Transcript No Slide Title

ASA
THE AMBULANCE SERVICE ASSOCIATION
THE VOICE OF THE NH
S AMBULANCE SERVICE
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME
JRCALC Conference - 3 November 2000 - Towards a Unified Approach
Collecting the right data
from the right forms at the
right time
STUART NICHOLLS
Manager, ASA NCEP
Alternative titles:
“Demonstrable improvement in the
quality of NHS patient care”
How to make possible what is desirable
How can we measure that the NSF is
working?
Structure of the presentation
Collecting the right data
from the right forms at the right time
• Aims and Objectives of the ASA NCEP
• Why ambulance services need to collect
accurate and timely data
• Work programme
• Professionalism
• National Service Frameworks
• Evidence Base/ Guidelines
ASA National Clinical
Effectiveness Programme
(ASA NCEP)
Aims & Objectives
“Bringing pieces of the jigsaw together”
“Supporting clinically effective practice”
“Creating the Links”
“Bringing pieces of the jigsaw together”
“Bringing pieces of the jigsaw together”
To provide guidance and support to the development and
implementation of clinical effectiveness education
programmes
To ensure the progression of clinical effectiveness within
the UK ambulance service through consultation with local
& national bodies
To identify and agree national priorities for clinical
effectiveness regimes
To participate in the development of multi-disciplinary
care pathways to ensure an integrated approach
To contribute to the development and production of
communication tools to serve the above objectives
“Supporting clinically effective practice”
“Supporting clinically effective practice”
Programme Web Site - audit database, links, publications,
information,resources www.asancep.org.uk
Training & Education - audit tools, workshops, evidence of
best practice, surveys
Newsletter - CANDOUR - latest information, examples of
good practice
Conferences - AMBEX 2000 - ASA/JRCALC - update skills
& Knowledge, different perspectives
Regional Groups - share information locally, feed into
national structure, collaborative & comparative
projects
“Creating the Links”
“Creating the Links”
Improvement in the
Quality of Care
Clinical Audit
Training
Clinical
Effectiveness
Education
Professional Self
Regulation
Clinical
Risk
Clinical Governance
How to make possible what is desirable
Effectiveness
what are we
trying to achieve?
have we made
things better?
Training &
Education
Research
Clinical Audit
cycle
are we achieving it?
Clinical Governance
what can we do to
make things better?
Evidence
why are we not
achieving it?
Risk
Why Ambulance Services should collect
Accurate and Timely Information
• Patient Record
• Clinical Audit
• Clinical Effectiveness
• Clinical Governance
ASA/ JRCALC
Minimum Data Set
What is the minimum data set ?
• Backbone for implementing clinical governance
• Evidence base
• Comparable data
ASA/ JRCALC
Minimum Data Set
What the minimum data set is NOT ?
• Not an audit tool
• Not answer all information requirements
• Not a blue-print for PRF’s
ASA/ JRCALC
Minimum Data Set
What are the benefits ?
•
•
•
•
Comparative clinical audit
Integrated Care Pathways
Risk Management
Clinical Effectiveness
ASA/ JRCALC
Minimum Data Set
Examples :
• National Service Frameworks
• National Standards
• National Clinical Audits
ASA/ JRCALC
Minimum Data Set
What will happen if we do not implement
the minimum data set ?
• Clinical Governance
• National Institute for Clinical Excellence
• Commission for Health Improvement
Plans 2000/2001
• Professionalism
• ‘Self-regulation and continuing professional
development are going to be the among the most
challenging issues of the next few years’
• ‘Health professionals will have to show that they are
capable, competent and keeping up with current
practice’
– Professor B Edwards, Chair CPSM
Plans 2000/2001
• Professionalism
• 3 approaches
– Log Book
– Observing practice
– Examination
• Clinical Audit
ASA/ JRCALC
Minimum Data Set
The role of the ASA National Clinical
Effectiveness Programme
• Clinical Audit Projects
• Clinical Audit Tools
• Clinical Governance
Plans 2000/2001
• Work plan
– Develop a Code of Practice for prehospital record
keeping and data collection
– ASA/JRCALC Minimum Data Set – Review of
Compliance
– Develop a rolling programme of audit
– Develop audit tools around agreed standards
An action plan for
saving lives
A comprehensive
health strategy
for England
Four priority areas
Cancer
Coronary heart disease & stroke
Accidents
Mental health
Measuring & monitoring progress
Tough national targets
Tailored local targets
Strong performance management
Regular reviews
Coronary heart disease & stroke
Target for 2010
To reduce the death rate
from coronary heart disease and
stroke & related diseases in people
under 75
by at least two fifths
NSF's will :
•set national standards and define
service models for a specific service
or care group
•put in place programmes to
support implementation
•establish performance indicators
against which progress within an
agreed timescale will be measured.
