{
  "abstract": "Aims and Objectives By December 2025, NHS Lanarkshire’s (NHSL) Flow Navigation Centre Plus (FNC+), aims to increase Call Before You Convey (CBYC) calls to 60 per week. The goal is to support Scottish Ambulance Service (SAS) decision-making, promote safe non-conveyance through alternative pathways, and reduce unnecessary Emergency Department attendances while improving patient experience and using ambulance resources efficiently.Across Scotland, healthcare systems, including Lanarkshire, face overcapacity, and pressures within SAS result in crews spending prolonged periods at Emergency Departments, delaying timely responses. These challenges compromise patient safety, cause avoidable delays in care, and increase the risk of adverse outcomes and mortality. The project uses quality improvement methods to embed the CBYC Pathway in practice through real-time data, staff education, and feedback to drive measurable change and enhance patient experience.Method and Design A collaborative Quality Improvement team was established, measures agreed, and SAS feedback analysed to inform action. An action plan and change ideas were co-designed and tested through sequential PDSA cycles, with outcomes monitored via run charts to guide learning. Four change ideas have been implemented since 11/08/2025: daily text reminders (later increased to three times daily), a revised process to improve response times, monthly feedback to SAS on outcomes, and SAS visits to FNC+ to support staff understanding. The initiative is being incorporated into newly qualified paramedic training, and education resources are in development to support sustainability.Results and Conclusion Early results show weekly call volume increased from a median of 34 to 44, average response times fell from 40 to 5 minutes, and patients managed without ED conveyance rose from 22.5 to 32 per week. This suggests structured quality improvement can embed the CBYC pathway, enhance system efficiency, and improve patient experience, with potential for broader adoption across urgent care pathways.",
  "authors": [
    {
      "affiliations": [
        "Chitwan Medical College"
      ],
      "name": "Loknath Poudel"
    },
    {
      "affiliations": [
        "NHS Lanarkshire"
      ],
      "name": "Jill Roche"
    },
    {
      "affiliations": [
        "NHS Lanarkshire"
      ],
      "name": "Bernie Harvie"
    }
  ],
  "title": "4037 Change in knowledge, attitude and practice of oxygen therapy among doctors and nurses after introduction of British thoracic society guidelines at emergency department of Chitwan medical college",
  "uid": "30edde65-3839-5c68-bce2-0fa7f9ee4f66"
}