Matched Data and Pre- Hospital Risk Management Sophie Clark The London Ambulance Service

Patient Journey Through LAS Data Collected on the Telephone Data Collected by the Clinician on Scene Clinician gives data to hospital... Hear and Treat (4%) See and Treat (30%)

No data available....

Risks of Limited Outcome Data No integration between services No method of corroborating the accuracy of LAS findings No understanding of the outcomes of conveyed patients or the care provided at A&E Paramedics denied lessons about identifying and caring for the acutely unwell No method to track patients in high risk groups, such as patients who die in A&E. Lack of data = Unknown (unmitigated) Risks

Cardiac Arrest Outcomes

= Patient Outcome Project

Responding Appropriately 43% of patients that are discharged from A&E are getting a response within 8 minutes. But 29% of patients who die in A&E do not get a response within 8 minutes. 11% of patients that will die in A&E are waiting over 30 minutes for an ambulance. Non-urgent patients are over triaged to the detriment of acutely unwell patients.

To reduce the risk of acutely unwell patients waiting for an ambulance. Responding Appropriately

Alcohol Intoxication Vasovagal Syncope UTI Minor Head Injury Viral Gastro- enteritis Lower Back Pain ACS COPD Gastritis LRTI Grand Mal Epilepsy C hest Pain Trop Negative Nervous System Disorder Depression Asthma Constipation Consto- chondritis Arrhythmia Other Abdo Pain – No Cause Wound Head Wound Face Mixed Overdose Minor Head Inj Urinary Tract Calculus Allergy Other Bone Joint Disorder Infectious Gastro- enteritis Reflux CCF AF Broncho- Pneumonia Epistaxis URTI Migraine Cellulitis Alcohol Dependence Hypo No Coma Postural Hypotension Shoulder Dislocation Thorax Inj TIA C-Spine Sprain Acute Confusion Face Contusion /Bruise NOF Stable Angina Knee Sprain Catheter Problem Alcohol Withdraw Pneumonia T2DM Results Only Palpitations Headache PD Neck Muscle Inj Dementia Stroke Alcoholic Gastritis PE Alcohol Sciatica Urine Retention  BP Colic Renal Failure Anaemia Infection BPR Schizophrenia Lumbar Sprain Ankle Sprain DVT Leg Wound Leg Bruise Home- less ♯ Humerus SVT Multiple Falls ACS Labyrinthitis GI Bleed Vertigo Tonsillitis Epilepsy Pancreatitis Bowel Obstruction Sepsis Osteo- arthritis Pseudo- seizure Headache Electrolyte Disorder Arthritis Pul- Oedema Bruise Foot Arm Wound ♯ Shoulder Left Before Being Seen Other Respiratory Disorder Admittance Rate By Sophie Clark

Alcohol Intoxication Vasovagal Syncope UTI Minor Head Injury Viral Gastro- enteritis Lower Back Pain ACS COPD Gastritis LRTI Grand Mal Epilepsy C hest Pain Trop Negative Nervous System Disorder Depression Asthma Constipation Consto- chondritis Arrhythmia Other Abdo Pain – No Cause Wound Head Wound Face Mixed Overdose Minor Head Inj Urinary Tract Calculus Allergy Other Bone Joint Disorder Infectious Gastro- enteritis Reflux CCF AF Broncho- Pneumonia Epistaxis URTI Migraine Cellulitis Alcohol Dependence Hypo No Coma Postural Hypotension Shoulder Dislocation Thorax Inj TIA C-Spine Sprain Acute Confusion Face Contusion /Bruise NOF Stable Angina Knee Sprain Catheter Problem Alcohol Withdraw Pneumonia T2DM Results Only Palpitations Headache PD Neck Muscle Inj Dementia Stroke Alcoholic Gastritis PE Alcohol Sciatica Urine Retention  BP Colic Renal Failure Anaemia Infection BPR Schizophrenia Lumbar Sprain Ankle Sprain DVT Leg Wound Leg Bruise Home- less ♯ Humerus SVT Multiple Falls ACS Labyrinthitis GI Bleed Vertigo Tonsillitis Epilepsy Pancreatitis Bowel Obstruction Sepsis Osteo- arthritis Pseudo- seizure Headache Electrolyte Disorder Arthritis Pul- Oedema Bruise Foot Arm Wound ♯ Shoulder Left Before Being Seen Other Respiratory Disorder Admittance Rate By Sophie Clark

Alcohol Intoxication Sepsis Left Before Being Seen Closed Fracture Neck of Femur Call Category Telephone Chief Complaint LAS Response time

Linked data is not routine practice in LAS This leads to a potential lack of integration and unmitigated risks. Linked data can aid understanding and quantifying the risks. Linked data can help safe decision-making at telephone triage and on scene. Defining a safe service? Conclusion This is only the start…..

Questions? Thank you for listening