New paper published on contextual factors for quality improvement in ambulance services

EMAS - A&E 5_750A new study from CaHRU is published this month in the Journal of Evaluation in Clinical Practice entitled ‘Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey’.

EMAS - A&E 9_750The study, involving a research team from CaHRU including Viet-Hai Phung, Nadya Essam, Dr Zahid Asghar and Professor Niro Siriwardena together with Anne Spaight from East Midlands Ambulance Service NHS Trust, explored clinical leadership and organisational culture and clinical engagement in quality improvement (QI) in the Ambulance Service Cardiovascular Quality Initiative, a QI collaborative involving all twelve ambulance services in England.

EMAS - PTS 2_750The study included a survey and qualitative analysis of free text responses from paramedics. Although paramedics perceived their organisations to have low levels of clinical leadership and culture of innovation overall, leadership behaviour and uptake of QI methods was significantly greater in those respondents who were directly involved in ASCQI. The QI collaborative led to significant improvements in prehospital care for acute myocardial infarction and stroke which may have been mediated through an improvement subculture linked to the QI collaborative.

New evidence synthesis on effectiveness of different models of delivering urgent care published

vhp2A new study ‘What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review‘ was published this month, and included CaHRU’s Viet-Hai Phung as one of the report co-authors. Over the last 15 years, The NHS has undertaken many reviews of urgent care. It has also recommended service delivery changes to improve access to, and the quality of, urgent care. Despite this, rising demand continues to strain the emergency and urgent care system.

NIn response, the National Institute for Health Research’s (NIHR) Health Services and Delivery Research (HSDR) programme commissioned this report from the University of Sheffield’s ScHARR as part of a wider series of evidence syntheses. The report contains five separate reviews linked to themes in the NHS England review – demand for urgent and emergency care; telephone triage and advice; ambulance clinicians managing patients with urgent conditions; delivering Emergency Department (ED) services; and emergency and urgent care networks. Alongside this, the team conducted systematic reviews and quality assessed additional primary research papers.

NThe key findings for each review were:

  • There is little empirical evidence to explain increases in demand for urgent care;
  • Telephone triage services provide appropriate and safe decision making with high patient satisfaction but the required clinical skill mix and effectiveness in a system is unclear;
  • Extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transport to hospital;
  • There is potential for GP services co-located within the ED to improve care;
  • No empirical evidence exists to support the design and development of urgent care networks.

The rapid review assessed the existing evidence base on delivering emergency and urgent care services. The research also identified two major gaps that further research needs to investigate. Firstly, we need to assess the current state of the urgent care. Secondly, we need to have a better understanding of the nature of demand, which can then be used to inform service delivery improvements.

Viet-Hai Phung

CaHRU to contribute to Institute for Healthcare Improvement Web and Action on Improving Prehospital Emergency Care

NProfessor Niro Siriwardena will join Dave Williams and EMS leaders from the United States and abroad, conducting pioneering work in the field of prehospital quality improvement, for an Institute for Healthcare Improvement Web and Action on Improving Prehospital Emergency Care the spring (March and April 2015). The Web and Action will consist of five sessions over the next two months.

NIn Session One, Introduction to Improving Prehospital Emergency Care Systems (Thursday, March 5, 2015, 12:00 PM – 1:00 PM Eastern Time), David Williams and Kedar Mate will introduce the agenda for the Web & Action Series, providing an overview of the history of ambulance service, the current state of the profession and improvement opportunities for prehospital care. Jerry Overton and Paul Gowens join Session Two, Early Identification of Deteriorating Patients (Thursday, March 19, 20, 12:00 PM – 1:00 PM ET), introduce the concept of early identification, resource allocation, and intervention and present the use of a prehospital early warning score to identify prehospital patients who are deteriorating (e.g., sepsis) to expedite transport, intervention, and emergency department notification.

NProf Niro Siriwardena and Jonathan Studnek present key care pathways for improving core prehospital care processes and outcomes in Session Three, Key Care Pathways – Change Package and Measurement of Time Sensitive Conditions (Thursday, April 2, 2015, 12:00 PM – 1:00 PM ET). They go on to discuss the development of a change package and measurement strategy in the NHS England Ambulance Trusts and profile case examples of improving care reliability in stroke and STEMI in the U.S. and U.K.

NIn Session Four, Prehospital Emergency Care Trigger Tool (Thursday, April 16, 2015, 12:00 PM – 1:00 PM ET), Loua Al Shaikh introduces the concept of trigger tools and the application the prehospital care ecosystem. Finally, Mike Taigman and Brenda Staffan lead Session Five, Paramedic Care in the Community (Thursday, April 30, 2015, 12:00 PM – 1:00 PM ET) where they define the emerging opportunity of utilising paramedics in the community through prevention, partnerships, intervention, and post discharge care.

Research from CaHRU helping to improve prehospital care around the world

EMAS - A&E 5_750Research undertaken by CaHRU with East Midlands Ambulance Service and other English ambulance services which has led to improvements in care in the UK is having an impact on improvement efforts in North America and the Middle East according to an article published in EMS World, ‘Improving Prehospital Care Around the World‘ by Dr David Williams CEO of Medic Health, improvement advisor and lead prehospital care and ambulance service system faculty at the prestigious Institute for Healthcare Improvement in the United States.

ascqilogoCaHRU’s work has informed improvement efforts in the United States such as American Medical Response’s Caring for Maria improvement collaborative and the EMS performance measures initiative in partnership with the National Highway Traffic Safety Administration and the National Association of State EMS Officials. It has also informed ongoing innovation work in United States and Middle East at the Institute for Healthcare Improvement.

EMAS - A&E 9_750The research which led to development of national indicators for English ambulance services and improvements in prehospital care for heart attack and stroke through the Ambulance Services Cardiovascular Quality Initiative is having worldwide impact.

Ambulance Services Cardiovascular Quality Initiative resources now online

ascqilogoThe new Ambulance Services Cardiovascular Quality Initiative (ASCQI) website was launched this month. The website describes how the ASCQI project, funded by the Health Foundation’s Closing the Gap in Clinical Communities Programme, achieved its aims as the first national quality improvement collaborative involving all English ambulance services.

The aims of ASCQI were to improve ambulance care for heart attack and stroke across England and specifically:

  • To improve the delivery of care bundles for AMI from 43% to over 70% within two years of the project
  • To improve delivery of care bundles for stroke from 83% to over 90% within two years of the project
  • To increase diffusion of quality improvement methods to frontline staff in ambulance services.

EMAS - A&E 5_750As a result of the collaborative nine out of twelve ambulance trusts showed a significant improvement in either the stroke or AMI care bundle, and seven out of twelve showed significant improvements for both AMI and stroke. Performance for the care bundle for AMI increased from 43 percent to 79 percent, and for stroke 83 percent to 96 percent during the two years of the project and these improvements have been maintained. These results were published in the journal Implementation Science. A secondary aim of the initiative was to begin to develop patient reported experience measures (PREMs) for AMI and stroke. Preliminary qualitative work for development of PREMS for ambulance services was published in the EMJ, and this work is being continued by Fiona Togher of CaHRU through a funded doctoral study.

EMAS - A&E 9_750The website includes a range of resources which were used by ambulance services to deliver the improvements that we saw nationally. The work is now helping to inform similar prehospital improvement initiatives in the Middle East and North America and will be featured in a session on key care pathways in a Web and Action webinar series developed by the Institute for Healthcare Improvement, a world leader in healthcare quality improvement based in the United States, starting in March 2015.