JRCALC Conference 2004JRCALC Conference 20041010thth November 2004. Royal College of Physicians November 2004. Royal College of Physicians

JRCALC Conference 2004JRCALC Conference 20041010thth November 2004. Royal College of Physicians November 2004. Royal College of Physicians

Mark Cooke BMedSci(Hons) MSc

National Clinical Effectiveness Manager

Ambulance Service Association

Move towards National AuditMove towards National AuditMove towards National AuditMove towards National Audit

• 2002/4 ~ 12002/4 ~ 1stst ever national audit within NHS Ambulance Services ever national audit within NHS Ambulance Services– Patients presenting with ST Elevation/?AMI ~ Over 13,000 patients

• 2002/4 ~ National audit of prehospital thrombolysis2002/4 ~ National audit of prehospital thrombolysis– 92% in 60 mins ~ Mean ‘call to needle’ = 40 mins

• 2003/4 ~ 12003/4 ~ 1stst ever national audit of ‘OoH Cardiac Arrest’ in NHS ever national audit of ‘OoH Cardiac Arrest’ in NHS– Over 22,000 patients in first 6 months

• 2003/4 ~ National Audit of Benzyl Penicillin (2 yrs combined data)2003/4 ~ National Audit of Benzyl Penicillin (2 yrs combined data)– Report in Jan 2005

• 2002/4 ~ 12002/4 ~ 1stst ever national audit within NHS Ambulance Services ever national audit within NHS Ambulance Services– Patients presenting with ST Elevation/?AMI ~ Over 13,000 patients

• 2002/4 ~ National audit of prehospital thrombolysis2002/4 ~ National audit of prehospital thrombolysis– 92% in 60 mins ~ Mean ‘call to needle’ = 40 mins

• 2003/4 ~ 12003/4 ~ 1stst ever national audit of ‘OoH Cardiac Arrest’ in NHS ever national audit of ‘OoH Cardiac Arrest’ in NHS– Over 22,000 patients in first 6 months

• 2003/4 ~ National Audit of Benzyl Penicillin (2 yrs combined data)2003/4 ~ National Audit of Benzyl Penicillin (2 yrs combined data)– Report in Jan 2005

National Audit of ThrombolysisNational Audit of ThrombolysisNational Audit of ThrombolysisNational Audit of Thrombolysis

• 24/31 Services now providing thrombolysis24/31 Services now providing thrombolysis

• 4 more services planning introduction before end 20044 more services planning introduction before end 2004

• GMAS and LAS evaluating alternative approaches to GMAS and LAS evaluating alternative approaches to revascularizationrevascularization

• Over 1300 patients thrombolysed to dateOver 1300 patients thrombolysed to date

• 1070 patients during last 12 months1070 patients during last 12 months

• 24/31 Services now providing thrombolysis24/31 Services now providing thrombolysis

• 4 more services planning introduction before end 20044 more services planning introduction before end 2004

• GMAS and LAS evaluating alternative approaches to GMAS and LAS evaluating alternative approaches to revascularizationrevascularization

• Over 1300 patients thrombolysed to dateOver 1300 patients thrombolysed to date

• 1070 patients during last 12 months1070 patients during last 12 months

National Audit of ThrombolysisNational Audit of Thrombolysis

Thrombolysis Progress by Month

88145

179225

279349

461

644

864

1094

1349

0

200

400

600

800

1000

1200

1400

1600

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04

May-04

Jun-04

Jul-04

Aug-04

Sep-04

Oct-04

Nov-04

nu

mb

er t

hro

mb

oly

sed

Thrombolysis Progress by Month

88145

179225

279349

461

644

864

1094

1349

0

200

400

600

800

1000

1200

1400

1600

Mar-03

Apr-03

May-03

Jun-03

Jul-03

Aug-03

Sep-03

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04

May-04

Jun-04

Jul-04

Aug-04

Sep-04

Oct-04

Nov-04

nu

mb

er t

hro

mb

oly

sed

Ambulance Service Jan-04 Mar-04 May-04 Jul-04 Sep-04 Nov-04Agent

Avon - - 5 9 17 20 TNK

Beds & Herts 3 6 10 12 15 19 TNK

Cov & Warwickshire 10 12 14 15 20 26 TNK

Cumbria 5 6 8 9 13 15 TNK

Dorset 65 79 101 127 145 160 TNK

East Anglia 1 2 6 23 43 75 TNK

East Midlands 36 37 45 57 82 108 rPA

Essex 37 53 78 105 123 146 TNK

Gloucestershire - - 0 1 1 3 rPA

Hampshire - - - 0 0 0 TNK

Hereford & Worcs 36 40 50 73 85 97 TNK

Kent - - - 5 10 13 TNK

Lancashire - 5 32 51 78 101 TNK

Lincolnshire 5 5 6 11 15 19 rPA

Mersey 10 18 26 30 42 62 TNK

North East - - 0 0 1 2 TNK

Oxfordshire - - - - 0 0 rPA

Royal Berkshire 7 18 33 38 44 47 TNK

Staffordshire 125 155 194 244 284 330330 rPA

Sussex 1 3 6 10 14 18 rPA/TNK

Tenyas - - - 1 1 1 TNK

Two Shires 0 1 1 2 5 8 TNK

West Midlands 0 1 3 6 9 13 TNK

Westcountry 8 20 26 35 47 66 TNK

13491349

National Audit of ThrombolysisNational Audit of Thrombolysis

Clinical Performance IndicatorsClinical Performance IndicatorsClinical Performance IndicatorsClinical Performance Indicators

