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.
The next pre-hospital, emergency and trauma care conference which brings together the latest research and practice in ambulance and prehospital care will take place on 4 February 2015 at Nottingham Conference Centre organised by TRUST (the Thematic Research Network for UnScheduled and Trauma Care), the University of Lincoln, East Midlands Ambulance Service and the 999 EMS Research Forum.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/10/2015-conference.pdf” height=”820″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
The invitation for abstracts for oral and poster presentations at the conference are now open with a deadline for submission of 14 November 2014. A prize of a funded trip to present work at an international conference will be awarded to the presentation judged to be highest quality research. Other prizes will be awarded for research most likely to affect practice and best poster.
The conference is relevant to healthcare practitioners (paramedics, doctors, nurses), health service managers, policy makers and academics. Conference registration (fee £40) will include access to all presentations and workshops, refreshments and lunch.
To download the submission and guidance form, please click here.
To register contact Susan Bowler: firstname.lastname@example.org
Online registration click here
Researchers from CaHRU with colleagues from the School of Health and Related Research (ScHARR) at the University of Sheffield have published a new study: “Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study” in the journal Health Expectations. The study’s lead author was Fiona Togher, PhD student and Graduate Research Assistant in CaHRU. She was supported in the work by Alicia O’Cathain, Professor of Health Services Research at the University of Sheffield, Viet-Hai Phung, Research Assistant in CaHRU, Janette Turner, Research Fellow at the University of Sheffield and Professor Niro Siriwardena, director of CaHRU. The study is part of a five year NIHR Programme for Applied Health Research, Prehospital Outcomes for Evidence Based Evaluation (PhOEBE).
The authors aimed to investigate the aspects of emergency ambulance care that were most valued by users of the service. Fiona and Viet-Hai interviewed people (patients and carers) that had used the ambulance service for a range of different conditions such as diabetes, suspected stroke, breathing difficulties and falls. The participants had also received various types of ambulance service response i.e. ‘hear and treat’ in which the participants received enhanced clinical assessment and advice over the telephone only, ‘see and treat’ in which the participants were treated on-scene by appropriately skilled clinicians without the need for hospital admission and the more familiar, ‘see and convey’ in which the participants received pre-hospital assessment and treatment before transportation to acute care.
The authors found that regardless of their specific clinical problem people valued similar aspects of their emergency ambulance service experience. Participants had often been extremely anxious about their health, and they most valued the reassurance they felt from receiving appropriate advice, treatment and care from ambulance service staff. It was found that the ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service.
The qualitative interview data collected from this research is now being re-analysed as part of Fiona’s doctoral studies to develop a Patient Reported Experience Measure (PREM) for use in UK ambulance services.