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Ambulance Quality Indicators: Clinical Outcomes

Ambulance Quality Indicators: Clinical Outcomes. Are they targets?. How are the AQIs measured?. What do the Clinical AQIs measure?. What are ‘Care Bundles’?. AMBULANCE QUALITY INDICATORS. Why were those complaints chosen?. What does ‘STEMI’, ‘ROSC’ and ‘Utstein’ mean?.

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Ambulance Quality Indicators: Clinical Outcomes

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  1. Ambulance Quality Indicators: Clinical Outcomes

  2. Are they targets? How are the AQIs measured? What do the Clinical AQIs measure? What are ‘Care Bundles’? AMBULANCE QUALITY INDICATORS Why were those complaints chosen? What does ‘STEMI’, ‘ROSC’ and ‘Utstein’ mean? How is the NEAS performing? How are we driving quality? How reliable/accurate is the data?

  3. Background • Cat B19 target replaced with 11 new indicators • Response Times/Targets • Audited Monthly, Reported Quarterly • Pilot: Apr 2011- Mar 2012 Live: Apr 2012 • Whole Sample and Patient Care Pathway • Openness and Transparency Quality of Care/Outcomes

  4. What are we measuring and Why? • 3 Medical Complaints: • Cardiac Arrest • Stroke • STEMI All three complaints are life threatening, require treatment as soon as possible and have registries planned to report on patient outcomes in the near future…

  5. Patient Outcomes • Cardiac Arrest: • Return of Spontaneous Circulation (ROSC) • Measures how many patients who are in cardiac arrest but following resuscitation have a pulse/heartbeat on arrival at hospital. • Survival to Discharge Rates • Measures the rate of those who recover from cardiac arrest and are subsequently discharged from hospital • Two Groups: 2. A Sub-Group (‘UTSTEIN’) 1. The Whole Group

  6. Return of Spontaneous Circulation - ROSC Patient has received CPR following Cardiac Arrest no exclude Yes (denominator) no Patient regains a heart beat on scene exclude Yes (ROSC) no Patient is transported to hospital and retains a ROSC at hospital doors exclude Yes ROSC on arrival at hospital

  7. Survival to Discharge ROSC on arrival at hospital = X Patient is alive according to NHS Spine no exclude Yes Hospital can verify that patient was discharged no exclude Yes Survival to Discharge nominator * Survival Rate is as a proportion of total cardiac arrest sample, e.g. if 5 patients survive out of a total of 100 patients, rate = 5%

  8. Cardiac Arrest - ROSC • High no. young patients and bystander CPR in May & August • NEAS is below the national average for the whole sample and above the national average for the Utstein sample • Local guidelines changed in August ‘11 – potentially successful

  9. Cardiac Arrest – Survival to Discharge • High no. young patients and bystander CPR in May & August • NEAS is generally above the national average for both samples • May see a slow decrease as we rely on data from Acute Trusts. If we do not receive data we must exclude from sample

  10. utcomes Stroke Measures the time it takes from the 999 call to the arrival at a specialist stroke centre so that they can be rapidly assessed for treatment called thrombolysis. STEMI Measures the time it takes from the 999 call to the patient receiving angioplasty at a PPCI Centre. Data extracted from MINAP. STEMI is an acronym meaning 'ST segment elevation myocardial infarction', which is a type of heart attack

  11. utcomes • Increase from August as MINAP internally scrutinised • Now transporting patients in a safe and efficient timeframe • Above national average • Potential delay within the PPCI centre?

  12. utcomes • One of the best performing Trusts • Demonstrating that we are transporting patients in a safe and efficient timeframe • Above national average • Audit those cases which exceeded 60mins

  13. Care Bundles “A Care Bundle is a group of interventions related to a condition that, when delivered together, result in better outcomes than when implemented individually.” (AQI Technical Guidance, 2011)

  14. Care Bundles - STEMI • Continuous quality improvement since June 2011 • Sample approx. 80 cases/month – 10/74 patients in Sept did not receive Care Bundle • Now above national average but need to continue to drive improvements • Feedback Log

  15. Care Bundles - Stroke • Fluctuates each month • Sample approx. 400 cases/month – Generally 10 patients do not receive Care Bundle each month • Now above national average but need to continue to drive improvements • Feedback Log

  16. Quality Assurance

  17. Continuously Improving Patient Care… • ROSC is continuously improving e.g. for VF/VT patients, • 28% in 2010 → 46% in 2011 • Continuously in the Top 2 Trusts in England for • transporting stroke patients within a safe timeframe • Post cardiac arrest patients have a higher than average • survival rate in the North-East following care by NEAS • NEAS have a strategy in place to drive quality • improvement using clinical audit data

  18. Any Questions…?

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