th

Janette Turner
Joanne Coster
Andrea Broadway-
Parkinson
Maggie Marsh
Viet-Hai Phung
Dan Bradbury
Richard Wilson
Dan Fall Andy Irving

• Develop better ways of measuring the performance, quality and impact of ambulance service care.
• Prioritisation of outcome measures.
• Provide better information about effectiveness and quality of care.

• The ambulance service is a gateway for many people with a range of health problems
• Everyone should think they are getting the best service that can be offered
• Measuring how well services are doing allows us to ensure this happens – identifies good and bad
• Also helps us assess whether new innovations are working and worthwhile

1. Meet the PhOEBE research team
2. Understand the PhOEBE process so far
3. Have an opportunity to discuss shortlisted measures
4. Choose the measure in each category which is most important to you
5. Feel that you have been involved and your view has been listened to
6. Understand how this day contributes to the process of selecting emergency ambulance quality measures.
7. Understand how the measures selected will be used in the next steps of the PhOEBE project.

Time Session
10:00 - 10:30 Arrival and coffee
10:30 – 11:00 Welcome, introductions and how we'll work
11:00 – 12:00 Patient Outcomes votes x 3
12:00 - 12:20 Coffee
12:20 – 13:00 Clinical Management Measures votes x 2
13:00 – 13:45 Lunch
13:45 -14:45 Whole Service Measures votes x 3
14:45 – 15:15 Comfort break (receive your expenses & grab a coffee to bring into the room)
15:15 - 15:30 Summary, next steps, evaluation and close

8 votes in 3 groups
Patient Outcomes
1. Pain
2. Survival
3 Re-Contacts
Clinical Management Measures
4. Accuracy of triage
5. Compliance with protocols
Whole Service Measures
6. Time (Definitive care)
7. Time (Response)
8. Accuracy of call identification & Assessment

Answer:
1. England!

Time Session
10:00 - 10:30 Arrival and coffee
10:30 – 11:00 Welcome, introductions and how we'll work
11:00 – 12:00 Patient Outcomes votes x 3
12:00 - 12:20 Coffee
12:20 – 13:00 Clinical Management Measures votes x 2
13:00 – 13:45 Lunch
13:45 -14:45 Whole Service Measures votes x 3
14:45 – 15:15 Comfort break (receive your expenses & grab a coffee to bring into the room)
15:15 - 15:30 Summary, next steps, evaluation and close

What are patient outcomes?
• Capture the effects, consequences or impact
(good or bad) of care provided
• Direct e.g. survival, disability, reduction in pain
• May reflect people’s views and opinions about the care they received.

Why do we measure pain?
• Pain is a major issue for people who are ill or injured
• Pain management - recognising patient pain
• Providing proportionate pain relief
• Pain relief drugs or e.g. applying splints to fractures

Number
Pain measures
1 Proportion of patients who report pain who are given analgesia (pain relief)
2 Proportion of all patients seen by an ambulance crew who have a pain assessment recorded
3
Proportion of patients reporting pain who have more than one pain score recorded
4
Proportion of patients who have a reduction in pain score after analgesia treatment

Why do we measure survival ?
• May indicate how well an ambulance service is performing
• Illness or injury may be so serious a patient cannot be saved
• Important to take this into account. Cardiac arrest - very small chance of surviving, stubbed toe – should be OK
• Many ways survival can be measured (all patients, specific groups of patients, and at different time points after health problem)

Number
Survival measures
1 Proportion of patients with cardiac arrest where resuscitation is attempted at the incident scene who have a pulse on arrival at the emergency department
2 Proportion of patients with a life-threatening condition
(amenable to emergency treatment) who are discharged alive from hospital
3 As above but for a specific clinical condition
(e.g. stroke, heart attack, cardiac arrest)
4 Proportion of 999 callers who die within 48 hours of first call

What makes re-contact rates so important?
• Some people re-contact services because their condition may get worse despite good treatment
• If the number of people re-contacting services is high it suggests the response to the first call for was not adequate
• Call may not have been properly assessed or patient not properly assessed at scene
• Risk to patients - seriousness of their condition is not recognised.
• Re-contact rates can be used as a measure of patient safety - high rates of re-contact suggest low levels of patient safety

Number
Re-contact measures
1 Proportion of all 999 calls referred for telephone advice only re-contacting the ambulance service within 24 hours
2 Proportion of patients left at home who are admitted to hospital within 72 hours
3 Proportion of all 999 calls re-contacting the ambulance service within 24 hours
4 Proportion of patients left at home who have a contact with any emergency/urgent health service within 24 hours