• Documented clinical care providedDocumented clinical care provided– JRCALC v3

• Like for like benchmarkingLike for like benchmarking

• Identification of best practice Identification of best practice – Areas for development ~ transferable lessons

• Documented clinical care providedDocumented clinical care provided– JRCALC v3

• Like for like benchmarkingLike for like benchmarking

• Identification of best practice Identification of best practice – Areas for development ~ transferable lessons

Clinical Outcome MeasuresClinical Outcome MeasuresClinical Outcome MeasuresClinical Outcome Measures

• Mortality as hard measure of performanceMortality as hard measure of performance

• PIAG approval / MINAP / ASA / CCAD / DHPIAG approval / MINAP / ASA / CCAD / DH– Access to patient outcome data

– Development of ambulance outcome database (ASA/MINAP)

• Lotus NotesLotus Notes– Fully funded as part of DH Funding to ASA

• Mortality as hard measure of performanceMortality as hard measure of performance

• PIAG approval / MINAP / ASA / CCAD / DHPIAG approval / MINAP / ASA / CCAD / DH– Access to patient outcome data

– Development of ambulance outcome database (ASA/MINAP)

• Lotus NotesLotus Notes– Fully funded as part of DH Funding to ASA

Ambulance Service PerformanceAmbulance Service PerformanceAmbulance Service PerformanceAmbulance Service Performance

• Now possible to collect more useful informationNow possible to collect more useful information

• A better and more useful indicator of ambulance A better and more useful indicator of ambulance service performance that reflects patient care service performance that reflects patient care

• 1. Speed of response1. Speed of response• 2. Clinical Care Provided2. Clinical Care Provided• 3. Clinical Outcome (alive/dead)3. Clinical Outcome (alive/dead)

• Now possible to collect more useful informationNow possible to collect more useful information

• A better and more useful indicator of ambulance A better and more useful indicator of ambulance service performance that reflects patient care service performance that reflects patient care

• 1. Speed of response1. Speed of response• 2. Clinical Care Provided2. Clinical Care Provided• 3. Clinical Outcome (alive/dead)3. Clinical Outcome (alive/dead)

What’s Next?What’s Next? National Audit of PAIN ManagementNational Audit of PAIN Management

2005/2006 ASA/JRCALC Workplan2005/2006 ASA/JRCALC Workplan

What’s Next?What’s Next? National Audit of PAIN ManagementNational Audit of PAIN Management

2005/2006 ASA/JRCALC Workplan2005/2006 ASA/JRCALC Workplan

• Patient SurveyPatient Survey• Pain AssessmentPain Assessment

– Documentation– Use of pain scores

• Pain ManagementPain Management– Use of analgesia

• Patient SurveyPatient Survey• Pain AssessmentPain Assessment

– Documentation– Use of pain scores

• Pain ManagementPain Management– Use of analgesia

ConclusionsConclusionsConclusionsConclusions

• The shift towards national audit and standardsThe shift towards national audit and standards– Working with senior key partners, DH, MINAP, HCC, NICE

– Engaging with member services

• Major headway madeMajor headway made– Milestones ~ National Benchmarking

• Priorities in line with national policy/guidancePriorities in line with national policy/guidance– NSFs (CHD, Older People, Children)

– NICE

• The shift towards national audit and standardsThe shift towards national audit and standards– Working with senior key partners, DH, MINAP, HCC, NICE

– Engaging with member services

• Major headway madeMajor headway made– Milestones ~ National Benchmarking

• Priorities in line with national policy/guidancePriorities in line with national policy/guidance– NSFs (CHD, Older People, Children)

– NICE

International DevelopmentsInternational DevelopmentsInternational DevelopmentsInternational Developments

Cochrane CollaborationCochrane Collaboration

Dedicated Dedicated Prehospital and Emergency HealthPrehospital and Emergency Health Field Field

Details atDetails at

www.cochranepehf.orgwww.cochranepehf.orgOr information flyers available here todayOr information flyers available here today

Cochrane CollaborationCochrane Collaboration

Dedicated Dedicated Prehospital and Emergency HealthPrehospital and Emergency Health Field Field

Details atDetails at

www.cochranepehf.orgwww.cochranepehf.orgOr information flyers available here todayOr information flyers available here today

Thank youThank youThank youThank you

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