PATIENT TRANSPORT POLICY

1.

PHILOSOPHY This policy will ensure that patient transport is of a high quality, enhancing the patients experience. Transport will only be approved for patients who legitimately require it, helping to ensure a reliable, efficient and cost effective service for all patients. In order to achieve this, there must be a strict adherence to the policy as Ambulance Transport should be the exception and not the rule. All staff are responsible for booking ambulance transport correctly. Training and awareness sessions will be given to all staff in order to achieve high compliance. Any Managers who wish any training for their staff should contact Patient Transport Manager on 01274 365427.

1.1

PATIENT TRANSPORT SERVICE (PTS) Patients are brought into outpatient departments at Bradford Teaching Hospitals NHS Foundation Trusts various treatment centres on a daily basis, Monday to Friday by Patient Transport Providers between the core hours of 8.00am and 6.00pm. For the purpose of outpatients the 1st appointment should be no earlier than 9.00am and the last appointment no later than 3pm. Patients who are discharged from Hospital Wards may also require the services of an ambulance to take them home. This service operates between Monday Friday 8.00 am and 6.00pm All elective admissions which require transport are also brought in during these hours.

1.2

EMERGENCY SERVICE The Emergency Service is the deployment of a fully equipped and fully staffed Paramedic Ambulance to the scene of, either a 999 call or any Urgent call from a Medical Practitioner. It is the responsibility of the PCTs to commission the emergency services and this is done on a West Yorkshire wide basis. On occasions it may be deemed necessary for the emergency service to convey an outpatient who requires the attention of a Paramedic crew en route to their appointment.

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POLICY STATEMENT Patient transport will only be available for patients who have a medical condition, which prohibits them from using any other forms of transport. All other methods of patients making their own way to treatment centres must have been examined before patient transport is requested. Patient transport can only be booked by a medical practitioner or their designated representative who has been trained in the booking of such transport and who has the relevant authorisation. A patients eligibility for transport is defined in appendix 1 together with the responsibilities around booking. Patients will only be transported by staff who have the requisite knowledge and skills and have had the specific training in the handling and moving of patients. This is the responsibility of the Patient Transport Provider.

3. 3.1

RESPONSIBILITY Chief Executive Is responsible for ensuring the Policy is implemented.

3.2

Deputy Chief Executive / Chief Nurse Responsible for managing the Patient Transport Service

3.3

General Managers Responsible for ensuring that the policy is implemented, monitored and disseminated within their areas of responsibility. They will work in close liaison with the Patient Service Manager for Patient Transport to resolve issues. Patient Service Managers Ensure the Policy is distributed and implemented in each ward and department. Ensure that any issues are investigated and actioned in liaison with the Patient Service Manager for Patient Transport Identify staff that will authorise and book transport and ensure that they complete the necessary training. Maintain training records of all staff that have undergone Patient Transport Training.

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3.5 3.6

Ward & Departmental ManagersEnsure that all staff are familiar and compliant with the Policy Ensure that any investigations are completed in compliance with the Service Manager for Patient Transport. Identify any training needs and ensure that appropriate staff have access to any relevant training, and complete training records of staff that have undergone the relevant training. Ensure that all staff are made aware of who the appropriate personnel are to contact for implementation All Staff Strictly adhere to the Trust Policy. Undergo any relevant training necessary Ensure that all other methods of the patient making their own way to the treatment centre have been explored regardless of their route of admission before booking any ambulance transport for discharge. Primary Care Trust Responsible for distributing the policy to Practices and for actually engaging with them in terms of implementation. Identifying those staff within the Practices who may require some support and training with regards to the implementation of the policy. Move towards practice based commissioning, and ensure that any issues are investigated and actioned and where appropriate relevant personnel involved. PATIENT TRANSPORT ARRANGEMENTS WITHIN THE ORGANISATION Patient Service Manager for Patient Transport The Patient Service Manager will operationally manage the Patient Transport Service in liaison with other Patient Service Managers and Patient Transport Providers.

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4. 4.1

4.2

Patient Transport Service Manager The Patient Transport Service Manager will provide all relevant information pertaining to activity and finance to the Medical Directors and General Managers for necessary action and will liaise with the Patient Service Managers.

4.3

Patient & Public Involvement Forum The Patient and Public Involvement Forum has been established with internal and external representation to review patient transport arrangements across the Trust. The Forum will meet on a monthly basis.

