PhOEBE - PowerPoint Presentation

Slide1

PhOEBE Patient and Public Involvement Day Ambulance service quality What matters to you? 4th June 2014 Slide2

Meet the team!

Janette Turner

Joanne

Coster

Richard Wilson

Andy Irving

Andrea Broadway-Parkinson

Maggie Marsh

Dan Fall

Viet-Hai

Phung

Dan Bradbury Slide3

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. Slide4

Why is this important?Slide5

Why it is importantThe ambulance service is a gateway for many people with a range of health problemsEveryone should think they are getting the best service that can be offeredMeasuring how well services are doing allows us to ensure this happens – identifies good and badAlso helps us assess whether new innovations are working and worthwhileSlide6

Aims & objectivesof today

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

Feel that you have been involved and your view has been listened to

Understand how this day contributes to the process of selecting emergency ambulance quality measures.

Understand how the measures selected will be used in the next steps of the PhOEBE project. Slide7

Today’s Programme

Time Session 10:00 - 10:30 Arrival and coffee

10:30 – 11:00Welcome, introductions and how we'll work11:00 – 12:00Patient Outcomes votes x 312:00 - 12:20Coffee

12:20

– 13:00

Clinical Management Measures votes x 2

13:00 – 13:45

Lunch

13:45 -14:45

Whole Service Measures votes x 314:45 – 15:15

Comfort break (receive your expenses & grab a coffee to bring into the room)15:15 - 15:30Summary, next steps, evaluation and closeSlide8

Voting process

8 votes in 3 groups

Slide9

Voting test! Question: Who is going to win the World Cup!? Answer:England! BrazilSpain

I don’t care! Slide10

Today’s Programme

Time Session 10:00 - 10:30 Arrival and coffee

10:30 – 11:00Welcome, introductions and how we'll work11:00 – 12:00Patient Outcomes votes x 312:00 - 12:20Coffee

12:20

– 13:00

Clinical Management Measures votes x 2

13:00 – 13:45

Lunch

13:45 -14:45

Whole Service Measures votes x 314:45 – 15:15

Comfort break (receive your expenses & grab a coffee to bring into the room)15:15 - 15:30Summary, next steps, evaluation and closeSlide11

Patient outcome measuresWhat 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.Slide12

Patient Outcomes1. Pain 2. Survival 3. Re-contactsSlide13

Pain

Why do we measure

pain?Pain is a major issue for people who are ill or injured Pain management - recognising patient painProviding proportionate pain relief Pain relief drugs or e.g. applying splints to

fractures Slide14

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 treatmentSlide15

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

I

mportant 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)Slide16

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 callSlide17

Re-contacts

What makes

re-contact rates so important?Some people re-contact services because their condition may get worse despite good treatmentIf 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 Slide18

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 hoursSlide19

Coffee break Slide20

Today’s Programme

Time Session 10:00 - 10:30 Arrival and coffee

10:30 – 11:00Welcome, introductions and how we'll work11:00 – 12:00Patient Outcomes votes x 312:00 - 12:20Coffee

12:20

– 13:00

Clinical Management Measures votes x 2

13:00 – 13:45

Lunch

13:45 -14:45

Whole Service Measures votes x 314:45 – 15:15

Comfort break (receive your expenses & grab a coffee to bring into the room)15:15 - 15:30Summary, next steps, evaluation and closeSlide21

Clinical ManagementMeasures

What makes clinical management measures important?

Triage

Accuracy

Call categories

Slide22

Clinical Management Measures

Appropriateness and accuracy of triageCompliance with protocols and guidelineSlide23

Appropriatenessand accuracy of triage Slide24

Appropriatenessand 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 attackSlide25

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 careA high rate of protocol compliance = optimum careA low rate suggests improvements are needed Slide26

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.Slide27

Lunch 1 – 1:45pm Slide28

Today’s Programme

Time Session 10:00 - 10:30 Arrival and coffee

10:30 – 11:00Welcome, introductions and how we'll work11:00 – 12:00Patient Outcomes votes x 312:00 - 12:20Coffee

12:20

– 13:00

Clinical Management Measures votes x 2

13:00 – 13:45

Lunch

13:45 -14:45

Whole Service Measures votes x 314:45 – 15:15

Comfort break (receive your expenses & grab a coffee to bring into the room)15:15 - 15:30Summary, next steps, evaluation and closeSlide29

Whole service measures

Time measures2. Accuracy of call identificationSlide30

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 serviceSlide31

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 arrestSlide32

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 life-threatening conditions

3

Proportion of emergency calls with a response time within an agreed standardSlide33

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 highSending a fast response using lights and sirens

- risks

to both ambulance crews and the

public

E

fficient use of resourcesSlide34

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.Slide35

Comfort break 14:45 – 15:15(receive your expenses & grab a coffee to bring into the room)Slide36

Evaluation

Yes = 1, No = 2

Have you;Understood what PhOEBE is all about? Had an opportunity to be involved and contribute your thoughts?

Felt listened to?

Enjoyed the day?

Please

add any

further comments on

your evaluation formsSlide37

Thank you! Slide38

For further information

Email:

phoebeprogramme@sheffield.ac.ukPost: Andy Irving, The PhOEBE Project, The University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 1DA. Tel: 0114 2224292. Fax: 0114 2220749