Meet the team!

PhOEBE Patient and Public Involvement Day

Ambulance service quality

What matters to you?

4th June 2014

Meet the team!

Janette Turner

Joanne Coster

Richard Wilson Andy Irving

Andrea Broadway-Parkinson

Maggie Marsh

Dan Fall

Viet-Hai Phung

Dan Bradbury

What is PhOEBE?

• 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.

Why is this important?

Why it is important

• 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

Aims & objectivesof today

1. Meet the PhOEBE research team 2. Understand the PhOEBE process so far3. Have an opportunity to discuss shortlisted measures4. Choose the measure in each category which is most

important to you5. Feel that you have been involved and your view has

been listened to6. 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.

Today’s Programme

Time Session 10:00 - 10:30 Arrival and coffee10:30 – 11:00 Welcome, introductions and how we'll work11:00 – 12:00 Patient Outcomes votes x 312:00 - 12:20 Coffee12:20 – 13:00 Clinical Management Measures votes x 213:00 – 13:45 Lunch 13:45 -14:45 Whole Service Measures votes x 314:45 – 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

Voting process8 votes in 3 groups

Patient Outcomes1. Pain2. Survival 3 Re-Contacts

Clinical Management Measures4. Accuracy of triage5. Compliance with protocols

Whole Service Measures6. Time (Definitive care)7. Time (Response) 8. Accuracy of call identification & Assessment

Voting test! Question: Who is going to win the World Cup!?

Answer:1. England! 2. Brazil3. Spain4. I don’t care!

Today’s Programme



Patient outcome measures

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.

Patient Outcomes

1. Pain 2. Survival 3. Re-contacts

Pain 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

Pain 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

Survival 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)

Survival 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

Re-contactsWhat 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

Re-contacts 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

Coffee break

Today’s Programme



Clinical ManagementMeasures

What makes clinical management measures important?

• Triage

• Accuracy

• Call categories

Clinical Management Measures

1. Appropriateness and accuracy of triage

2. Compliance with protocols and guideline

Appropriatenessand accuracy of triage

Appropriatenessand 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.

Lunch 1 – 1:45pm

Today’s Programme



Whole service measures

1. Time measures

2. Accuracy of call identification

Time measuresHow 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

Time measures(Definitive care)

Number Time measures (Definitive care)

1 Proportion of eligible patients who arrive at definitive care within agreed timescales

2 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

Time measures (Response time)

Number Time measures (Response time)

1 Proportion of emergency calls for conditions that are not life-threatening with a response time of 30 minutes or less

2 Proportion of emergency calls with a response time within an agreed standard for calls for life-threatening conditions

3 Proportion of emergency calls with a response time within an agreed standard

Accuracy of call identification and assessment

• 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 Accuracy of call identification and assessment

1 Number of life-threatening (category A) calls not identified as category A as a proportion of all 999 calls

2 Number of calls that are not life-threatening identified as category A calls as a proportion of all 999 calls

3 Proportion of calls transferred for telephone clinical advice that are completed with self-care advice or referral to an appropriate service

4 Proportion of category A calls attended by a paramedic

5 Proportion of patients who are treated on scene or left at home who are referred to an appropriate pathway or primary care

6 Proportion of patients transported to ED by 999 emergency ambulance and discharged without treatment or investigation(s) that needed hospital facilities

7 Proportion of patients who potentially could be left at home who are successfully discharged at the scene.

Comfort break 14:45 – 15:15(receive your expenses &

grab a coffee to bring into the room)

EvaluationYes = 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

Thank you!

For further information Email: [email protected]: Andy Irving, The PhOEBE Project, The

University of Sheffield, Regent Court, 30 Regent St,

Sheffield, S1 1DA. Tel: 0114 2224292. Fax: 0114 2220749

Meet the team!

Documents

Transcript of Meet the team!