Terms of reference: 4.4 To monitor patient transport activity on a monthly basis and highlight any inefficiencies To develop action plans around these inefficiencies ensuring a quality service for all patients To raise the profile of patient transport across the Trust paying particular attention to the achievement of correct mobility bookings To develop, monitor and review any protocols / policies / guidelines relevant to patient transport Encourage feedback from patient transport users and take action where appropriate

Contract Monitoring Group The Contract Monitoring Group will be chaired by the Head of Procurement and will meet on a monthly basis. Its functions will be; To discuss agenda items which include monthly monitoring activity and finance reports with the providers To implement action plans produced by the Patient and Public Involvement Forum around inefficiencies To take action on any complaints

5.

MONITORING All patient transport journeys carried by the Patient Transport Service will be monitored on a monthly basis by the Patient Transport Services Manager and monthly figures will be sent to the General Managers, which will demonstrate activity and finance figures. Any deviations from the Service Level Agreement with the Patient Transport Providers will be acted upon immediately.

6.

ESCORTS Escorts will be allowed to travel depending on the severity of the patients medical condition and an assessment which must be completed and signed off by the Consultant of Care or General Practitioner. (Appendix 6). Definitions of this would include: Children under 16 years of age Patients with dementia or suffering from a confused state Patients who have hearing or sight impairments Patients who have a terminal diagnosis

Please note when an escort is requested, family members must be approached first to see if they are capable of taking the patient to and from hospital. Details of all escort journeys will be forwarded to the General Managers by the Service Manager for Patient Transport on a monthly basis for action.

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ABORTIVE JOURNEYS An abortive journey is when an ambulance sets off to collect a previously booked patient and arrives at the house to collect the patient, but for some reason that patient does not travel (See Appendix 5 used for reasons for abortive journeys) Details of all abortive journeys will be forwarded to the General Managers by the Patient Transport Services Manager on a monthly basis for action. Groups to investigate abortive journeys and follow up the reasons and take any appropriate action.

8.

EQUIPMENT HANDLING As there are health and safety risks attached to the conveyance of equipment with patients on board vehicles there is only a limited amount of equipment which can be carried. In the first instance it must be restricted to one piece of equipment to aid the mobility of the patient and one piece of luggage. Arrangements to convey any other items must be made separately. The conveyance of any equipment must be made with the service provider at the time of booking. The failure to do so may result in the refusal to carry any such equipment.

9.

BARIATRIC PATIENTS No patient over 30 stone will be conveyed by the current Patient Transport Service Providers. Alternative arrangements must be made for any patient who exceeds 30 stone. Any Acute patients are to be organised with the A/E Communications Centre. A minimum of 72 hours is required for the booking of any Bariatric Patient but wherever possible 1 weeks notice should be given to enable the Providers to carry out their own risk assessment.

10.

MRSA POSITIVE PATIENTS Patients with a MRSA positive diagnosis that have an open wound which is covered with either a dressing or clothing can be transported by the normal patient transport service crews. Patients with an uncovered leaking wound should be transported by an A&E crew or primary care assistant crew.

11.

TRANSPORTATION OF PATIENTS WITH A CHEST DRAIN Patients with a chest drain in situ should be accompanied by nursing staff and have either a paramedic or medical escort in case they develop a tension pneumothorax.

12.

D.N.R. (DO NOT RESUSCITATE) PATIENTS Any patient with a life expectancy above 24 hour will be conveyed by the Patient Transport Service as they have now received the relevant training in DNR. In Bradford

there are clear procedures set up with the Coroners department and hospices if a DNR Patient should die on board a vehicle. 13. TRANSPORT OF PATIENTS WITH INFUSIONS OR SYRINGE DRIVERS IN SUTU Where a patient has a mini, automated and battery operated, Graseby MS26 or MS16A subcutaneous syringe driver in situ then the booking would normally be handled by PTS without any Nurse escort. Any known unstable patients should be considered for transport by the A&E Ambulance Crews. The syringe driver must not be disconnected or stopped for the journey. Patients with IV pumps or infusion lines running should be transported by A&E Ambulance Crews. If any of these devices are running containing drugs, then a nurse escort must be provided. If an infusion line is running and it contains only IV fluids for which a paramedic is licensed, then a nurse escort is not necessary. If an IV pump or infusion line is disconnected by Medical or Nursing staff prior to transfer, then stable patients can travel with PTS. Any intra-spinal infusions must travel with an A&E crew and there must always be a nurse escort. Nurse escorts will be responsible for making their own way back to the Hospital or Hospice via an authorised taxi should the ambulance be unable to bring them back to their place of work. 14 14.1 FINANCIAL BENEFITS AVAILABLE FOR PATIENTS The Hospital Travel Costs Scheme Under the Hospital Travel Costs Scheme (HTCS) patients can claim back public transport costs. If they have to travel by car or taxi they can claim back petrol costs, parking charges or taxi fares. They automatically qualify for the HTCS if they are claiming: Income Support Income Based Job Seekers Allowance Working Tax Credit or Child Tax Credit (in certain cases) The Guarantee Credit of Pension Credit

