PATIENT TRANSPORT


care, whether it is home, or the next destination in their care pathway. If they aren’t, the build-up of this backlog means that the next appointments and the ones thereafter cannot take place on time. The patients, clinicians, and other care workers, are then behind schedule, and, should this continue day after day, a health condition that was meant to be treated with scheduled care suddenly becomes an emergency, and adds even more pressure to the emergency service… and so the endless cycle continues.


What do we mean by patient flow? Simply put, ‘patient flow’ is the smooth transfer of patients from a place of residence to a place of care and back, so that they can receive the treatment that is appropriate to their needs. The smooth flow of patients through the healthcare system also means that patients are transported to and from appointments at as close to the expected appointment/ discharge time as possible, which in turn prevents resulting bottlenecks in the system.


Is this just good logistics? NEPTS is often viewed as a simple service solution, akin to last mile courier or public transport. This is not the case, as it has unique challenges, and is more than just ‘good logistics’, the key elements of it including: n The healthcare environment/vulnerable user group.


n A requirement for specialist equipment. n The type, blend, and timing, of journeys.


No two journeys identical This means that no two days and no two patient journeys will ever be identical in nature. Even if the route, vehicle, and patient variables are similar, we cannot accurately predict external factors such as traffic, re-routing, and/or delays in a patient being ready from a place of residence or from the appointment. To add to this, vulnerable patients may require planning for a journey that is often reactive in nature. Critical and agile decision-making without compromising on patient care and service delivery is vital. This also means that there can be a requirement for specialist equipment and training where dedicated resources are essential, and these resources cannot be shared while being deployed, thus limiting the ability to surge when required.


Complex ‘eco systems’


Additionally, healthcare environments are complex ‘eco systems’, and patient transport is not straightforward with social distancing measures in place. Where previously four patients could be transported on one vehicle, that isn’t possible, which means that existing NEPTS resources should have capacity to stretch


ERS Medical says that using its Patient Transport Resource Modelling Tool it can ‘provide evidence to support ongoing and upcoming decision making’ across NHS England and Improvement, CCGs, CSUs, and hospital Trusts.


and flex as needed. Furthermore, if social distancing measures are lifted, any additional capacity that has been created needs to be reallocated to maximise efficiency.


Even if we leave these facts aside for a minute, no two journeys are the same – because NEPTS relates to people, and each patient is different. They are individuals with changing requirements, and that needs to be always remembered. Good patient experience and quality of service are not just about arriving within a short time window. If patients are in a safe, comfortable setting it may also be that the reassurance of knowing exactly when they will be collected has better outcomes than the uncertainty of a ‘we will get there as soon as possible’ approach.


Key factors that need to be considered in planning for non-emergency patients include:


Unknown variables n Patient requirements (unforeseen illness, restroom/food breaks etc).


n Changes to the condition of patients. n Did Not attend (DNA) resulting in aborts/cancelled journeys.


n Hospital delays (appointment delays, discharge paperwork, medication). n Vehicle breakdown.


Known variables n Drop off/delivery time, (within boundaries, KPIs).


n Maximum time on vehicle. n Vehicle capacity/configuration. n Patient requirements (O2 bariatric etc).


, carry chair,


n Road conditions (traffic, geography etc).


n The type, blend, and timing, of journeys is often overlooked, but this is key to NEPTS efficiency and smooth patient flow.


In general terms, the logistics of this nature are split into two types: a) Set routes (think ‘last mile’ parcel logistics, pathology courier) – Pre-planned ‘milk run’-style routes from a central hub to multiple drop- off/ pickups and back to hub.


b) On demand (think taxi or frontline ambulance) –A pool of resource is available to react to demand when requested.


A non-emergency patient transport service is a blend of the above two types: a) 60-90% of journeys are pre-planned up to agreed times the night before the day of the journey.


• Inward – from multiple locations (patients’ homes), to a smaller number of hubs (healthcare locations). • Outward – Hubs to home locations.


b) 10-40% are on-the-day bookings, and are often booked within an hour of the expected pick-up time.


• Most are outward i.e., hub to home.


To highlight this point, there are good logistics systems that will manage, and even automate, either type ‘a’ or type ‘b’, but there isn’t a unified system that manages to blend the two together effectively.


Consequently, NEPTS is about more than just applying clever logistic principles. It needs a human approach that can’t be delivered with a good planning system on its own.


Supporting smooth patient discharge The DHSC’s white paper proposes bringing forward measures to facilitate smooth patient discharge, and putting in place a legal framework for a ‘Discharge to Assess’ model. This will mean that NHS continuing healthcare (CHC), NHS Funded Nursing Care (FNC) assessments, and Care Act assessments, can take place after an individual has been discharged from acute care. The paper states that ‘this will replace the existing legal requirement for all assessments to take place prior to discharge’.


Having a reliable, non-emergency patient transport service will wholly support this measure – but how would this work in everyday practical situations, given the changes brought about by the pandemic? In addition to having highly trained, patient-focused staff, the value that a transport provider can bring is in using real insight to inform decision making. For instance, we use daily on-the-


July 2021 Health Estate Journal 29


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