A research project which may help to save hundreds of lives by transforming the way heart attacks and strokes are treated by frontline ambulance crews has been recognised at a prestigious national healthcare awards ceremony.
Health research specialists from the University of Lincoln worked with East Midlands Ambulance Service and the other 11 English ambulance trusts to raise consistency of standards in the delivery of ‘care bundles’ for heart attack and stroke.
Care bundles are best practice guidelines which set out how ambulance crews should treat patients where a stroke or heart attack (acute myocardial infarction) is suspected.
In the case of stroke, the checklist involves using the face, arm and speech test (FAST) to check for symptoms, as well as taking blood glucose and blood pressure measurements. For heart attack, it involves giving aspirin, a drug called GTN which opens the arteries, taking verbal pain scores and administering pain-relief (analgesia).
These all-in-one packages of treatment are classed as ‘critical to quality’ indicators – a status which recognises the significant effect they can have on patients’ experience or chances of correct management and recovery.
At the outset of the research, which was funded by the Health Foundation, the team found stark regional variations in how consistently care bundles were delivered. National data revealed the AMI care bundle was employed in full only 43% of the time on average and for stroke the figure was 83%.
Working with frontline health service professionals across the 12 ambulance trusts, the researchers devised a unique quality improvement system which combined both quantitative and qualitative measures to gauge how frequently clinicians were applying the care bundles, identify common obstacles which hindered them, illustrate the benefits brought about by making small sequential changes and share examples of ‘best practice’.
The approach enabled the project team to identify how improvements might be made, implement these improvements more widely and then roll these out to other regions if they proved to have an impact. By the end of the two-year project, the care bundles were being used in full 79% of the time for heart attack and 96% of the time for stroke.
Professor Niroshan Siriwardena, who leads the Community and Health Research Unit at the University of Lincoln, said: “The key to the success of this project was the successful collaboration with frontline ambulance clinicians who ultimately deliver these care bundles. By developing a strong and open network for quality improvement, and clear channels for communication which illustrated clearly how small changes could produce real, tangible results, we have witnessed sustained improvements in the quality of care across England. If these improvements can be maintained and built upon, this work will produce much improved outcomes for many of the 225,000 men and women who will suffer a stroke or heart attack in England each year and with it save many hundreds of lives.”
The Ambulance Service Cardiovascular Quality Initiative is a quality improvement programme involving the University of Lincoln, East Midlands Ambulance Service and the National Ambulance Clinical Quality and Research Groups, which represents all 12 English ambulance trusts. The two-year project was funded with a grant of £380,000 from the Health Foundation. The initiative is the first time all 12 English ambulance services have been involved in a single quality improvement project. The project was shortlisted in the ‘Enhancing Care with Data and Information Management’ category at the annual Health Service Journal Awards, which took place on 20th November 2012.
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