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|CANDOUR - Issue 10 - June 2000
The newsletter of the ASA/ JRCALC Clinical Effectiveness Committee and the ASA Clinical Effectiveness Programme
In this issue :
Development of National Clinical Guidelines for Ambulance Services the latest from the ASA/JRCALC Clinical Effectiveness Committee
Clinical Audit Database for Coronary Heart Disease developed by the ASA to meet the requirements of the National Service Framework
ASA/JRCALC Conference 3rd November 2000
Book Review - "Research Methods and Statistics in Health Care"
Scottish Ambulance Service - Clinical Performance: A Pilot Study
Northern & Yorkshire Patient Report Form towards a regional PRF
Development of National Clinical Guidelines for Ambulance Services
It has long been recognised that there is a need for a set of national clinical guidelines for ambulance services. Panoramas Casualties programme highlighted this issue but, aside from its unfair criticism, the drive towards national clinical guidelines and away from postcode prescribing has been a priority of the NHS for several years now.
The most recent example is the National Service Framework (NSF) for Coronary Heart Disease. The table below shows the milestones and goal of the NSF for ambulance services:
Initiatives such as clinical audit, clinical effectiveness and clinical governance have all been put in place for two reasons. Firstly to improve the quality of care provided within the NHS and secondly to reduce variation in treatment and outcome for patients. Clinical governance now means that every individual within the NHS is accountable for clinical quality with Chief Executives accountable for sustaining continual clinical quality improvement within their Trusts. One of the elements to clinical governance is the sharing of best practice to reduce variation in care and outcome, to learn from each other and to improve the quality of care we all provide as individuals and as organisations.
Indeed the ASA is very much part of the NHS Effective Clinical Practice Programme through the ASAs National Clinical Effectiveness Programme, which supports clinical audit, clinical effectiveness and the development of clinical guidelines in collaboration with the National Institute for Clinical Excellence (NICE). One of the key objectives of NICE is the development of national guidelines across the NHS working in partnership with the medical professions.
At the last meeting of the Joint ASA/JRCALC Clinical Effectiveness Committee it was reported that JRCALC have established a sub-committee to co-ordinate the development of a set of national clinical guidelines for use by UK Ambulance Services. This sub-committee will be working jointly with the ASA/ JRCALC Clinical Effectiveness Committee and the ASA National Clinical Effectiveness Programme to ensure links are established and maintained with UK ambulance services, the professional bodies (ASA & JRCALC) and with NICE. The sub-committee is representative of the skills required to develop a set of national clinical guidelines including academics, researchers, clinicians and ambulance service personnel.
Initially work will be based upon the guidelines developed by Dr Iain McNeil, Dr John Scott and Dr Chris Carney amongst others which have already been submitted to JRCALC in draft form. Thanks must go to all those involved, from Bedfordshire & Hertfordshire Ambulance & Paramedic Ambulance Service NHS Trust (especially Lesley Cave and her team), Surrey Ambulance Service NHS Trust and East Anglia Ambulance Service NHS Trust, who contributed to this initial work which very much lays the foundations from which subsequent guidelines will be drawn,
The sub-committee will also co-ordinate their work with that of the Welsh Ambulance Service NHS Trust who have secured a grant from the Clinical Effectiveness Support Unit (CESU the Welsh NICE) to develop twenty four prehospital clinical guidelines over the next three years. This will enable resources to be pooled and will avoid any unnecessary duplication of work. All the guidelines produced will be clinically effective with research being undertaken where necessary to bridge any gaps in the evidence base.
This in an exciting initiative which will undoubtedly improve the quality of prehospital care provided by the UKs ambulance services and reduce variation in patient treatment and outcome. As the guidelines are developed updates and news will be published here in CANDOUR and also on the website http://www.asancep.org.uk in the new guidelines section.
Clinical Audit Database for Coronary Heart Disease
When the National Service Framework for Coronary Heart Disease was finally published in March 2000, it outlined a set of clinical audits which are to be undertaken on an annual basis by ambulance services. The milestones and goal of the NSF were described in the previous article showing the action being taken. In summary by October 2000 the ambulance service is expected to have adopted a systematic approach to determining whether agreed clinical standards for AMI are being met. This means the implementation of clinical audit techniques to measure adherence to and the effectiveness of prehospital standards for AMI.
The table below describes all the annual clinical audits to be undertaken within the CHD NSF :
The objective of the ASA National Clinical Effectiveness Programme (ASANCEP) is to support the development of clinical audit and as part of the contract with NICE for 2000/2001 the ASA are required to initiate benchmarking of performance for Time to 1st shock by March 2001.
