PhOEBE - University of Sheffield

Report
PhOEBE
Patient and Public Involvement Day
Ambulance service quality
What matters to you?
4th June 2014
Meet the team!
Janette Turner
Joanne Coster
Richard Wilson
Andrea BroadwayParkinson
Maggie Marsh
Dan Fall
Viet-Hai Phung
Dan Bradbury
Andy Irving
What is PhOEBE?
• Develop better ways of
measuring the
performance, quality
and impact of
ambulance service care.
• Prioritisation of
outcome measures.
• Provide better
information about
effectiveness and quality
of care.
Why is this important?
Why it is important
• The ambulance service is a gateway for many
people with a range of health problems
• Everyone should think they are getting the
best service that can be offered
• Measuring how well services are doing allows
us to ensure this happens – identifies good
and bad
• Also helps us assess whether new innovations
are working and worthwhile
Aims & objectives
of today
1.
2.
3.
4.
Meet the PhOEBE research team
Understand the PhOEBE process so far
Have an opportunity to discuss shortlisted measures
Choose the measure in each category which is most
important to you
5. Feel that you have been involved and your view has
been listened to
6. Understand how this day contributes to the process of
selecting emergency ambulance quality measures.
7. Understand how the measures selected will be used in
the next steps of the PhOEBE project.
Today’s Programme
Time
Session
10:00 - 10:30
Arrival and coffee
10:30 – 11:00
Welcome, introductions and how we'll work
11:00 – 12:00
Patient Outcomes votes x 3
12:00 - 12:20
Coffee
12:20 – 13:00
Clinical Management Measures votes x 2
13:00 – 13:45
Lunch
13:45 -14:45
Whole Service Measures votes x 3
14:45 – 15:15
Comfort break (receive your expenses & grab a coffee to
bring into the room)
15:15 - 15:30
Summary, next steps, evaluation and close
Voting process
8 votes in 3 groups
Patient Outcomes
1. Pain
2. Survival
3 Re-Contacts
Clinical Management Measures
4. Accuracy of triage
5. Compliance with protocols
Whole Service Measures
6. Time (Definitive care)
7. Time (Response)
8. Accuracy of call identification & Assessment
Voting test!
Question:
Who is going to win
the World Cup!?
Answer:
1. England!
2. Brazil
3. Spain
4. I don’t care!
Today’s Programme
Time
Session
10:00 - 10:30
Arrival and coffee
10:30 – 11:00
Welcome, introductions and how we'll work
11:00 – 12:00
Patient Outcomes votes x 3
12:00 - 12:20
Coffee
12:20 – 13:00
Clinical Management Measures votes x 2
13:00 – 13:45
Lunch
13:45 -14:45
Whole Service Measures votes x 3
14:45 – 15:15
Comfort break (receive your expenses & grab a coffee to
bring into the room)
15:15 - 15:30
Summary, next steps, evaluation and close
Patient outcome measures
What are patient outcomes?
• Capture the effects, consequences or impact
(good or bad) of care provided
• Direct e.g. survival, disability, reduction in pain
• May reflect people’s views and opinions about
the care they received.
Patient Outcomes
1. Pain
2. Survival
3. Re-contacts
Pain
Why do we measure pain?
• Pain is a major issue for people who are ill or injured
• Pain management - recognising patient pain
• Providing proportionate pain relief
• Pain relief drugs or e.g. applying splints to fractures
Pain
Number
Pain measures
1
Proportion of patients who report pain who are given
analgesia (pain relief)
2
Proportion of all patients seen by an ambulance crew
who have a pain assessment recorded
3
Proportion of patients reporting pain who have more
than one pain score recorded
4
Proportion of patients who have a reduction in pain
score after analgesia treatment
Survival
Why do we measure survival ?
• May indicate how well an ambulance service is
performing
• Illness or injury may be so serious a patient cannot be
saved
• Important to take this into account. Cardiac arrest - very
small chance of surviving, stubbed toe – should be OK
• Many ways survival can be measured (all patients,
specific groups of patients, and at different time points
after health problem)
Survival
Number
Survival measures
1 Proportion of patients with cardiac arrest where
resuscitation is attempted at the incident scene who have a
pulse on arrival at the emergency department
2 Proportion of patients with a life-threatening condition
(amenable to emergency treatment) who are discharged
alive from hospital
3 As above but for a specific clinical condition
(e.g. stroke, heart attack, cardiac arrest)
4
Proportion of 999 callers who die within 48 hours of first call
Re-contacts
What makes re-contact rates so important?
• Some people re-contact services because their condition may
get worse despite good treatment
• If the number of people re-contacting services is high it
suggests the response to the first call for was not adequate
• Call may not have been properly assessed or patient not
properly assessed at scene
• Risk to patients - seriousness of their condition is not
recognised.
