2. S AA THE AMBULANCE SERVICE ASSOCIATION THE VOICE OF THE NH S AMBULANCE SERVICE NATIONAL CLINICAL EFFECTIVENESS PROGRAMME

3. Collecting the right data from the right forms at the right time STUART NICHOLLS Manager, ASA NCEP JRCALC Conference - 3 November 2000 - Towards a Unified Approach

4. Alternative titles: “Demonstrable improvement in the quality of NHS patient care” How to make possible what is desirable How can we measure that the NSF is working?

5. Aims and Objectives of the ASA NCEP Why ambulance services need to collect accurate and timely data Work programme Professionalism National Service Frameworks Evidence Base/ Guidelines Structure of the presentation Collecting the right data from the right forms at the right time

6. Aims & Objectives “Bringing pieces of the jigsaw together” “Supporting clinically effective practice” “Creating the Links” ASA National Clinical Effectiveness Programme (ASA NCEP)

7. “Bringing pieces of the jigsaw together”

8. To provide guidance and support to the development and implementation of clinical effectiveness education programmes To ensure the progression of clinical effectiveness within the UK ambulance service through consultation with local & national bodies To identify and agree national priorities for clinical effectiveness regimes To participate in the development of multi-disciplinary care pathways to ensure an integrated approach To contribute to the development and production of communication tools to serve the above objectives

9. “Supporting clinically effective practice”

10. Programme Web Site - audit database, links, publications, information,resources www.asancep.org.uk Training & Education - audit tools, workshops, evidence of best practice, surveys Regional Groups - share information locally, feed into national structure, collaborative & comparative projects Conferences - AMBEX 2000 - ASA/JRCALC - update skills & Knowledge, different perspectives Newsletter - CANDOUR - latest information, examples of good practice

11. “Creating the Links”

12. Clinical Audit Clinical Effectiveness Clinical Risk Clinical Governance Training Education Professional Self Regulation Improvement in the Quality of Care

13. what can we do to make things better? what are we trying to achieve? are we achieving it? why are we not achieving it? Clinical Audit cycle have we made things better? Research Effectiveness Evidence Risk Training & Education Clinical Governance How to make possible what is desirable

14. Why Ambulance Services should collect Accurate and Timely Information Patient Record Clinical Audit Clinical Effectiveness Clinical Governance

15. ASA/ JRCALC Minimum Data Set What is the minimum data set ? Backbone for implementing clinical governance Evidence base Comparable data

16. ASA/ JRCALC Minimum Data Set What the minimum data set is NOT ? Not an audit tool Not answer all information requirements Not a blue-print for PRF’s

17. ASA/ JRCALC Minimum Data Set What are the benefits ? Comparative clinical audit Integrated Care Pathways Risk Management Clinical Effectiveness

18. ASA/ JRCALC Minimum Data Set Examples : National Service Frameworks National Standards National Clinical Audits

19. ASA/ JRCALC Minimum Data Set What will happen if we do not implement the minimum data set ? Clinical Governance National Institute for Clinical Excellence Commission for Health Improvement

20. Plans 2000/2001 Professionalism ‘Self-regulation and continuing professional development are going to be the among the most challenging issues of the next few years’ ‘Health professionals will have to show that they are capable, competent and keeping up with current practice’ –Professor B Edwards, Chair CPSM

21. Plans 2000/2001 Professionalism 3 approaches –Log Book –Observing practice –Examination Clinical Audit

22. ASA/ JRCALC Minimum Data Set The role of the ASA National Clinical Effectiveness Programme Clinical Audit Projects Clinical Audit Tools Clinical Governance

23. Plans 2000/2001 Work plan –Develop a Code of Practice for prehospital record keeping and data collection –ASA/JRCALC Minimum Data Set – Review of Compliance –Develop a rolling programme of audit –Develop audit tools around agreed standards

24. An action plan for saving lives A comprehensive health strategy for England

25. Four priority areas Cancer Coronary heart disease & stroke Accidents Mental health

26. Measuring & monitoring progress Tough national targets Tailored local targets Strong performance management Regular reviews

27. Coronary heart disease & stroke Target for 2010 To reduce the death rate from coronary heart disease and stroke & related diseases in people under 75 by at least two fifths

29. NSF's will : set national standards and define service models for a specific service or care group put in place programmes to support implementation establish performance indicators against which progress within an agreed timescale will be measured.

