Integrated unscheduled care navigation hub models in ambulance services: a narrative review

Background: To provide ‘the right care in the right place, first time’, some ambulance services have collaborated with local acute and community trusts to provide integrated unscheduled care navigation hubs (IUCNHs) for patients and staff. They pool their resources to coordinate more appropriate responses to unscheduled care demands compared to the emergency department. Aims: To inform development, this literature review focusses on multi-professional collaborative practice in delivering patient and professional teleconsultations within emergency medical services. Methods: Comprehensive databases were searched using terms related to multi-professional emergency medical service patient triage and remote clinical support since 2005. No collaborative models like the IUCNHs were identified, so interventions relating to similar aims and functions were included and reviewed. Findings: After screening 2127 titles, 21 articles were identified that reported on senior clinical decision making support and direct patient teleconsultation. No studies were identified evaluating interagency record pooling or referral streamlining. Conclusions: Multi-professional collaboration in urgent care navigation will benefit from further research. Clinical teleconsultation has been reported as beneficial in reducing emergency department transportation rates in a variety of systems. However, the transferability of those findings and the impact of navigation hubs on the wider health and social care system remain unknown.