• Re-contact rates can be used as a measure of patient safety high rates of re-contact suggest low levels of patient safety
Re-contacts
Number
Re-contact measures
1 Proportion of all 999 calls referred for telephone
advice only re-contacting the ambulance service
within 24 hours
2 Proportion of patients left at home who are admitted
to hospital within 72 hours
3 Proportion of all 999 calls re-contacting the
ambulance service within 24 hours
4 Proportion of patients left at home who have a
contact with any emergency/urgent health service
within 24 hours
Coffee break
Today’s Programme
Time
Session
10:00 - 10:30
Arrival and coffee
10:30 – 11:00
Welcome, introductions and how we'll work
11:00 – 12:00
Patient Outcomes votes x 3
12:00 - 12:20
Coffee
12:20 – 13:00
Clinical Management Measures votes x 2
13:00 – 13:45
Lunch
13:45 -14:45
Whole Service Measures votes x 3
14:45 – 15:15
Comfort break (receive your expenses & grab a coffee to
bring into the room)
15:15 - 15:30
Summary, next steps, evaluation and close
Clinical Management
Measures
What makes clinical
management measures
important?
• Triage
• Accuracy
• Call categories
Clinical Management Measures
1. Appropriateness and
accuracy of triage
2. Compliance with
protocols and
guideline
Appropriateness
and accuracy of triage
Appropriateness
and accuracy of triage
Number
Appropriateness and accuracy of triage measures
1
Proportion of all calls referred for telephone advice
returned for a 999 ambulance response
2
Number of calls prioritised correctly to appropriate
level of response as a proportion of all 999 calls
3
Proportion of life-threatening category A calls
correctly identified as category A
4
Proportion of calls for a specific condition correctly
identified at the time of the call, for example cardiac
arrest, stroke, heart attack
Compliance with protocols
and guideline measures
Why are protocols and guidelines important?
• Documents that specify how, or in what manner, a
particular clinical problem or incident is to be treated
• Incorporates best practice for the condition so
patients receive the most up to date and effective
care
• Measure is about how often ambulance crew follow a
protocol and provide the specified care
• A high rate of protocol compliance = optimum care
• A low rate suggests improvements are needed
Compliance with
protocols and
guideline measures
Number Compliance with protocols and guideline measures
1
Proportion of all cases with a specific condition who are treated
in accordance with established protocols and guidelines, e.g.
stroke, heart attack, diabetes, falls.
2
Proportion of cases that comply with end of life care plans
where these are available.
3
Proportion of all cases with a specific condition who meet the
established criteria for transfer, who are transported to an
appropriate specialist facility, e.g. a heart attack, stroke or
major trauma centre.
Lunch 1 – 1:45pm
Today’s Programme
Time
Session
10:00 - 10:30
Arrival and coffee
10:30 – 11:00
Welcome, introductions and how we'll work
11:00 – 12:00
Patient Outcomes votes x 3
12:00 - 12:20
Coffee
12:20 – 13:00
Clinical Management Measures votes x 2
13:00 – 13:45
Lunch
13:45 -14:45
Whole Service Measures votes x 3
14:45 – 15:15
Comfort break (receive your expenses & grab a coffee to
bring into the room)
15:15 - 15:30
Summary, next steps, evaluation and close
Whole service measures
1. Time measures
2. Accuracy of call
identification
Time measures
How well the ambulance service organises itself:
• to answer the call
• correctly identify the problem
• dispatch a suitable vehicle
• ensure that the patient is transported to the
most suitable place for treatment
• Definitive care = getting to the best place for the
problem - stroke patient to a specialist stroke
centre, fall patient with no injury left at home
and referred to a falls service
Time measures
(Definitive care)
Number
Time measures (Definitive care)
1
Proportion of eligible patients who arrive at
definitive care within agreed timescales
2
Time of call to time to definitive care
3
Time of call to CPR start time where CPR is
required. Average time from call to start of
CPR in cases of cardiac arrest
Time measures
(Response time)
Number Time measures (Response time)
1
Proportion of emergency calls for conditions
that are not life-threatening with a response
time of 30 minutes or less
2
Proportion of emergency calls with a response
time within an agreed standard for calls for lifethreatening conditions
3
Proportion of emergency calls with a response
time within an agreed standard
Accuracy of call
identification and assessment
• Under-triage – level of care not high enough
• Category A call is not recognised - slower
response with treatment delay may have
serious consequences
• Over-triage – level of care too high
• Sending a fast response using lights and sirens
- risks to both ambulance crews and the public
• Efficient use of resources
Accuracy of call
identification measures
Number
Accuracy of call identification and assessment
1
Number of life-threatening (category A) calls not identified as category A as a
proportion of all 999 calls
2
Number of calls that are not life-threatening identified as category A calls as a
proportion of all 999 calls
3
Proportion of calls transferred for telephone clinical advice that are completed
with self-care advice or referral to an appropriate service
4
Proportion of category A calls attended by a paramedic
5
Proportion of patients who are treated on scene or left at home who are
referred to an appropriate pathway or primary care
6
Proportion of patients transported to ED by 999 emergency ambulance and
discharged without treatment or investigation(s) that needed hospital facilities
7
Proportion of patients who potentially could be left at home who are
successfully discharged at the scene.
Comfort break 14:45 – 15:15
(receive your expenses &
grab a coffee to bring into the room)
Evaluation
Yes = 1, No = 2
Have you;
1. Understood what PhOEBE is all about?
2. Had an opportunity to be involved and contribute your
thoughts?
3. Felt listened to?
4. Enjoyed the day?
Please add any further comments on your evaluation forms
Thank you!
For further information
Email: [email protected]
Post: Andy Irving, The PhOEBE Project, The
University of Sheffield, Regent Court, 30 Regent
St,
Sheffield, S1 1DA.
Tel: 0114 2224292. Fax: 0114 2220749

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