They must remember to keep their travel and parking receipts to get a refund they must take these to the relevant office in the hospital, along with proof that they are receiving benefit (for example, their benefit award letter). If necessary, they can claim help before they travel. 14.2 D L A (Disability Living Allowance) & Motability If they are aged 65 or under and have severe mobility problems they may be eligible for the motability component of DLA. Receipt of the allowance can allow them to access the motability scheme where they can use the benefit to buy or rent a car.

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Help with Car Parking Charges Patients whose treatment requires them to make repeated attendance at a clinic / ward will qualify for concessionary parking. Typical areas include Cardiology, Rehabilitation, Dermatology, Haematology and Oncology. The nearest relative or friend of a patient will qualify for concessionary parking after having visited a patient for over 7 days. Typical areas include Intensive Care Unit, Neonatal Unit, The Childrens Unit and the Coronary Care Unit and the Progressive Care Unit Relevant documentation for completion by ward / dept staff can be obtained from the Estates Services Manager, BRI.

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PATIENT TRANSPORT ENQUIRIES Any problem or query relating to patient transport should be directed to Patient Services Manager for Patient Transport on 01274 364406 or Patient Transport Manager on 01274 365427 for assistance.

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TRAINING The Trust will provide Mandatory training for staff who regularly book ambulance transport for patients as part of their job role. Training will include the identification and eligibility of patients and the categories of transport available and how to deal with any issues that may arise. A Flowchart has been produced to demonstrate the steps necessary to achieve the correct type of transport. The following appendices are attached to this report relating to the above: Appendix 1 - Eligibility for Transport Appendix 2 - Categories of Transport available Appendix 3 - Questions to ask patients Appendix 4 - Flowchart for patients requiring transport Appendix 5 - Reasons for Abortive Journeys Appendix 6 - Eligibility form for escorts A Transport Tutorial has been completed on E Learning and is ready for use by all staff. It can be found on the Intranet under Patient Admin on the Trust Web Site.

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POLICY REVIEW

This policy will be reviewed in January 2009. This is the responsibility of the Deputy Chief Executive. Date - January 2007 Claire Bayliss Patient Services Manager Peter Bateman Patient Transport Service Manager 7

APPENDIX 1

ELIGIBILITY FOR TRANSPORT

HIGH DEPENDANCY

Stretcher Cases Patients who require Oxygen on the journey On continuous intravenous support Patient requires specialist handling

ESSENTIAL TRANSPORT

Is medically or mentally unfit to travel by any other means or is frail and blind and requires assistance from another person to walk as a result of their condition, mobility difficulties or treatment.

ESCORTS

Escorts will be allowed to travel depending on the severity of the patients medical condition and an assessment which must be completed and signed off by the Consultant of Care or General Practitioner. (Appendix 5)

G.P.S

The role of the GP is the responsibility for determining the medical need for transport for the 1st inward journey to hospital. All subsequent follow ups must be authorised by the person in charge of the department the patient is attending. i.e. Senior Nurse or Therapist in charge. It should not be possible for the GPs staff to book follow up appointments for transport unless the patient has been referred back to the GP by the clinical department. If the patient does not meet the above criteria then it should be up to them to make their own transport arrangements.

