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With the increasing demand on ambulance services, paramedics are tasked to arrange as much out of hospital care as possible, to develop integrated systems of care and work with hundreds of different providers – all in the 15 minutes allocated for assessment. A UK ambulance trust is navigating and leading much of this work as one of the first trusts to implement a general practitioner referral policy as an alternate to direct conveyance. The paper aims to discuss this issue.

Here the authors discuss the referral scheme, examine the limited evidence available and discuss what is needed to influence prospective success of implementing this scheme in other trusts.

Limited evidence for these schemes are described, however there is a clear gap in critical appraisal and methodologically rigorous evidence needed to implement these schemes in other ambulance schemes.

In order to facilitate collaboration of healthcare services and to minimize the burden of increasing numbers of patients, communication and discussion of alternate routes of care is crucial. This viewpoint piece is one of the first to emphasize the potential benefits of such schemes.

Broad coalitions of companies, governments, and research institutions in several countries are currently designing massive electronic infrastructures for their roadways. Known collectively as intelligent vehicle‐highway systems (IVHS), these technologies are intended to ease toll collection and commercial vehicle regulation, provide drivers with route and traffic information, improve safety and ultimately support fully automated vehicles. Although many aspects of IVHS are uncertain, some proposed designs require the system to collect vast amounts of data on individuals′ travel patterns, thus raising the potential for severe invasions of privacy. To make social choices about IVHS, it is necessary to reason about potentials for authoritarian uses of an IVHS infrastructure in the hypothetical future. Yet such reasoning is difficult, often veering towards Utopian or dystopian extremes. To help anchor the privacy debate, places IVHS privacy concerns in an institutional context, offering conceptual frameworks to discuss the potential interactions between IVHS technologies and the computer design profession, standards‐setting bodies, marketing organizations, the legal system and government administrative agencies.

Investigates the increased waiting time costs imposed on society due to inappropriate use of the emergency department by patients seeking non‐emergency or primary care. Proposes a simple economic model to illustrate the effect of this misuse at a public or not‐for‐profit hospital. Provides evidence that non‐emergency patients contribute to lengthy delays in the ER for all classes of patients. Proposes a priority queuing model to reduce average waiting times.

This paper aims to present the current state of evidence regarding the mental health literacy of paramedics and student paramedics and whether mental health literacy affects the care that paramedics provide to their patients with mental illness.

Embase, PubMed, Medline and Google Scholar were searched for recent (2010–2020) English language published articles using the key phrases paramedic AND/OR ambulance AND mental health AND mental health literacy. Additional searches of the reference lists of included articles were undertaken. A descriptive thematic analysis was used to arrive at a narrative synthesis of the study findings.

The emergency medical services system has taken a primary role in the care of patients with mental illness but has limited capacity for non-emergency psychosocial situations. Negative and judgemental attitudes amongst paramedics towards patients with mental illness is a significant issue and remains a barrier to patients seeking medical care for mental illness. Improved care provision and patient engagement might result from specific education aimed to better enhance paramedics’ mental health literacy.

This literature review provides insights into the current practice of mental health training for Australian undergraduate paramedic science students and the implications for patient care. Recommendations for educational strategies are provided.

The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care.

The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic’s care model and the organisation’s performance and associated patient outcomes.

The literature directly concerned with Mayo Clinic’s distinctive ethos and approach to patient care is limited in scope and largely confined to “grey” sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation.

Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar.

There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients.

The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals.

In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients.

In Spring 2015, Texas experienced record-breaking floods, causing deaths, injuries, and widespread property and infrastructure damage. However, little is known about those who encountered access barriers to disaster support in Texas. The purpose of this paper is to examine the unmet disaster-related needs from 2-1-1 calls during evacuation, flooding, and early recovery phases.

The 2-1-1 Texas Information and Referral Network’s caller database was used to identify real time, non-emergency, unmet disaster-related caller needs longitudinally. The two-month study period included a baseline week before flashflood (05/01/2015) into early recovery (06/30/2015). Caller unmet needs were categorized and graphed by type daily throughout the study period.

Of the 4,880 disaster-related 2-1-1 calls from Texas’ 254 counties, 1,183 callers needed housing help, compared to 442 utilities, 409 food and 109 medically related assistance. Total calls quickly peaked at 405 calls/day during Memorial Day weekend when Greater Houston flooded. Despite total calls decreasing gradually during recovery, they remained four times higher than baseline. Unmet needs varied by type, especially during early recovery. Housing, food, and medical unmet needs surged when Houston flooded. Although medical calls were lowest volume than other basic needs, demand for medical assistance had a higher threshold throughout early recovery.

Examination of unmet needs over disaster phases identified longitudinal patterns of demand and effectiveness of disaster management efforts.

Using real-time 2-1-1 data to monitor types of unmet demand is valuable to tailor timely and effective disaster support, reduce access barriers, and allocate disaster support services and supplies to the vulnerable communities.

Identifies the factors associated with the over utilisation of emergency services or the under utilisation of primary care services. Uses a two year abstraction of medical records containing 2035 visits across 253 children under the age of two. Shows that parents who used less primary care services and too much emergency care provision were often black, single unsupported mother from low income families with low education and little insurance. Cites barriers as location, lack of transport and cost.

The study aims to provide an exploratory investigation of the magnitude of the customer-centric approach in the specific area of healthcare as a contribution to the scarce and preliminary literature on this topic. In particular, it explores the role of sharing economy-based (SE-based) platforms as an experiential touchpoint to co-create value within different levels. Specifically, the purpose of the study is threefold. First, it aims to address the service experience innovation in healthcare with a customer-centric approach. Second, it seeks to define the role of the SE-based platform as a touchpoint to redefine business processes, and third, it measures the co-created value within the network when redesigning the service experience.

To address the research question, the authors proposed an analysis of service innovation and customer centricity in healthcare networks by using the case study of Saluber, an SE-based platform that offers logistics services for non-emergency medical transportation in the Campania region (south of Italy). By using a qualitative approach, the authors analysed primary and secondary data from multiple sources of evidence.

The results show that a customer-centric approach based on the SE-based platform can improve the customer experience and help to redesign and expand the business processes of healthcare organisations. A multilevel model demonstrates the possible service innovations that use SE principles that can co-create value for the customer (micro level), for the healthcare network (meso level) and for the community (macro-level).

This study provides managerial implications for the players who intend to take advantage of the possibilities offered by service innovations developed by the health and social organisations in the network. The SE-based platform helps redefine business processes to improve clinical and financial outcomes and improves the overall customer experience within this network.

This study allows new and important reflections from ethical, social and managerial points of view and underlines how digital platforms act as a support for healthcare services, not as a substitute.

There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals.

The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility.

The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants.

Limitations of the study include the lack of control group.

This program is easy to disseminate and could improve the quality of care and costs.

This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.