Ambulance Services Cardiovascular Quality Initiative findings published in Implementation Science

EMAS-PTS2_750The results of a national Quality Improvement Collaborative study, the Ambulance Services Cardiovascular Quality Initiative (ASCQI) were published this week in the international academic journal Implementation Science. The article entitled The effect of a national quality improvement collaborative on prehospital care for acute myocardial infaction and stroke in England showed large and significant improvements in the quality of care provided by 11 ambulance services (out of 12) in England for people with heart attack and stroke. Members of the CaHRU team involved in the study included Professor Siriwardena, Dr Zowie Davy and Fiona Togher together with visiting fellows at CaHRU who are members of the research team at EMAS including Anne Spaight, Debbie Shaw and Nadya Essam. Professor Michael Dewey, chair in epidemiological statistics in London was the statistician on the project.

EMAS - A&E 9The project has been part of a programme of work, Prehospital and Emergency Quality and Outcomes, developed through collaboration between academics from the Community and Health Research Unit and ambulance services across the United Kingdom, particularly East Midlands Ambulance Service NHS Trust (EMAS). This collaboration has enabled a strategic partnership between the University of Lincoln and EMAS to undertake research which is relevant to ambulance services, focusing on health issues of regional and national importance, and conducted with ambulance staff in order to increase the impact of the research by improving prehospital care for emergencies.

EMAS - A&E 6bThe study examined the period between January 2010 and February 2012. Across England overall, the percentage of emergency cases where care bundles (packages of essential care) were delivered in full increased from 43% to 79% for heart attack and from 83% to 96% for stroke. ASCQI supported frontline staff, and their management, to introduce improvements using checklists, aide memoires, individual and group feedback and sharing of information within and between different trusts to improve the reliability of care for people with heart attack and stroke. The project was shortlisted for an HSJ award in 2012.

 

Influenza as a trigger of cardiovascular events and the potential for influenza vaccination to prevent them

A further study, published in the Journal of Infectious Diseases, points to a link between influenza as a trigger of cardiovascular events, while presentations given in the past week in Toronto suggest that influenza vaccination might prevent such events.

Charlotte Warren-Gash and colleagues at the London School of  Hygiene and Tropical Medicine, have published a new study, “Influenza Infection and the Risk of Acute Myocardial Infarction in England and Wales: A CALIBER Self-Controlled Case Series Study”, which provides further evidence that influenza rather than other respiratory infections, trigger heart attacks. This is accompanied by an editorial in the same issue of the journal by Niroshan Siriwardena, “Increasing Evidence that Influenza is a Trigger for Cardiovascular Disease”.

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Community and Health Research Unit at SAPC and RCGP Annual Scientific Meeting, Glasgow

Members of the Community and Health Research Unit from the University of Lincoln recently attended the combined Society of Academic Primary Care and RCGP Annual Scientific Meeting in Glasgow where they were selected to give five oral presentations on some of the team’s current research into cardiovascular disease, adult vaccination and insomnia treatment. The conference provided a wonderful opportunity for junior and senior members of the team to present work at an international conference. 

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ASCQI presented at International Forum on Quality and Safety in Health Care in Paris, April

In April 2012 Professor Niro Siriwardena and Fiona Togher travelled to Paris with colleagues, Nadya Essam, Debbie Shaw (East Midlands Ambulance Service [EMAS]) and David Francis (East of England Ambulance Service) to attend the 17th International Forum on Quality and Safety in Healthcare.

The team presented work undertaken as part of the Ambulance Service Cardiovascular Quality Initiative (ASCQI) a two year nationwide project involving all 12 ambulance trusts in England and the University of Lincoln funded by the Health Foundation.

From the 2,000 poster submissions that were originally received, around 900 were selected for display following a two stage peer review process. Fiona, Nadya and Debbie were all invited to present their work during the poster presentation session held. This provided a brilliant opportunity to talk to interested delegates from around the world about the quality improvement work and research that is being undertaken at the University and East Midlands Ambulance Service.

Fiona Togher

Fiona represented the IS-PROVE team, which also includes Professor Siriwardena and Dr Zowie Davy. Their poster entitled “The importance of qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital and emergency care of stroke and heart attack” attracted attention from French, Swedish and American delegates that were keen to find out more. Nadya Presented on ergonomic redesign to improve care for heart attack and Debbie presented on ‘Joining the dots’ and the use of annotated control charts for quality improvement in ASCQI.

Debbie Shaw

With a tough act to follow from last years’ excellent event in Amsterdam, Paris was just as enjoyable,  thought provoking and inspiring. The key note speakers were again outstanding and captivated the audiences with their motivational reflections on working in health care and how to improve the quality of care provided to patients.

The opening keynote by Maureen Bisagnano from the Institute for Healthcare Improvement focused on goal oriented patient care, ‘what matters to patients’ and the redesign of services for patients. We heard about leadership from Dr David Williams, a Canadian professor of surgery who has been an astronaut and now leads a regional health organisation in Toronto.

Another highlight of the conference was the session entitled “Delivering better care to rural communities inAfrica” which focused on the application of quality improvement methods including Plan, Do, Study, Act cycles, to reducing asphyxia in newborn babies and mortality rates in children under the age of five. The success of the initiatives was amazing, more so because of the limited resources of equipment and manpower available.

Nadya Essam

One of the most inspiring speeches was given by Dr. Nancy Snyderman, who is not only a paediatrician and an ENT surgeon but also chief medical editor for NBC news in America – and an award winning journalist! Her speech focused on the importance of listening to patients and hearing what they are actually saying as opposed to what health care professionals presume they are saying. This central message resonated with what we are aiming to achieve through the patient experience studies that we are conducting in prehospital care in Lincoln and EMAS.

The take home message from this conference was that the application of quality improvement methodologies makes a real difference to the standard of care that is provided to patients; there were hundreds of examples of fantastic successes from around the world and in some instances the evidence translated to a significant contribution of quality improvement projects to saving lives.

Fiona Togher and Niro Siriwardena