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THE AMBULANCE SERVICE ASSOCIATION
THE VOICE OF THE NH S AMBULANCE SERVICE
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME
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JRCALC Conference - 3 November 2000 - Towards a
Unified Approach
Collecting the right data from the right forms at
the right time
STUART NICHOLLS
Manager, ASA NCEP
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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?
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Structure of the presentation Collecting the
right data from the right forms at the right time

• 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

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ASA National Clinical Effectiveness Programme
(ASA NCEP)
Aims Objectives
Bringing pieces of the jigsaw together
Supporting clinically effective practice
Creating the Links
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Bringing pieces of the jigsaw together
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Bringing pieces of the jigsaw together
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
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Supporting clinically effective practice
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Supporting clinically effective practice
Programme Web Site - audit database, links,
publications, information,resources
www.asancep.org.uk
Training Education - audit tools, workshops,
evidence of best practice, surveys
Newsletter - CANDOUR - latest information,
examples of good practice
Conferences - AMBEX 2000 - ASA/JRCALC - update
skills Knowledge, different perspectives
Regional Groups - share information locally, feed
into national structure, collaborative
comparative projects
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Creating the Links
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Creating the Links
Improvement in the Quality of Care
Clinical Audit
Training
Clinical Effectiveness
Education
Professional Self Regulation
Clinical Risk
Clinical Governance
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How to make possible what is desirable
Effectiveness
Research
Clinical Audit cycle
have we made things better?
are we achieving it?
Training Education
Clinical Governance
Evidence
what can we do to make things better?
why are we not achieving it?
Risk
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Why Ambulance Services should collect Accurate
and Timely Information

• Patient Record
• Clinical Audit
• Clinical Effectiveness
• Clinical Governance

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ASA/ JRCALCMinimum Data Set
What is the minimum data set ?

• Backbone for implementing clinical governance
• Evidence base
• Comparable data

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ASA/ JRCALCMinimum Data Set
What the minimum data set is NOT ?

• Not an audit tool
• Not answer all information requirements
• Not a blue-print for PRFs

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ASA/ JRCALCMinimum Data Set
What are the benefits ?

• Comparative clinical audit
• Integrated Care Pathways
• Risk Management
• Clinical Effectiveness

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ASA/ JRCALCMinimum Data Set
Examples

• National Service Frameworks
• National Standards
• National Clinical Audits

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ASA/ JRCALCMinimum 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

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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

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Plans 2000/2001

• Professionalism
• 3 approaches
• Log Book
• Observing practice
• Examination
• Clinical Audit

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ASA/ JRCALCMinimum Data Set
The role of the ASA National Clinical Effectivenes
s Programme

• Clinical Audit Projects
• Clinical Audit Tools
• Clinical Governance

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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

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An action plan for saving lives
A comprehensive health strategy for England
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Four priority areas
Cancer Coronary heart disease
stroke Accidents Mental health
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Measuring monitoring progress
Tough national targets Tailored local
targets Strong performance management Regular
reviews
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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
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• 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.

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• 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.

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• 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)

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• 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

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Clinical Governance in Practice
Evidence based practice for MI, cardiac arrest
Cat A response times Pre-arrival instructions
Integrated Care Pathways
Record keeping Patient Report Form with min/data
set for cardiac patients
NSF CHD
Patient/public involvement Community CPR
Clinical Effectiveness outcomes
Clinical Risk Management
Multi disciplinary audit
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Boxplot showing range of data collected on
ambulance service patient report forms
Maximum of 270 fields (JRCALC/ASA Minimum Data
Set)
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Frequency of data collected as required to
monitor the prehospital management ofacute
coronary heart disease (sample)
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Evidence for Change III Survey
How is your clinical audit data captured ?
Scanned into a database 14
(40) Manually entered into a database 18
(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 only 14
(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.
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• 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.

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• 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

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Other NHS Organisations
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Royal College of Physicians (London) Clinical
Effectiveness Evaluation Unit MINAP - Myocardial
Infarction National Audit Project CCAD - Central
Cardiac Arrest Database
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The Future
Accurate and Timely Information - backbone of
quality initiatives
Framework - clinical governance/ professionalism
Clinical Audit - benchmarking/ continual
improvement
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THE AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME
Supporting Effective Clinical Practice
www.asancep.org.uk www.ambex.co.uk www.jrcalc.org
.uk