New Medical Service and streamlining of medical resources in Region Sjælland

The narrative is part of the Find & Enlarge movement. Success stories of innovation in the public sector.

The story in headlines

In Region Sjælland, they have succeeded in streamlining the limited medical resources, beds and the use of emergency ambulance rides. A better opportunity was created for citizens to have a dialogue with a doctor, stay in their own home and gain insight into their own medical situation. We succeeded by working with new roles and workflows — the paramedic is the sparring partner for the medical guard and the e-doctors are virtual advisors in the e-hospital. Read the full story and find inspiration for innovation in your organization.

What's done new?

In November 2021, Region Sjælland started the realization of the new thinking of the upcoming regional medical service. This was accomplished by the establishment of two pre-hospital visitation units in the north and south of the region. Ambulance staff were employed in April 2022 to tackle this task and from 1 October would staff the medical guard units alongside a doctor during parts of the medical guard's opening hours.

What is new is that the cars have been equipped with laboratory equipment so that the staff can come out to the sub-acute citizens to investigate whether the citizen should be admitted to a hospital, admitted to his own home, can stay at home or need to go to a relief site in the municipality.

In addition, outside the opening hours of the medical ward, the staff performs visitation and treatment tasks in professional sparring dialogue with the doctors of the e-hospital. The e-hospital is a so-called electronic hospital, where the e-doctor can hospitalize citizens for treatment in their own homes.

A further part of the innovation is the mobile treatment unit, where nurses drive out and go to the dormitory of citizens who are admitted to their own homes through professional dialogue with the doctors of the e-hospital.

At night, it is the paramedics who drive out alone and watch over the citizens for the medical guard. When a citizen needs to be conferenced with the medical rear guard (medical guard), this can be done via video consultation. The doctor is given an informed basis to give his professional assessment in relation to the clinical observations and measurements made by the paramedics.

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Why was the effort started?

There was a shortage of doctors and a need to use the doctors where they are really needed. Several patients wanted to stay at home and be treated in their own homes. Residents of remote areas also expressed a desire to be able to contact a doctor more easily. At the same time, it wanted to avoid emergency departments that are overloaded by citizens who did not need to be there. You also saw loaded ambulances and admissions via ambulances and you wanted to make sure the ambulance can get out there where it's really needed.

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What preconditions have been central?

In order to succeed, the mobile treatment units have gained access to the Health Platform, so that they can see what medicines citizens receive, treatment history, etc. Region Sjælland has gone digital. In addition, the Medical Guard has been rebuilt with Junior Doctors and the Association of Specialist Physicians, after PLO agreement stopped with the end of September 2022. A strong new partnership.

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What challenges have been encountered along the way?

Two actors are put together, each of whom has their own task. The emergency staff and the experienced medical guards, from the old scheme — the Paramedics, when the doctor is present, carry out relevant measurements and carry out treatment. The doctor supervises and prescribes medications, hospitalizes or terminates the citizen.
New common workflows need to be found. Culture and professional groups must find each other in a new interaction. The organization needs to be built up and create new communities.

Preliminary results

Of the citizens surveyed, 70% were completed to their own homes instead of an ambulance taking the citizen to the hospital. 2019 figures should be looked at in terms of benchmarking and learning. The region has become more aware of whether citizens are getting happy that they can call more frequently. People are happy and comfortable to be seen. The feeling is that as a patient you are seen and treated. It is felt that there is time for the patient in the Medical Guard, and this gives time to do a thorough examination. The doctor can see via video, for example, the rash on children and thus save transport time. Doctors see that the new skills that paramedics have are needed.

Spreading potential

We believe that the other regions can benefit from the experience and innovation of the medical service, and we are seeing great interest from the other regions and within the region. There is a follow-on group that follows the medical guard and picks up on results and learning. PHC cannot guarantee to be able to provide resources for the above, as we are facing a return of ambulance services in 50% of the region.