Up to $640,000 to support the national transfer and further implementation of key elements identified from a previously evaluated Extended Care Paramedic program.
HWA has a program to test the expansion of the scope of practice for clinical roles. One of the projects is ‘Extending the Role of Paramedics’. This grant seeks to support the national transfer and further implementation of key elements identified from an Extended Care Paramedic (ECP) program that commenced in December 2008 as a joint initiative of South Australian (SA) Health and the SA Ambulance Service (SAAS).
Recognising that community need for Extended Care Paramedic services will differ across Australia, the Extending the Role of Paramedics program supports the national implementation and testing of key elements of the Extended Care Paramedic model whilst allowing flexibility to enable potential respondents to tailor the model to their local requirements.
Coordinated national implementation and testing of the Extended Care Paramedic program is required to understand:
- the costs and benefits of the proposed paramedic workforce innovation
- the future recommendations for the sustainability of such an innovation
- the support and considerations, at a national level, of broader issues that impact on the integration of expanded scope of practice roles into the Australian health system.
HWA recognises that:
- state and territory ambulance organisations in Australia operate under different governance arrangements
- there are existing Extended Care Paramedic (ECP) models, or equivalent in operation, locally in some states
SA Ambulance Service Extended Care Paramedic Program
The SA Ambulance Service (SAAS) Extended Care Paramedic (ECP) program trained and transitioned experienced Intensive Care Paramedics (ICP) operating in traditional paramedic roles into health professionals with an expanded scope of practice able to extend their role and deliver emergency health care in a range of settings.
In the SAAS ECP program, ICPs were carefully selected for additional training to Extended Care Paramedic level. In South Australia, an ICP is defined as an experienced paramedic who has undertaken further education building upon their depth of knowledge and problem solving abilities. The characteristic of intensive care paramedic practice is that it is defined by judgement based on problem assessment and understanding of underpinning principles more than by defined pathways or protocols. In SA, the academic level associated with this grasp of knowledge and problem solving abilities equates to a graduate diploma or equivalent.
In the context of the SAAS program, an Extended Care Paramedic is defined as an experienced paramedic at ICP level who has subsequently gained extra expertise in evaluation and assessment of complex clinical and social/environmental situations. The ECP has advanced problem solving and negotiating/communicating skills. Extended Care Paramedics work as an integrated part of a multidisciplinary care team, utilising their assessment, problem-solving, judgement and communication skills to ensure that the patient receives the right care delivered in the right situation at the right time by the right members of the health care team.
In the SAAS ECP program, ECPs work collaboratively with other health care professionals to deliver emergency health care in settings within the community. Extended Care Paramedics provide alternate care pathways for patients and assist in reducing unnecessary emergency department (ED) presentations. Attendance by an ECP often reduces the disruption to patients and their carers by reducing the need for transportation to a hospital.
The SAAS ECP program has proved to be particularly beneficial to those in residential aged care facilities; however it is not limited to this setting alone. Evaluation of the program has demonstrated its success through a significant reduction in the numbers of ED presentations. Importantly, the role was positively received by all participating health professionals and those receiving care. The program has been operationalised in SA to cover all metropolitan Adelaide regions.
Project Overview and Implementation
This Extending the Role of Paramedics program asks respondents to consider key elements of the SAAS ECP program (detailed further in clause 4 and Schedule 1) that are transferable to the local context; allow for skills transfer from the Extended Care Paramedic to the health professionals in the community; and does not provide a substitution service for general practice but instead offers a complementary value-add service through development of an extended care paramedic role.
HWA encourages innovation and collaboration in the form of partnering arrangements developed by respondents that cross public/private or geographic boundaries.
HWA promotes consideration of the sustainability of the Extended Care Paramedic role beyond the Project lifespan and consideration of the feasibility for future national implementation.
Each successful respondent will be required to monitor and report on common key Project evaluation indicators (outlined in clause 3.3 and 3.4) with assistance from a HWA-appointed evaluation consultant. In addition, HWA welcomes the development by successful respondents of locally relevant key Project evaluation indicators with assistance from a HWA-appointed evaluation consultant.
The collation of key Project evaluation indicators will contribute to a collaborative evaluation of the overall Extended Care Paramedic expanded scope of practice initiative to inform the national reform agenda with regards to future developments for this workforce. This will enable the key program evaluation indicators listed below to be addressed:
- workforce productivity efficiency and effectiveness of the expanded scope of practice, including cost effectiveness
- increased workforce capacity
- sustainability of the implemented model
- impact on patient outcomes
- quality and safety.
The results of the Extended Care Paramedic collaborative evaluation effort will in turn inform the evaluation of the collaborative HWA Expanded Scope of Practice program, independent of health professions. This broad evaluation piece will foreshadow and support the consideration, at a national level, of broader issues that impact on the integration of expanded scope of practice roles into the Australian health system. This may include consideration of:
- Education pathways – a nationally consistent and recognised process for delivering and undertaking education for expanded scope of practice roles
- Legislation – a legislative framework that facilitates expanded scope of practice activities
- Funding – strategies to combat the ‘siloing’ of resource allocation and funding to support expanded scope roles; and recognition by health insurers of the services provided through an expanded scope and extended role.
To support the evaluation process, a collaborative and action learning approach will enable sites to receive support and direction from HWA and the appointed evaluators; and share learnings between sites. Evaluators will be present at HWA-run workshops to support capacity building and ensure the capture of local evaluation measures, recommendations for the final collaborative paramedic report and input to the collaborative HWA expanded scope of practice program.
HWA will provide funding of up to a maximum of $640,000 (excluding GST), in addition to respondent co-contribution in the form of funding and resources, to successful respondent organisations. This funding will be provided over a twenty-four-month period and will be disbursed over three phases.
Scope of requirements
Key Objectives of the Project
This Extending the Role of Paramedics project will focus on expanding the competencies and capabilities of paramedics (at SA ICP equivalent level) to provide, in collaboration with other health care professionals, emergency health care to patients in their usual residence through an extended role wherever appropriate.
It aims to be complementary to the primary care delivered by the patient’s usual General Practitioner.
The Extending the Role of Paramedics project seeks to:
- reduce costs to the health system associated with emergency department presentations or early entry into aged care facilities that could be more effectively and appropriately managed in the patients’ usual place of residence, and involves the patients usual GP wherever possible
- increase the capability and capacity of aged care and community health professionals to deliver quality care in the patients’ usual place of residence
- minimise disruption to patients, their carers and family by providing high level care in their