A A S THE AMBULANCE SERVICEASSOCIATION 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” 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” 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” Improvement in the Quality of Care Clinical Audit Training Clinical Effectiveness Education Professional Self Regulation Clinical Risk Clinical Governance
what are we trying to achieve? How to make possible what is desirable Effectiveness Research Clinical Audit cycle have we made things better? are we achieving it? Training & Education Clinical Governance Evidence what can we do to make things better? 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/ JRCALCMinimum Data Set What is the minimum data set ? • Backbone for implementing clinical governance • Evidence base • Comparable data
ASA/ JRCALCMinimum 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/ JRCALCMinimum Data Set What are the benefits ? • Comparative clinical audit • Integrated Care Pathways • Risk Management • Clinical Effectiveness
ASA/ JRCALCMinimum Data Set Examples : • National Service Frameworks • National Standards • National Clinical Audits
ASA/ JRCALCMinimum 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/ JRCALCMinimum 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, non-traumatic 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 Integrated Care Pathways Record keeping Patient Report Form with min/data set for cardiac patients NSF CHD Patient/public involvement Community CPR Clinical Effectiveness outcomes Clinical Risk Management Multi disciplinary audit
50% range 86 (median) Boxplot showing range of data collected on ambulance service patient report forms Maximum of 270 fields (JRCALC/ASA Minimum Data Set)
Frequency of data collected as required to monitor the prehospital management ofacute coronary heart disease (sample)
Evidence for Change III Survey How is your clinical audit data captured ? Scanned into a database 14 (40%) Manually entered into a database 18 (51%) Electronically captured by computer 1 (3%) Not captured 2 (6%) How much data is captured and held on a database ? Every patient record 6 (17%) All emergency records 2 (6%) Extended skill use only 14 (40%) Other (specify) 4 (11%) None/Blank 9 (26%) 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.
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
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 SERVICEASSOCIATION NATIONAL CLINICAL EFFECTIVENESS PROGRAMME “Supporting Effective Clinical Practice” www.asancep.org.uk www.ambex.co.uk www.jrcalc.org.uk