A paper published by the CaHRU team in the journal Implementation Science, ‘The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England‘ came top in the journal’s measures of social media circulation (altmetrics) in 2014.
The study was funded as part of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) by the Health Foundation under their Closing the Gap in Clinical Communities programme and led to improvements in care for heart attack and stroke in England. More recently the ASCQI team have been funded by the Health Foundation under their Widening Improvement programme to spread the learning from ASCQI to other clinical areas in ambulance services in the Improving Prehospital and Ambulance Care and Treatment following ASCQI (ImPACT-ASCQI) project. This work was presented recently at the EMS99 Forum conference in Nottingham.
The findings from ASCQI and resources are also being disseminated in a new website and the result are having impact in other areas of the world such as Quatar and the United States.
Research 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.
CaHRU’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.
The 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.
The 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.
As 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.
The 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.
A new study focusing on decision making by paramedic and specialist paramedic staff and conducted in three English National Health Service (NHS) Ambulance Service Trusts was published this month. The study, entitled ‘A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety‘ published in the Journal of Health Services Research and Policy was led by Dr Rachel O’Hara from ScHARR at the University of Sheffield and included Professor Niro Siriwardena, director of CaHRU, and Debbie Shaw, visiting fellow at CaHRU, and both members of the East Midlands Ambulance Research Alliance at East Midlands Ambulance Service NHS Trust.
The study involved observation and interviews, analysis of digital diaries and focus groups with paramedic staff. Different types of decision were identified, ranging from the decision to convey a patient to the emergency department, use of specialist emergency pathways or the decision to treat and leave a patient at home. Systemic influences and risk factors affecting decision making included demand, performance priorities, access to care options, risk tolerance, training, communication, feedback and resources.
The study highlighted the complexity of paramedic decision making and system factors which could worsen risk. Decision making has been studied in other settings but rarely in the prehospital environment, and the uncertainty which paramedics have to face when making decisions needs further work. The study forms part of the Prehospital Emergencies Quality and Outcomes programme at CaHRU.