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.
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.
Professor Niro Siriwardena and the CaHRU team have been awarded a major grant from the Health Foundation under their Scaling Up Improvement programme. The project is led by Lincolnshire Community Health Services NHS Trust supported by the University of Lincoln, University of Nottingham, the East Midlands Academic Health Science Network and 17 of the region’s Clinical Commissioning Groups.
The aim of the study is to spread an intervention called PINCER (pharmacist-led information technology intervention for reducing clinically important errors in medication management) across East Midlands general practices and then more widely across the United Kingdom using a quality improvement collaborative, a model which CaHRU have used in previous projects.
The project will provide participating GP practices access to computer software that automatically reviews prescriptions together with expert support from a pharmacist who will work with practice staff to review prescriptions and drugs monitoring. This will reduce the risk of drug errors and failure to monitor, particularly in those people with more than one long term condition on a combination of drugs. Pharmacists and GPs will share learning as part of the project.
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.