Time Session
10:00 - 10:30 Arrival and coffee
10:30 – 11:00 Welcome, introductions and how we'll work
11:00 – 12:00 Patient Outcomes votes x 3
12:00 - 12:20 Coffee
12:20 – 13:00 Clinical Management Measures votes x 2
13:00 – 13:45 Lunch
13:45 -14:45 Whole Service Measures votes x 3
14:45 – 15:15 Comfort break (receive your expenses & grab a coffee to bring into the room)
15:15 - 15:30 Summary, next steps, evaluation and close

What makes clinical management measures important?
• Triage
• Accuracy
• Call categories

1. Appropriateness and accuracy of triage
2. Compliance with protocols and guideline

Appropriateness and accuracy of triage
Number
Appropriateness and accuracy of triage measures
1 Proportion of all calls referred for telephone advice returned for a 999 ambulance response
2 Number of calls prioritised correctly to appropriate level of response as a proportion of all 999 calls
3 Proportion of life-threatening category A calls correctly identified as category A
4 Proportion of calls for a specific condition correctly identified at the time of the call, for example cardiac arrest, stroke, heart attack

Compliance with protocols and guideline measures
Why are protocols and guidelines important?
• Documents that specify how, or in what manner, a particular clinical problem or incident is to be treated
• Incorporates best practice for the condition so patients receive the most up to date and effective care
• Measure is about how often ambulance crew follow a protocol and provide the specified care
• A high rate of protocol compliance = optimum care
• A low rate suggests improvements are needed

Compliance with protocols and guideline measures
Number Compliance with protocols and guideline measures
1
Proportion of all cases with a specific condition who are treated in accordance with established protocols and guidelines, e.g.
stroke, heart attack, diabetes, falls.
2
Proportion of cases that comply with end of life care plans where these are available.
3
Proportion of all cases with a specific condition who meet the established criteria for transfer, who are transported to an appropriate specialist facility, e.g. a heart attack, stroke or major trauma centre.

Time Session
10:00 - 10:30 Arrival and coffee
10:30 – 11:00 Welcome, introductions and how we'll work
11:00 – 12:00 Patient Outcomes votes x 3
12:00 - 12:20 Coffee
12:20 – 13:00 Clinical Management Measures votes x 2
13:00 – 13:45 Lunch
13:45 -14:45 Whole Service Measures votes x 3
14:45 – 15:15 Comfort break (receive your expenses & grab a coffee to bring into the room)
15:15 - 15:30 Summary, next steps, evaluation and close

1. Time measures
2. Accuracy of call identification

How well the ambulance service organises itself:
• to answer the call
• correctly identify the problem
• dispatch a suitable vehicle
• ensure that the patient is transported to the most suitable place for treatment
• Definitive care = getting to the best place for the problem - stroke patient to a specialist stroke centre, fall patient with no injury left at home and referred to a falls service

(Definitive care)
Number
Time measures (Definitive care)
1
2
Proportion of eligible patients who arrive at definitive care within agreed timescales
Time of call to time to definitive care
3 Time of call to CPR start time where CPR is required
.
Average time from call to start of
CPR in cases of cardiac arrest

(Response time)
Number Time measures (Response time)
1
2
3
Proportion of emergency calls for conditions that are not life-threatening with a response time of 30 minutes or less
Proportion of emergency calls with a response time within an agreed standard for calls for lifethreatening conditions
Proportion of emergency calls with a response time within an agreed standard

• Under-triage – level of care not high enough
• Category A call is not recognised - slower response with treatment delay may have serious consequences
• Over-triage – level of care too high
• Sending a fast response using lights and sirens
- risks to both ambulance crews and the public
• Efficient use of resources

Accuracy of call identification measures
Number
1
2
3
4
5
6
7
Accuracy of call identification and assessment
Number of life-threatening (category A) calls not identified as category A as a proportion of all 999 calls
Number of calls that are not life-threatening identified as category A calls as a proportion of all 999 calls
Proportion of calls transferred for telephone clinical advice that are completed with self-care advice or referral to an appropriate service
Proportion of category A calls attended by a paramedic
Proportion of patients who are treated on scene or left at home who are referred to an appropriate pathway or primary care
Proportion of patients transported to ED by 999 emergency ambulance and discharged without treatment or investigation(s) that needed hospital facilities
Proportion of patients who potentially could be left at home who are successfully discharged at the scene.

(receive your expenses & grab a coffee to bring into the room)

Yes = 1, No = 2
Have you;
1. Understood what PhOEBE is all about?
2. Had an opportunity to be involved and contribute your thoughts?
3. Felt listened to?
4. Enjoyed the day?
Please add any further comments on your evaluation forms

For further information
Email: phoebeprogramme@sheffield.ac.uk
Post: Andy Irving, The PhOEBE Project, The
University of Sheffield, Regent Court, 30 Regent
St,
Sheffield, S1 1DA.
Tel: 0114 2224292. Fax: 0114 2220749