Right Care, Right Place: Co-Locating MDTs to Reduce Emergency Conveyance

Introduction:
Rising demand on urgent and emergency care services requires integrated models that support rapid multidisciplinary decision-making and reduce avoidable hospital conveyance.

A pilot co-location multidisciplinary team (MDT), involving Ambulance, Frailty and Urgent Community Response (UCR) services, was implemented to provide senior clinical oversight and coordinated care planning for older adults living with frailty contacting emergency services.

Method:
A retrospective review of summary data from all co-located MDT sessions delivered during a seven-day pilot period of four-hour sessions was undertaken.

A quality improvement methodology using Plan–Do–Study–Act (PDSA) cycles supported optimisation of the co-location model, delivered from the SECAMB office.

Data included presenting complaint, conveyance outcomes, ambulance utilisation, and onward referral pathways.

Descriptive analysis assessed patient presentations and the impact of MDT working on ambulance conveyance and emergency department (ED) attendance.

Results:
Across seven MDT days, 137 patients were discussed (57 males, 80 females), with a mean of approximately 20 patients per day; 88.6% were aged ≥75 years.

Falls-related presentations were most common (44 cases, 32.1%), including falls with head injury (7.3%), followed by shortness of breath (22.5%).

Overall, 99 patients (72.3%) were managed without hospital conveyance. Baseline data suggest that without MDT co-location only 29% would not have been conveyed; therefore, MDT working prevented approximately 10 ambulance conveyances and 12 ED attendances per day through senior clinical decision-making and alternative care pathways.

Where conveyance was required, escalation was predominantly via ED referral. The MDT enabled diversion to UCR (34.3%), Frailty Virtual Wards (12.1%), and primary care (14.3%). Of the 137 patients discussed, 22.4% re-presented to ED within seven days.

Conclusion:
This pilot demonstrates that co-location MDT working supports high-volume clinical decision-making while delivering measurable reductions in ambulance utilisation and ED attendance.

The model enhances inter-service collaboration and enables safe management of frail patients within the community.