A team from CaHRU including Prof Niro Siriwardena, Fiona Togher and Viet-Hai Phung were represented at the EMS999 Research Forum Conference on Quality Improvement and Innovation Research in Prehospital Care in Nottingham on 4th February 2015. The conference, supported by the Health Foundation through their Spreading Improvement Programme, brought together the latest research and best practice in prehospital care. The conference featured several posters from ambulance services in England participating in the IMPACT-ASCQI project led by CaHRU.
Professor Siriwardena kicked off the Conference with a keynote lecture on the evolution of quality improvement in prehospital care, ‘Prehospital quality improvement; past, present and future‘ which, innovatively, used some familial anecdotes to illustrate the links between principles of quality improvement and lessons for life!
Following the keynote was Richard Pilbery from Yorkshire Ambulance Service to talk about his experiences of speaking at the Paramedics Australasia Conference on the Australian Gold Coast. This was the prize that Richard won at last year’s EMS 999 Research Forum for producing the best poster. Following the first session, Matthew Booker from the University of Bristol presented his work on why ambulances are called for primary care problems followed by Mohammed Iqbal from EMAS on development of a novel pain assessment tool for improving prehospital pain management. Both presentations generated much interest, with Matthew winning the prize for best presentation at the end of the day.
Just before lunch, Fiona Togher presented her poster, which showcased her doctoral study on development of patient-related experience measures for the ambulance service. The presentation was both well-delivered and well-received, with some thoughtful questions from the audience in response. In the afternoon, there was a workshop presented by Niro Siriwardena with Janette Turner from ScHARR on ‘Disseminating and Publishing Improvement Research’. This workshop was useful for all those with an interest in publishing articles, dealing with a number of themes including how to structure an article to which journals it should be pitched at.
The range and content of the posters and presentations demonstrated the continuing importance of the EMS 999 Research Forum for anyone with an interest in undertaking research in prehospital care.
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 e-learning website ‘QI Learning‘ has been launched by CaHRU as an introduction to quality improvement for health and social care professionals. The e-learning programme is based on CaHRU’s work on quality improvement and covers four main areas: managing quality, tools and techniques, evaluation and improving practice.
QI learning was developed with the BrandFour Design Agency as part of the ImPACT-ASCQI project, with support from the Health Foundation’s Widening Improvement Programme, based on a new book by Steve Gillam and Niro Siriwardena, ‘Quality improvement in primary care‘ published by Radcliffe Publishing in 2014. Also included in the resources section of the e-learning programme are a series of webinars which build on this material. The aim of the programme is to foster a sustainable and long-term increase in quality improvement knowledge and skills to the wider community of healthcare (medical, nursing and allied health) staff .
The programme also includes an evaluation and self-assessment for learners to complete and print out a certificate of learning.