Patient outcomes

Improving clinical quality is at the heart of our vision - we want to ensure world class outcomes for patients; they deserve nothing less. In order to know we're making improvements we need to be able to measure and evaluate our clinical performance. Historically, measuring clinical quality and patient outcomes has not been the priority for the ambulance service - it has all been about response times... but we are very pleased to say that this is changing!

Clinical Performance Indicators

Clinical Performance Indicators (CPIs) are aspects of care that can be measured to monitor and evaluate the quality of clinical care provided to patients. They have been developed nationally with input from all ambulance trusts in the country and cover the following areas:

Care of pre-hospital ST elevation MI (STEMI) patients (heart attacks)
Care of patients presenting in cardiac arrest (presumed cardiac in origin)
Care of stroke patients
Care of patients presenting with hypoglycaemia
Care of asthma patients

We need CPIs to allow benchmarking of clinical practice between ambulance trusts in order that they can be sure of maintaining and improving clinical practices against national best practice. This monitoring and reporting helps patients be assured that they will be given the best care no matter where they go in the country.

Do ambulance trusts have specific CPIs?

The National CPIs were developed specifically for ambulance trusts by the National Ambulance Service Clinical Quality Group (NASCQG), formerly known as the National Ambulance Clinical Audit Steering Group (NACASG), which has representatives from each of the 12 Ambulance Trusts in England. The group receives guidance from the Directors of Clinical Care (DOCC) forum.

How is each CPI measured?

Each CPI contains a ‘care bundle’ and performance against each element of that bundle is recorded. The elements within those bundles are:

STEMI – Aspirin, GTN and analgesia (preferably Morphine) given plus two pain scores recorded to establish the effectiveness of treatment given.
Cardiac Arrest – Return of Spontaneous Circulation (ROSC) on hospital arrival following an attempted resuscitation; an emergency response arrival at the patient’s side within 4 minutes; Advanced Life Support (ALS) provider in attendance.
Stroke – Facial, Arm/Limb weakness and Speech impairment (FAS) test is completed; Blood Pressure (BP) recorded; Blood Glucose (BG) recorded.
Hypoglycaemia – BG recorded pre-treatment; BG recorded post-treatment; any treatment administered recorded, including the administration of oral carbohydrates.
Asthma – Respiration rate recorded; Oxygen Saturation (SpO2) levels recorded; peak flow recorded pre treatment; peak flow recorded post treatment; any Beta2 agonist (e.g. salbutamol, terbutaline, etc.) that are administered.

Each CPI is audited twice a year nationally - these are called cycles. We can track our performance against the previous cycle - the latest progress update was issued in October 2010.

Do the CPIs form part of the Trust performance measures?

Yes, the Care Quality Commission (CQC) has in previous years used this information to assess ambulance trusts' clinical performance, and this performance has contributed to the Quality of Services rating in the Annual Health Check in previous years.