30. Ambulance trusts: milestones and goal Heart attack (AMI & ACS) October 2000 The ambulance service has an effective means for setting service clinical standards for common conditions. The ambulance service has a systematic approach to determining whether agreed clinical standards are being met. April 2001 The ambulance service has an agreed service-wide protocol for the management of suspected AMI. April 2002 The ambulance service has clinical audit data no more than 12 months old that describe all the relevant items listed in the AMI chapter. NSF goal Every ambulance service should offer complete and correct packages of audited effective interventions to all people assessed as having a suspected AMI, demonstrated by clinical audit data no more than 12 months old.

31. % Category A calls to emergency services attended within 8 minutes of a call for professional help by a trained individual with a defibrillator number and % of patients eligible for thrombolysis arriving at hospital within 30 minutes of call for professional help (‘call to door’ time) number and % of patients eligible for thrombolysis receiving it within 20 minutes of arrival at hospital (‘door to needle time’) number and % of patients eligible for thrombolysis receiving it within 60 minutes of call for professional help (‘call to needle time’)

32. number and % of adult patients with out-of-hospital, non- traumatic cardiac arrest who reach hospital alive and survive to leave hospital number and % of patients with suspected AMI, given at least 300 mg aspirin within 60 minutes of call for professional help

33. NSF CHD Cat A response times Pre-arrival instructions Evidence based practice for MI, cardiac arrest Integrated Care Pathways Clinical Effectiveness outcomes Multi disciplinary audit Clinical Risk Management Record keeping Patient Report Form with min/data set for cardiac patients Patient/public involvement Community CPR Clinical Governance in Practice

34. 86 (median)50% range Boxplot showing range of data collected on ambulance service patient report forms Maximum of 270 fields (JRCALC/ASA Minimum Data Set)

35. Frequency of data collected as required to monitor the prehospital management of acute coronary heart disease (sample)

36. How is your clinical audit data captured ? Scanned into a database 14 (40%) Manually entered into a database18 (51%) Electronically captured by computer 1 (3%) Not captured 2 (6%) How much data is captured and held on a database ? Every patient record 6 (17%) All emergency records 2 (6%) Extended skill use only14 (40%) Other (specify) 4 (11%) None/Blank 9 (26%) 6 (17%) services only collect data for ad hoc audit projects. 1 (3%) service collects data for 10% of patient records on top of extended skills. Evidence for Change III Survey

37. Recommendations  The ASA NCEP to create a register of current patient report forms in use by UK ambulance services.  The ASA NCEP to create a register of other data collection methods in use by ambulance services, including arrangements for data collection required as part of the National Service Framework for Coronary Heart Disease (CHD NSF).  All ambulance services to adopt standard data collection procedures for the CHD NSF through the use of the ASA/JRCALC clinical audit database for prehospital cardiac care.  All ambulance services to share best practice in patient report form design and data collection, including the standardisation of codes used.

38. Recommendations cont.  All ambulance services to revise the design of their patient report form in terms of content in light of NSF's and JRCALC guidelines.  All ambulance services to ensure data is collected for every patient episode.  The following principles should be adopted when redesigning patient report forms: a) Move towards real time data collection b) Improve the efficiency and accuracy of data collected from the PRF c) Reduce 'waste' both on the form and in the processes of collection and analysis i.e. remove anything that does not add value or takes value away d) Ensure the patient report form meets the needs of patient data requirements e.g. NSF's and national guidelines e) Reduce or eliminate the variation in the quality of data collected, both between individual patient report forms and between ambulance services

39. Other NHS Organisations

40. Royal College of Physicians (London) Clinical Effectiveness Evaluation Unit MINAP - Myocardial Infarction National Audit Project CCAD - Central Cardiac Arrest Database

43. The Future Accurate and Timely Information - backbone of quality initiatives Framework - clinical governance/ professionalism Clinical Audit - benchmarking/ continual improvement

44. THE AMBULANCE SERVICE ASSOCIATION NATIONAL CLINICAL EFFECTIVENESS PROGRAMME www.asancep.org.uk www.ambex.co.ukwww.jrcalc.org.uk “Supporting Effective Clinical Practice”