Ambulance trusts: milestones and goal
Heart attack (AMI & ACS)
October 2000
The ambulance service has an effective means for setting service
clinical standards for common conditions.
The ambulance service has a systematic approach to determining
whether agreed clinical standards are being met.
April 2001
The ambulance service has an agreed service-wide protocol for
the management of suspected AMI.
April 2002
The ambulance service has clinical audit data no more than 12
months old that describe all the relevant items listed in the AMI
chapter.
NSF goal
Every ambulance service should offer complete and correct
packages of audited effective interventions to all people assessed
as having a suspected AMI, demonstrated by clinical audit data
no more than 12 months old.
• % Category A calls to emergency services attended within 8
minutes of a call for professional help by a trained individual
with a defibrillator
• number and % of patients eligible for thrombolysis arriving
at hospital within 30 minutes of call for professional help
(‘call to door’ time)
• number and % of patients eligible for thrombolysis
receiving it within 20 minutes of arrival at hospital (‘door to
needle time’)
• number and % of patients eligible for thrombolysis
receiving it within 60 minutes of call for professional help
(‘call to needle time’)
• number and % of adult patients with out-of-hospital, nontraumatic cardiac arrest who reach hospital alive and
survive to leave hospital
• number and % of patients with suspected AMI, given at
least 300 mg aspirin within 60 minutes of call for
professional help
Clinical Governance in Practice
Evidence based practice
for MI, cardiac arrest
Cat A response times
Pre-arrival instructions
Patient/public involvement
Community CPR
Clinical Effectiveness
outcomes
Integrated Care Pathways
Record keeping
Patient Report Form with
min/data set for cardiac
patients
NSF
CHD
Clinical Risk Management
Multi disciplinary audit
Boxplot showing range of data collected
on ambulance service patient report forms
Maximum of 270 fields (JRCALC/ASA Minimum Data Set)
250
200
150
133
100
97
50% range
86 (median)
69
50
0
42
Frequency of data collected as required to monitor
the prehospital management of
acute coronary heart disease (sample)
Data field
(JRCALC/ASA MDS)
Number of PRF's
where field present
Percentage of PRF's
where field present
Cardiac Arrest
26
65%
Witnessed Arrest
18
45%
9
22.5%
CPR/ALS prior to
ambulance arrival
Initial rhythm
15
37.5%
22
55%
Time of first shock
25
62.5%
ROSC (at hospital)
5
12.5%
By whom
Evidence for Change III Survey
How is your clinical audit data captured ?
Scanned into a database
Manually entered into a database
Electronically captured by computer
Not captured
14
18
1
2
(40%)
(51%)
(3%)
(6%)
How much data is captured and held on a database ?
Every patient record
All emergency records
Extended skill use only
Other (specify)
None/Blank
6 (17%) services only collect data for ad hoc audit projects.
1 (3%) service collects data for 10% of patient records
on top of extended skills.
6 (17%)
2 (6%)
14 (40%)
4 (11%)
9 (26%)
Recommendations
 The ASA NCEP to create a register of current patient report forms in use
by UK ambulance services.
 The ASA NCEP to create a register of other data collection methods in use
by ambulance services, including arrangements for data collection required
as part of the National Service Framework for Coronary Heart Disease
(CHD NSF).
 All ambulance services to adopt standard data collection procedures for the
CHD NSF through the use of the ASA/JRCALC clinical audit database for
prehospital cardiac care.
 All ambulance services to share best practice in patient report form design
and data collection, including the standardisation of codes used.
Recommendations cont.
 All ambulance services to revise the design of their patient report form
in terms of content in light of NSF's and JRCALC guidelines.
 All ambulance services to ensure data is collected for every patient
episode.
 The following principles should be adopted when redesigning patient
report forms:
a) Move towards real time data collection
b) Improve the efficiency and accuracy of data collected from
the PRF
c) Reduce 'waste' both on the form and in the processes of
collection and analysis i.e. remove anything that does not add
value or takes value away
d) Ensure the patient report form meets the needs of patient data
requirements e.g. NSF's and national guidelines
e) Reduce or eliminate the variation in the quality of data
collected, both between individual patient report forms and
between ambulance services
Other NHS Organisations
Royal College of Physicians (London)
Clinical Effectiveness Evaluation Unit
MINAP - Myocardial Infarction National Audit Project
CCAD - Central Cardiac Arrest Database
The Future
Accurate and Timely Information
- backbone of quality initiatives
Framework
- clinical governance/ professionalism
Clinical Audit
- benchmarking/ continual improvement
THE AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME
“Supporting Effective Clinical Practice”
www.asancep.org.uk
www.ambex.co.uk
www.jrcalc.org.uk