BUS SERVICES Many buses call at the Bradford Royal Infirmary and St Lukes Hospital and both sites are located on First Bradfords Overground network, which means they are served by modern, high quality buses running frequent services every 10 minutes throughout the day. In addition there are a number of other bus services that also run from early until late, seven days a week. Services 617,618,620 and 680 connect BRI to the city centre in 20 minutes and they run to the Hospital every 5 minutes. Services 570,571,640,641,845, and 846 connect St Lukes Hospital from the City Centre every 6 minutes. 8

Internet users are able to visit www.wymetro.com which includes a journey planner and timetables. MetroLine can be contactable on 0113 245 7676 and is open from 7am to 10pm every day and provides up to date travel information and helps you organise your journey. Information is also available in large print or Braille and for people who are hard of hearing there is a Typetalk-friendly text phone on 0113 242 8888. Metro buses now have the new type Kneeler buses which lower the step to ground level making it simple for all people including the disabled to get on and off. CAR PARKING There are parking areas at the Trust Hospitals which are not used and often not known about. At both sites there are several disabled parking areas near to access points at the hospitals. There are short stay areas for 20 minutes which is sufficient time for escorts to take the patient to the relevant clinic. Pay and display areas at both sites are available and rarely oversubscribed particularly the Smith Lane Pay and Display site at BRI. Concessionary charges are available for people regularly attending call back clinics in Cardiology, Rehabilitation, Dermatology, Haematology and Oncology. Concessionary charging arrangements are also available for frequent visitors to the Intensive Care Unit, Neonatal Unit, The Childrens Unit and the Coronary Care Unit. The nurses on the progressive care unit and the wards will be able to tell you if you qualify for any of the concessionary arrangements.

APPENDIX 2

CATEGORIES OF TRANSPORT AVAILABLE

SALOON CAR: (DRIVER ONLY) Available for mobile patients who only require the minimal assistance in walking or transportation. AMBULANCE 1: (DRIVER ONLY) Available for patients who are not able to get in a car but are able to get into an ordinary ambulance or tail lift vehicle with minimal assistance. AMBULANCE 2: (DRIVER & ATTENDANT) Ambulance vehicle with driver and attendant equipped with a carrying chair. This type of vehicle is available for persons who have limited mobility and the require assistance of 2 staff. A carrying chair is available to lift patients out of their homes (over steps) to the ambulance. The attendant stays in the back of the vehicle at all times when any patients are on board. T 1: (DRIVER ONLY) An ambulance with an electronic tail lift or ramp at the rear of the vehicle. This vehicle carries a wheelchair and is available for patients who are unable to walk to the ambulance. The patient is wheeled to the vehicle and lifted on the ramp and, once inside is able to transfer to a seat. Care must be taken that access to and from the house is acceptable for a driver only taking into account any steps. T 2: (DRIVER & ATTENDANT An ambulance with an electronic tail lift or ramp at the rear of the vehicle. This vehicle carries a wheelchair and is available for patients who are unable to walk to the ambulance. The patient is wheeled to the vehicle and lifted on the ramp and, once inside is able to transfer to a seat. The reason for booking an attendant would be for patients who have steps at their home and require 2 personnel to assist them, and for various reasons may require an attendant to sit with them in the rear of the vehicle. CH 1: (DRIVER ONLY) For a child 5 years of age and under who is able to travel in a car. This vehicle carries a child seat or booster cushion to comply with legislation. W 1: (DRIVER ONLY) An ambulance with an electronic tail lift or ramp at the rear of the vehicle. This vehicle carries a wheelchair and is available for patients who are unable to walk to the ambulance. The patient is conveyed to the vehicle by means of either the ambulance wheelchair or the patients own wheelchair and lifted on the ramp and, once inside, the wheelchair is clamped down securely

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with the patient in situ. Care must be taken that access to and from the house is acceptable for a driver only taking into account any steps. W 2: (DRIVER AND ATTENDANT) An ambulance with an electronic tail lift or ramp at the rear of the vehicle. This vehicle carries a wheelchair and is available for patients who are unable to walk to the ambulance. The patient is conveyed to the vehicle by means of either the ambulance wheelchair or the patients own wheelchair and lifted on the ramp and, once inside, the wheelchair is clamped down securely with the patient in situ. The reason for booking an attendant would be for patients who have steps at their home and require 2 personnel to assist them, and for various reasons may require an attendant to sit with them in the rear of the vehicle. STR: (DRIVER & ATTENDANT) An ambulance equipped with a stretcher for any patient who is required to lay down in transit either through medical reasons or the patient has a long leg cast. NB. Patient Transport Services staff will escort all those patients who are particularly frail or vulnerable to the appropriate area and handover their care to appropriate personnel.

