Ambulance Quality Indicators:
Clinical Outcomes
What do the
Clinical AQIs
measure?
Why were
those
complaints
chosen?
How
reliable/accurate
is the data?
Are they
targets?
AMBULANCE
QUALITY
INDICATORS
How are we
driving
quality?
How are the
AQIs
measured?
What are
‘Care
Bundles’?
What does
‘STEMI’,
‘ROSC’ and
‘Utstein’ mean?
How is the
NEAS
performing?
Background
 Cat B19 target replaced with 11 new indicators
 Response Times/Targets
Quality of Care/Outcomes
 Audited Monthly, Reported Quarterly
 Pilot: Apr 2011- Mar 2012 Live: Apr 2012
 Whole Sample and Patient Care Pathway
 Openness and Transparency
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…
Patient Outcomes
Cardiac Arrest:
1. 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.
2. Survival to Discharge Rates
Measures the rate of those who recover from cardiac arrest and are
subsequently discharged from hospital
2. A Sub-Group
(‘UTSTEIN’)
Two Groups:
1. The Whole Group
VF/VT
NON-SHOCKABLE RHYTHM
Return of Spontaneous Circulation - ROSC
Patient has received CPR
following Cardiac Arrest
no
exclude
no
exclude
no
exclude
Yes (denominator)
Patient regains a
heart beat on scene
Yes (ROSC)
Patient is transported to
hospital and retains a
ROSC at hospital doors
Yes
ROSC on arrival at hospital
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%
Cardiac Arrest - ROSC
% of Cardiac Arrest Patients in VF/VT achieving a ROSC on
arrival at hospital
80.0
30.0
70.0
25.0
60.0
Oct-11
Sep-11
Oct-11
Sep-11
0.0
Aug-11
0.0
Jul-11
10.0
Jun-11
5.0
May-11
National Average
20.0
Aug-11
National Average
NEAS
30.0
Jul-11
10.0
40.0
Jun-11
NEAS
May-11
15.0
50.0
Apr-11
20.0
% ROSC
35.0
Apr-11
% ROSC
% of Cardiac Arrest Patients where CPR was attempted achieving
a ROSC on arrival at hospital
• 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
Cardiac Arrest – Survival to Discharge
Survival to Discharge: All Cardiac Arrest Patients where CPR has
been attempted
Survival to Discharge: All Patients in VF/VT where CPR has been
attempted
60.0
18.0
16.0
10.0
8.0
NEAS
6.0
National Average
4.0
2.0
0.0
40.0
30.0
NEAS
National Average
20.0
10.0
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
0.0
Apr-11
% Patients Surviving to Discharge
12.0
% Patients Surviving to Discharge
50.0
14.0
• 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
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
utcomes
• Increase from
August as MINAP
internally
scrutinised
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
NEAS
National Average
• Now transporting
patients in a safe
and efficient
timeframe
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
• Above national
average
Apr-11
% arriving within 150mins
% of STEMI patients arriving at a PPCI within 150 mins
• Potential delay
within the PPCI
centre?
utcomes
% of Stroke patients arriving at a Hyper-acute Centre within 60mins
100.0
90.0
70.0
60.0
50.0
40.0
NEAS
30.0
National Average
• Demonstrating that
we are
transporting
patients in a safe
and efficient
timeframe
• Above national
average
20.0
10.0
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
0.0
Apr-11
% arriving within 60mins
80.0
• One of the best
performing Trusts
• Audit those cases
which exceeded
60mins
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)
FAST
Test
GTN
Aspirin
STEMI
Pain
Relief
Stroke
Blood
Pressure
2 Pain
Scores
Blood
Glucose
Care Bundles - STEMI
• Continuous quality
improvement since
June 2011
% of STEMI patients receiving the appropriate Care Bundle
100.0
90.0
70.0
60.0
50.0
40.0
NEAS
30.0
National Average
20.0
10.0
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
0.0
Apr-11
% receiving care bundle
80.0
• 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
Care Bundles - Stroke
• Fluctuates each
month
% Stroke Patients receiving the appropriate Care Bundle
98.0
96.0
92.0
90.0
88.0
NEAS
86.0
National Average
84.0
82.0
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
80.0
Apr-11
% receiving care bundle
94.0
• 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
Quality Assurance
ASSURANCE
Audit 100% of cases
RISK
PRF documentation
reflects performance
Manual audits
Audit areas of potential risk e.g. stroke >60mins MINAP / SINAP
Collaborate with Operational Management to
improve quality
Feedback log used in Performance
Management, Appraisals and Training
WQA / Sunderland Internal Audit /
NEAS Internal Audit
Reliance on hospitals
for outcome data
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
Any Questions…?