NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement revise the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction to reflect each element of the call to balloon response and review this indicator alongside the critical time standards workstream.
Discussions have taken place regarding revising the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction to reflect each element of the call to balloon response and evaluate where improvements can be made.
In preparing a response to the recommendations the following clinical and operational leads have been involved – Dan Boden (Interim National Clinical Director for Urgent and Emergency Care); Anthony Marsh (National Strategic Adviser of Ambulance Services); Dr David Macklin (Clinical Advisor, NHS England and NHS Improvement); and Nick Linker (National Clinical Director for heart disease). Consideration has been given to data sources and where the data will be published. Colleagues from the critical time standards workstream have been involved in these discussions. Following on from these discussions NHS England and NHS Improvement will explore the feasibility, the associated burdens and benefits of additional data collection, and potential unintended consequences of reporting the component parts of the call to balloon time to reflect the times for call to scene, on scene, scene to door and door to balloon.
A standing item of “emerging risks and research highlighting factors impacting on effective ambulance response” has been added to the agenda of the Joint Ambulance Improvement Programme Board, where matters of concern can be raised and actioned as appropriate.
Discussions have taken place regarding revising the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction and the need to evaluate and review the individual components of the call to balloon response, in particular the call to door elements. Consideration has been given to data sources and where these data will be published. It is proposed to report the component parts of the call to balloon time to reflect the times for call to scene, on scene, scene to door and door to balloon and to analyse where improvements can be made to reduce the call to balloon time. We will explore the feasibility, the associated burdens and benefits of this additional data collection, and potential unintended consequences before finalising any new national data collection. Subject to these findings, improvements will be realised through supporting those trusts and local systems with the greatest challenges to improve. This work will run alongside the critical time standards work..
Further details on the critical time standards work can be found on the NHS England and NHS Improvement website https://www.england.nhs.uk/2019/10/public-back-nhs-plans-for-new-rapid-care-measures/ for https://www.england.nhs.uk/2021/05/wide-support-for-more-comprehensive-urgent-care-indicators/.
TIMELINE: Revisions to the Clinical Quality Indicator will be explored during Summer 2021. Any revisions will be taken to the Autumn 2021 Ambulance Transformation Forum meeting for approval; implementation timeframe to be determined. The critical time standards implementation time frame is currently being reviewed.
Response received on 15 June 2021.
Association of Ambulance Chief Executives
HSIB recommends that the Association of Ambulance Chief Executives, working with the College of Paramedics and cardiology specialists, produces a position
statement on the use of pre-hospital thrombolysis by paramedics.
The Association of Ambulance Chief Executives (AACE) have developed and issued a position statement for the use of pre-hospital thrombolysis for patients who are having a heart attack. The statement applies to clinicians, including paramedics and ambulance nurses working in a pre-hospital setting for NHS ambulance services in the UK. Development of the statement was led by an ambulance service Medical Director who brought together representatives from four organisations - the Association of Ambulance Chief Executives, the College of Paramedics, the British Cardiothoracic Society, and the Joint Royal Colleges Ambulance Liaison Committee.
This group of experts included lead paramedics, cardiologists, nurses, and Doctors who all had an interest in the pre-hospital management of heart attacks. Relevant evidence was sought to inform the position statement such as from the National Institute for Health and Care Excellence. A consensus was reached regarding the content of the statement and the position statement was approved and issued by the AACE National Ambulance Service Medical Directors group on 20th July 2021. The use of pre-hospital thrombolysis in UK NHS Ambulance Services is not supported other than in specific geographical areas where this treatment cannot be provided any other way within accepted timelines. Further details can be found in the position statement.
ACTION: An ambulance service Medical Director brought together representatives from four organisations-the Association of Ambulance Chief Executives, the College of Paramedics, the British Cardiothoracic Society, and the Joint Royal Colleges Ambulance Liaison Committee who agreed a consensus for a UK wide position statement on the use of pre-hospital thrombolysis that was issued on 20th July 21.
TIMELINE: Completed on 20th July 2021.
Response received on 26 July 2021.
NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement support the Joint Ambulance Improvement Programme to respond to emerging risks and research highlighting factors impacting on effective ambulance response.
A standing item of “emerging risks and research highlighting factors impacting on effective ambulance response” has been added to the agenda of the Joint Ambulance Improvement Programme (JAIP) Board, where matters of concern can be raised and actioned if appropriate. The JAIP board meets every two months and membership comprises senior representation from ambulance services and key stakeholders.
TIMELINE: The JAIP Board meets every two months. The item has been added to the agenda starting with the June 2021 meeting.
Response received on 15 June 2021.