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APPENDIX 3

QUESTIONS TO CLARIFY BEFORE DETERMINING THE MODE OF TRANSPORT REQUIRED

You should never ask the patient, relative, carer if ambulance transport is required for their journey to hospital. If the issue of transport does not arise then it should be assumed that the patient can make their own way in and home. If the question of transport does arise then you could refer to the following questions 1. Why do you require an ambulance to take you into hospital? (Answers can vary from its too far, I have to get 2 buses, I cant afford the taxi fare, Ive always had one, its my right, I have paid my stamp, I cant walk). Very rarely will anyone request one genuinely on a medical need. Do you go out anywhere else? Do you go shopping? Do you go out to Bingo? Do you ever go to the pub? Do you ever visit relatives?

2. 3. 4. 5. 6.

The following question to the above could be: 7. How do get there or what mode of transport do you use then?

And finally 8. Cant you use that mode of transport to bring you to hospital?

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FLOWCHART FOR PATIENTS REQUIRING TRANSPORT

APPENDIX 4

Can the patients make their own way in / return home WYMAS BOOKING NUMBER 08451 203189
Assist the patient where necessary to make arrangements and inform them about concessionary parking charges and procedure when relevant to the patients condition

Yes

No

Can the Patient walk unaided

Yes

No

Does the patient need an assistant as well as the driver due to their medical condition?

Can the Patient travel in a car?

Can the Patient travel sat up

Does the Patient need to lie down or have a long leg pot?

Does the Patient travel in their OWN wheelchair

Yes

Yes

No

Yes

Yes

No

Book SC

Yes

Can the Patient climb steps into the Ambulance

Does the Patient require paramedic attention?

Is there more than 1 step at home?

Does the Patient require a WYMAS W/Chair?

Book A2

Yes

No

Yes

No

Yes

No

Yes

No

Can the Patient manage steps at their home?

Can the Patient manage steps at their home?

Book A/E

Book Stret.

Book W2

Book W1

Book T2

Yes

No

Yes

No

Does the patient need an assistant as well as the driver due to their medical condition?

Book A1

Book A2

Book T1

Book T2

Yes
WHERE AN ASSESSMENT HAS TAKEN PLACE AND AN ESCORT HAS BEEN REQUESTED TO TRAVEL THE APPROPRIATE BOOKING FORM SHOULD BE FAXED TO 01274 365755 FOR AUTHORISATION AND BOOKING
Book A2

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APPENDIX 5

REASONS FOR ABORTIVE JOURNEYS CODE NO

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

REASON
No Reply Dep't Closed Patient on Holiday No Appointment Weather Conditions Not Ready Made Own Way In / Home Refused to Travel Too Ill to travel Hospital In Patient Deceased Treatment Finished Wrong Address Cancelled by Hospital Cancelled by Patient Escort Policy Double Booking Incorrect Booking Wrong Mobility

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APPENDIX 6

ALL details on Form to be completed accurately when booking transport which requires an escort

Patient Eligibility Form

Patient Name . Hospital Number .. Address & Postcode Date of Birth Appointment Details: Hospital and Consultant / Clinic to be visited Date of Appointment Time of Appointment Reason escort required (Must meet the criteria - See item 6) PLEASE IDENTIFY WITH X Child under 16 Suffers from Hearing Sight Impairment Dementia or Impairment confused Terminal Cases

Type of transport required PLEASE CIRCLE THE REQUIRED BOX See Appendix 2 for criteria identification S.C AMB 1 AMB 2 T 1. T2 CH 1 W.1 W2 STR

Hospital Doctor / GP Details Hospital Doctor / GP .

PLEASE PRINT NAME

Signature of Hospital Doctor / GP . Practice Address

IF APPLICABLE

Contact Details .
This form must be completed and either posted or faxed to Peter Bateman, Patient Transport Services Manager, Extension Block, SLH or faxed to Karon Snape, Assistant General Manager, NCSS Fax No. 01274 364718 who will make the transport booking. Should any problems arise please contact Peter Bateman on 01274 365427, #6829 or Karon Snape 01274 366679 or #6168 Any incorrectly filled in forms will be unauthorised and returned which may result in the appointment not being accepted by the transport provider. (All parts of the form must be fully completed) No escorts will be booked until a signed / completed form is received.
This form will be used for auditing purposes and cross-referencing information with WYMAS.

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