clinical Governance processes so that we are all able to understand the care we provided from the patient’s perspective, further helping us to learn and improve the care we provide. care. More info on the Patient Support service our Patient Liaison Clinicians provide can be found in our Spring 2020 Helipad.

It’s safe to say that the term ‘our patients’ resonates across the organisation even more since becoming clinically independent. Our Patient Support service underlines our commitment to our patients’ care and longer-term well-being as we support them through what can be life-changing experience.

If you’d like to get in touch with our Patient Liaison Clinicians, please email [email protected] or call 0800 061 4344.

A snapshot of the past (busy) year as an independent healthcare provider...

The last 12 months of Devon Air Ambulance being ‘clinically independent’ have been one of the busiest on record and we were deployed to 1411 patients. Of those patients, 45% were for medical incidents (e.g. cardiac arrest, strokes) and 55% were for trauma incidents (accidents, RTCs etc.).

The busiest months in this period were June - July, the busiest day of the week was Sunday and busiest time of the day was midday. Over half of the patients we conveyed were taken past the nearest hospital and onto a specialist treatment centre that would offer them the best chance of a successful outcome for their specific condition or injuries.

In April 2019, flying hours were extended to 19 hours a day from our Exeter airbase, meaning our service is available up to 2am every day. By March 2020 we have worked with communities across Devon to establish a network of 144 Community Landing Sites to support operations during the ‘hours of darkness’. In February of this year, we introduced two new Critical Care Cars into the service that will build resilience and extend our critical care capabilities across Devon, when our aircraft are offline.

Heat Map showing 12-months of deployments by Devon Air Ambulance since becoming an independent healthcare provider. (Location dots indicate general area, not exact locations)

Whilst the vast majority of the patients we helped over the past year were from Devon, we are also regularly tasked to assist patients in our neighbouring counties. For example, during this period we were deployed to 81 patients in Cornwall, 113 patients in Somerset and 44 patients in Dorset.

It’s reassuring to know that all of the enhanced skills, training and expertise that Devon Air Ambulance now provides as an independent healthcare provider are being utilised to bring about the greatest benefit to the largest number of people in our region.