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Recommended Minimum Data Set

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CONTENTS

Published by the Ambulance Service Association National Clinical Effectiveness Project

  CONTENTS
Introduction - Minimum Data Set
1. Context - Why have a minimum data set ?
2. What is the minimum data set ?
3. What the minimum data set is not ?
4. What are the benefits of a minimum data set ?
5. What will happen if we do not implement the minimum data set ?
6. The role of the ASA Clinical Effectiveness Project
Conclusion
Minimum Data Set

   

Introduction - Minimum Data Set

Following the review by all UK ambulance services, and based on their consensus, this paper outlines the final recommendations of the Joint ASA/JCALC Clinical Effectiveness Committee for adopting the minimum data set requirements for patient report forms.

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1. Context - Why have a minimum data set ?

We are all now part of the evolving culture of clinical governance within the NHS. This is a compulsory quality assurance mechanism to ensure clinical practice is evidence-based, clinically and cost effective, and patient focused. The key components of clinical governance are clinical audit, clinical risk, education and training. All of the above need to be underpinned by robust, accurate and timely information. The minimum data set provides a framework from which all UK ambulance services can achieve the information requirements of clinical governance.

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2. What is the minimum data set ?

It is the essential backbone for effectively implementing all the components of clinical governance, including clinical risk and clinical audit, by laying the foundations for an accurate evidence base which can be used to compare clinical practice across UK ambulance services. The full data set is listed at the end of this document.

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3. What the minimum data set is not ?

  1. It is not an audit tool in its own right – it does however, form the basis from which audit tools can be developed.
  2. It will not answer all information requirements – it is a minimum data set and not designed to be comprehensive.
  3. It is not a blue-print for patient report form design – the data should be collected in some form or other not necessarily on the PRF.

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4. What are the benefits of a minimum data set ?

  1. It will enable comparative clinical audit
  2. Unless we are measuring pre-hospital care against the same variables it is impossible to draw any comparison or conclusion and the data again becomes meaningless.
    If future collaboration and comparisons are to be made, common data sets and definitions must be used. Also, in this new age of clinical governance, collaboration, national service/ performance frameworks, and benchmarking, it is vital that all data collection is uniform and accurate i.e. the minimum data set is adopted as common practice, otherwise poor information will become an excuse for poor performance and the real reasons for disparities in the provision of pre-hospital health care will not be uncovered.
    As stated previously, the minimum data set is not an audit tool in itself. However, by adopting the minimum data set robust clinical audit tools can be developed into which truly comparative information can be fed and firm conclusions drawn without any disclaimers covering the quality and definition of the data.
  3. It will facilitate the implementation of integrated care pathway’s.
  4. It is equally important that the collection of this minimum data set goes hand in hand with the collection of data on patient progress through A&E and beyond. Only when measurable outcomes can be collected will we be able to truly evaluate the service we provide in the pre-hospital environment. We must be able to close the audit loop and evaluate the outcome of care. This should include common ways of following patients through the health care system and linking the relevant pre-hospital, hospital and other health care databases.
  5. It will focus risk management policies

Clinical governance equates to clinical responsibility. Taking the example of the Bolam principal – peer opinion states that if the majority of other processional clinicians would have done exactly the same under the given circumstances, then protection for the action is guaranteed. This has relevance to clinical risk, clinical governance and the closure of the paramedic title. Through governance, education and the obligation to audit practice, each individual will be responsible for their actions. It is therefore vitally important that, to achieve the security of the Bolam principal, the minimum data set must be recorded to allow for clinical audit and clinical risk management. This includes the recording of pertinent negatives (i.e. why something was not done) to ensure all clinical decisions are documented.

We must therefore, in conjunction with the minimum data set, collect all data from all patient report forms (PRF’S) to ensure we know we are doing the right things and doing the right things right. The minimum data set should be recorded somewhere and somehow whether on the PRF or elsewhere as long as all databases are able to be cross-referenced and the data is retrievable. This will not mean prescriptive PRF designs or content. Hopefully however, greater collaboration and the adoption of a common data set with common audit tools will lead to sharing of good ideas and best practice creating a streamlining of PRF designs.

  1. It will result in clinically effective practice.
    Without a minimum data set we can’t produce a robust evidence base from which decisions on clinical effectiveness can be based. Only when true comparisons are made through benchmarking of identical data sets and definitions can a robust evidence base be built.

Examples:

  1. South East Ambulances Clinical Audit Group – Although a regional evidence based protocol was developed for the treatment of pre-hospital hypoglycaemia, there were several large obstacles which had to be tackled in order to compare data sets collected by the seven collaborating services. These included different standards/ protocols and differing data sets. Some services had to collect extra data whilst others ignored data they already collected.
  2. National Service Frameworks – unless all UK ambulance services are collecting the same data it would be impossible to benchmark performance and decide which is the most clinically effective practice based on the evidence.
  3. Nationally recommended protocols/ standards – a commonly adopted minimum data set will allow for direct comparison of which standards/ protocols are effective. Again benchmarking exercises can highlight good practice and lead to the development of common standards based on the evidence, with the minimum data set as their foundation.

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5. What will happen if we do not implement the minimum data set ?

Within the quality strategy of the New NHS there are several mechanisms which require robust, accurate and timely data to enable quality improvement processes such as clinical audit, clinical governance, research and benchmarking. The adoption of the minimum data set is the only way in which UK ambulance services can guarantee the quality of the information collected form patient report whilst ensuring this information is comparable with other services.

Within clinical governance there are processes by which the NHS will carry out spot checks on the quality systems employed by ambulance services. For example, the National Institute for Clinical Excellence (NICE) will actively promote standard setting and benchmarking of clinical performance through National Performance Assessment Frameworks and National Service Frameworks. The Commission for Health Improvement will also monitor these quality assurance measures on a regular basis, and have the power to address, with substantial pressure, individual trusts where shortcomings may exist.

Also, looking to the near future and the development of Electronic/ Computer Patient Report Forms, which are already based on the minimum data set, and their adoption over the next few years will mean easier data collection, collaboration and comparison.

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6. The role of the ASA Clinical Effectiveness Project

The National ASA Clinical Effectiveness Project has as one of its longer term objectives the establishment of regional and national collaborative projects in order to produce an evidence base of clinically effective pre-hospital practice. The project’s role will therefore be in supporting the adoption of the minimum data set and developing robust clinical audit tools, into which the minimum data set will feed to provide the evidence base and allow for benchmarking exercises leading to improvements in the quality and effectiveness of pre-hospital care provided by UK ambulance services.

However, if any audit tools, especially those used on a regional/ national level are to be used for comparison or collaboration, then the data and definitions used in any data collection must be uniform. This is where the minimum data set’s role is of vital importance.

Any national clinical audits will act in the same way as audits designed and conducted by the Royal Colleges for doctors, there will be an obligation to carry out the audit and therefore a requirement to record the minimum data set. This will be reinforced through the closure of paramedic title and professional self-regulation.

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Conclusion

It is therefore strongly recommended that every UK ambulance service adopts the minimum data set outlined here. Without this spine quality initiatives such as clinical audit and clinical governance will be seen to be flimsy under the scrutiny of NICE and the Commission for Health Improvement.

It is a minimum data set and not comprehensive for all information needs. It does, however, provide a framework for clinical audit, clinical risk and clinical governance.

It is not an audit tool in itself although it will form the spine of clinical audit tools currently under development to enable comparison and benchmarking of clinical performance.

CLICK HERE TO VIEW THE ASA/JCALC MINIMUM DATA SET OF PATIENT INFORMATION

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