DEFINITIONS
1 Proportion: can be expressed as a number out of a total e.g., 2 out of 10;
as a percentage e.g., 60%; or a ratio e.g., 2:1. In the ambulance service
examples might be when the number of instances criteria were met e.g.,
proportion of callers surviving discharge from hospital would be expected to
be high, near 90%. Proportion can be used to compare different services,
ambulance trusts, patient groups and medical conditions etc. It is better to
use than numbers as it takes in to account variation in the number of cases
different services may see.
2 Patient outcomes: measures capturing effects, consequences and impact
of care given on individuals. Effects, good or bad, may be direct, e.g. on pain
reduction, or indirect, reflecting people's opinions on the care they have
received.
3 Clinical management measures: reflect how well ambulance services
respond to, and treat, a range of health problems appropriately. The
measures include decision making e.g., if an ambulance is needed; what
patient assessment and treatment is given at the scene.
4 Whole service measures: reflect an ambulance service's ability to
organise and manage itself to provide timely, competent emergency and
urgent care for its population. E.g., the proportion of all 999 calls responded
to in 8 minutes, reflects how well the service uses its resources such as
matching its supply of vehicles and crews to varying demand.
5 The patient experience: tries to measure which aspects of care or service
patient’s value and contribute to a positive experience, e.g., the crew's
demeanour, language, behaviour and clinical care. The ability, to assess how
people perceive their experience, is an important measure in the overall
quality of care provided. Currently, there is no standard method of measuring
people's experiences after contacting the ambulance service. Recent patient
interviews can be used in future to develop a patient experience outcome
measure.
6 Re-contact rates: are important if a patient re-contacts the ambulance
service, A & E department or other related service fairly soon after the initial
call. If the number of people re-contacting services is high, it suggests an
inadequate response to the first call or it wasn’t assessed well.
1
If someone is treated at home and left, and then re-contacts the ambulance
service or goes to A & E, then a wrong decision may have been made to
leave them at home. Risks to patients increase and the right treatment may
be delayed. Re-contact rates can be used as a measure of patient safety.
7 Triage: concerned with “sifting and sorting” e.g., identifying a call's
urgency; right response by sending out correct personnel speedily; matching
resources to needs. “Over triage” means level of care is too high and this
could have been used for a more urgent patient; “Under triage” means care
was too low e.g., taking a stroke sufferer to a local hospital rather than a
regional stroke unit. Computer systems or flow charts (“triage tools”) are
used to help decision making from answers to questions about the patient.
8 Accuracy: matters because it is about how well ambulance service
personnel correctly apply and interpret triage etc. to help in diagnosis,
sending the right response and providing the right care at the scene. A high
level of accuracy suggests the ambulance staff were well trained. A low level
may mean patients may have received inappropriate care. Accuracy can be
measured broadly (which 999 calls need fastest response) or specifically for
certain conditions (taking heart attack patient to specialist treatment unit
directly, after diagnosis).
9 Protocol compliance: protocols are documents which stipulate how a
clinical problem or incident is treated and incorporates current best practice
so a patient receives the most up to date and effective treatment. It
measures how often ambulance crew follow a protocol and provide care
specified. A high level of compliance suggests optimum care.
10 Definitive care: is the level or type of care needed to treat a condition
properly. Usually this applies to hospitals, but could be the patient's home.
For serious conditions definitive care is important as it could be life-saving,
e.g., taking a stroke victim to a stroke care centre to aid a good recovery. For
less serious conditions treatment at home or in the community may be better
for a patient and save an unnecessary visit to hospital. Delays in reaching
definitive care could result in poor outcomes.
11 Pain measurement: pain management makes a significant contribution
to the patient experience. It is concerned with recognising when a patient has
pain; how much pain they have; providing proportionate pain relief. It could
be drugs or a splint for a fracture. Properly managed pain means a good
patient experience and reflects the quality of care.
2
12 Patient safety: measuring patient safety assesses whether there are
risks to patients from poor or unsafe care. One method can be measured by
re-contacts as this can be a risk to patient safety.
13 Different call categories: ensure 999 calls are prioritised appropriately
and timely. Calls are graded and Category A are the most serious life
threatening ones and 75% should get a response in 8 minutes.
14 “Never” events: are serious, mostly preventable patient safety incidents
that should not occur e.g., in the ambulance service, giving drugs the wrong
way or failing to monitor and respond to incorrect oxygen levels. These
events should be close to zero.
15 Resuscitation: is the treatment for people who have stopped breathing
and have no heartbeat. It includes CPR: stands for Cardio-Pulmonary
Resuscitation; the “kiss of life”; or heart massage and may also include
applying an electrical shock (defibrillation), giving drugs and assisting
breathing.
16 Survival: one way of measuring how well an ambulance service is
performing is to measure survival or mortality rates, taking into account the
likelihood of whether the patient would survive or not e.g., cardiac arrest. If a
survival rate is higher/lower than expected, then the ambulance service is
performing better/worse. Survival can be measured for all patients or specific
groups of patients at different times after the event.
17 Record keeping: ambulance services routinely collect information e.g.,
what happened, location, times, patient's age and condition etc. The accuracy
of these records helps the onward care of the patient. Complete, accurate
records help the ambulance service with staff monitoring, support and training.
3