The College commends South Australia’s parliamentary review of House of Assembly Petition No 84 of 2021 - SA Ambulance Service Resourcing, and has submitted four system-wide recommendations to address the issues of ramping and access block within the state’s health system.
The petition was referred to the SA’s Legislative Review Committee in December to inquire into, consider and report to Parliament on request to urge the government to take immediate steps to:
The College’s recommendations, which are primarily focused on the second point, span the wider implementation of Community/Extended Care Paramedics, more comprehensive telehealth services, the expansion of the Urgent Care system, and the introduction of a Chief Paramedic Officer to oversee better utilisation of the paramedic workforce within South Australia.
Rather than focusing on ramping as an isolated issue - one that is generally a symptom of in-patient hospital services unable to meet patient demands - the College supports putting in place a range of system-wide interventions to help address this and other health access issues, including the introduction of alternative service delivery models such as Community Paramedicine/Extended Care Paramedics, in which paramedics apply their training and skills in non-traditional community-based environments outside of the usual emergency response/transport model.
Expansion of these models of care could support hospital-avoidance initiatives and potentially reduce costs to the health system associated with emergency department presentations. As such, the College recommends the wider implementation of Community/Extended Care Paramedic practice across South Australia, both as part of, and separate to, the SA Ambulance Service, to play a key role as part of the health workforce in multidisciplinary teams alongside GPs, nurses, and allied health professionals.
The College recommends that Community Paramedics should be utilised:
• In Urgent Care centres
• With GP clinics and health clinics to provide clinic and in-home health care as part of multidisciplinary teams and utilising telehealth
• With aged care, NDIS and home-care service providers
• As part of palliative care teams
• In “Hospital in the Home” programs
• With SA Ambulance to treat and refer low/mid-acuity patients in the community away from EDs
• In rural and country areas to be utilised across the health service, providing the emergency response ambulance service, and supporting volunteer ambulance officers, but also working with the local GPs and health clinics, and country hospitals.
Recommendation 1: Wider implementation of Community/Extended Care Paramedics practice across urgent care, primary care, and aged care, to support quality patient-centred care through organised health care networks.
The College believes that telehealth has a crucial role to play in the delivery of health services in all areas but particularly in rural and remote South Australia. The ongoing shortage of general practitioners, health professionals and other health services, especially in rural and remote areas, is a significant barrier to the health of South Australians resulting in delays to care and unnecessary transport and hospital admissions.
By introducing a comprehensive telehealth service, in addition to the Community Paramedic model, paramedics would be well placed to provide a wider range of health interventions with the assistance of medical specialists located across Australia.
Recommendation 2: Expansion of comprehensive telehealth services to support quality patient-centres care across South Australia.
Urgent Care centres
Urgent Care centres are one viable option to assist in reducing ramping, by diverting low-mid acuity patients away from hospital emergency departments, resulting in ambulances being able to return on-road in a reduced time frame. The College notes that South Australia has a handful of Urgent Care centres currently in operation, and the College supports the utilisation of Urgent Care centres as a system wide solution. The Urgent Care network should be expanded and further integrated and coordinated with emergency departments and ambulance services to ensure patients are guided to the most appropriate mode of care.
The College believes that the focus needs to be on improving the integration between emergency departments, Urgent Care centres and ambulance services, and the wider health system, as well as targeted patient education initiatives so that communities are comfortable in receiving care away from the traditional hospital emergency setting that they may be used to.
Recommendation 3: Extend and expand the Urgent Care system across South Australia by increasing the number and scope of the Priority Care Centres and/or replicating the Central Adelaide Local Health Network Sefton Park model, ensuring full integration in the health system.
Recommendation 4: Introduce the role of Chief Paramedic Officer within the senior health officer roles to engage and better utilise the paramedic workforce.
The role is critical to ensure that difficult problems facing health systems can be addressed with a co-designed, multidisciplinary, interprofessional approach. A Chief Paramedic Officer would enable the South Australian government to have an expert paramedic available to advise how paramedics could contribute to existing health systems through their unique clinical skill set and help to address some of the health workforce challenges seen across the health system, particularly around the metropolitan, rural, remote divide.