Transcript Ambulance Quality Indicators 2012
Ambulance Quality Indicators: Clinical Outcomes
What do the Clinical AQIs measure?
Are they targets?
Why were those complaints chosen?
How reliable/accurate is the data?
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
Two Groups:
2. A Sub-Group (‘UTSTEIN’)
1. The Whole Group
VF/VT NON-SHOCKABLE RHYTHM
Return of Spontaneous Circulation - ROSC
Patient has received CPR following Cardiac Arrest
Yes (denominator) no
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
no no exclude exclude exclude
ROSC on arrival at hospital = X
Survival to Discharge
Patient is alive according to NHS Spine
Yes no exclude
Hospital can verify that patient was discharged
Yes no exclude
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
35.0
% of Cardiac Arrest Patients where CPR was attempted achieving a ROSC on arrival at hospital
30.0
25.0
20.0
15.0
10.0
5.0
0.0
NEAS National Average 80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
% of Cardiac Arrest Patients in VF/VT achieving a ROSC on arrival at hospital
NEAS National Average • 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
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Survival to Discharge: All Cardiac Arrest Patients where CPR has been attempted
NEAS National Average 60.0
Survival to Discharge: All Patients in VF/VT where CPR has been attempted
50.0
40.0
30.0
20.0
10.0
0.0
NEAS National Average • 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
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
% of STEMI patients arriving at a PPCI within 150 mins
NEAS National Average • 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?
utcomes
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
% of Stroke patients arriving at a Hyper-acute Centre within 60mins
NEAS National Average • 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
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) GTN FAST Test Aspirin STEMI Pain Relief 2 Pain Scores Blood Pressure Stroke Blood Glucose
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Care Bundles - STEMI
% of STEMI patients receiving the appropriate Care Bundle
NEAS National Average • 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
98.0
96.0
94.0
92.0
90.0
88.0
86.0
84.0
82.0
80.0
Care Bundles - Stroke
% Stroke Patients receiving the appropriate Care Bundle
NEAS National Average • 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
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