Development and outcomes of the patient refer-back service model by ambulance in the Lampang Provincial network

Abstract

This research and development study aimed to develop and evaluate an ambulance-based patient refer-back service model in the Lampang Provincial Network. The study was guided by the World Health Organization (WHO) Six Building Blocks framework and systems theory using an Input–Process–Output (IPO) model. The study was conducted in three phases: 1) a situation analysis using focus group discussions and in-depth interviews with 13 stakeholders, including administrators, physicians, nurses, and patients; 2) development and implementation of the model in collaboration with nurses from 13 referral centers; and 3) evaluation of the developed model among 1,214 refer-back patients from March to October 2025 and 13 referral-center nurses. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using descriptive statistics and a paired t-test.

The RBM LAMPANG Model comprised five components: 1) a four-node refer-back network; 2) standard operating procedures; 3) a standardized patient refer-back process; 4) real-time bed management through a centralized dashboard; and (5) a patient-safety risk surveillance and workforce capacity-building system. The mean refer-back time decreased from 32 hours and 36 minutes to 8 hours, a 75.46% reduction. Adverse events decreased from 0.50% to 0.16%. Nurses’ scores for perception, understanding, and adherence to the guidelines increased significantly (t = 8.89, p-value < .001).

The RBM LAMPANG Model improved coordination, reduced delays, and enhanced the quality and safety of ambulance-based patient refer-back services across the Lampang Provincial Network, with nurses serving as key service coordinators.