In order to achieve these objectives and work towards the clinical audit requirements listed above the ASANCEP has been able to purchase a bespoke clinical audit database for coronary heart disease on behalf of every ambulance service.
Tenax Health Systems Limited in collaboration with the ASANCEP have developed a clinical audit database which will record and report on all the data required by the CHD NSF and more. This will allow performance in every ambulance service to be truly and effectively compared with other services and will allow for national clinical audits around CHD. For example, we will for the first time be able to get an accurate picture of aspirin administration rates with all data bias removed, the effectiveness of fast-tracking systems can be examined allowing for the sharing of effective clinical practice and improving the quality of care provided for AMI patients across the UK.
The clinical audit database is flexible enough to allow for existing data sources to be downloaded to avoid duplication, but is robust enough to ensure the definitions and data collection methods used are identical in each setting to allow true comparisons to be made without any disclaimers covering the quality of the data.
Each ambulance service will receive a free copy of the clinical audit database courtesy of the ASANCEP who will continue to develop and support the software with Tenax Health Systems Limited. The adoption of technology which reports on clinical audit data against the CHD NSF and allows for benchmarking of performance is central to the process of clinical governance in improving the quality of patient care. This applies as much to individuals as to the performance of the organisation as a whole, and it is hoped that as the software is developed over the coming months it will be able to audit individual performance as well as the performance of the organisation against the National Service Framework.
For more information about the clinical audit database contact either of the following:
Stuart Nicholls, Manager, ASA National Clinical
Effectiveness Programme c/o Kent Ambulance NHS Trust,
Heath Road, Coxheath, Maidstone, Kent. ME17 4BG Tel/Fax:
01622 664929, email: [email protected], web:
Alternatively visit Tenax Health Systems Limited at AMBEX 2000 - Stand Q38.
Joint ASA/JRCALC Conference 2000
3 November 2000
The conference will have an emphasis on clinical improvement and the promotion of
Effective Clinical Practice
will be circulated as soon as they are confirmed.
and more details will follow in CANDOUR.
Nicholls, Manager, ASA National Clinical Effectiveness
"Research Methods and Statistics in Health Care"
Norma G. Reid and Jennifer R.P. Boore
It is not often that one comes across texts relating to research methods and statistics that are non-taxing and welcoming to the newcomer to these fields. "Research Methods and Statistics in Health Care" by Norma Reid and Jennifer Boore helps to bridge this gap and provides a text which is clear, concise and easy to follow and which does so with a clinical emphasis.
Although written for the practising nurse this book is suitable for other health care professions and may prove useful to the ambulance technician or paramedic wishing to undertake an area of research or to analyse the results of clinical audit from a scientific perspective. It begins by addressing the role and usefulness of research methods and statistics within the health care professions followed by an introduction to research methods and a step-by-step account of basic statistical techniques, and concludes with practical examples illustrating the value of these techniques and methods.
Given the increasing emphasis on clinical audit and the importance of research and evidence-based practice in todays society and the significance of Clinical Governance, this text should go far in assisting those who wish to embark on this pursuit and in assisting them in their acquisition of skills to enhance their professional performance and ultimately to improve the quality of their patient care.
Presented in a handy portable size "Research Methods and Statistics in Health Care" is likely to appeal not only to those undertaking clinical audit as part of their main clinical role but also to those undertaking courses of further study including those based within the higher education establishment. It is written in a user-friendly format which touches on many of the key issues without covering them in great depth but leads the way to further exploration and study.
The wide range of contents in this book, including the steps involved in the research process, ethical considerations, research techniques, the approach to describing and summarising data and the importance of testing hypotheses, render it a useful adjunct to anyone wishing to become involved in clinical research, clinical audit or clinical trials.
Reviewed by Rose Ann OShea, Senior Lecturer, Department of Nursing and Paramedic Sciences, University of Hertfordshire. February 2000.
Scottish Ambulance Service - Clinical Performance: A Pilot Study
All emergency and urgent records from Command and Control Systems covering Scotland were sampled for a one-week period covering 26/11/97 to 03/12/97. Patient Report Forms for the same period were cross-referenced and analysed by experienced Operational Officers. This involved 10,033 patient-journeys, made up of 5,540 emergency and 4,491 urgent (or short-term planned) patient-journeys.
In the overview of the service, titled "A case-note audit of patient report forms. Are the Service making the most of existing patient and clinical information?", the following sub-objectives were identified:
In order to achieve these objectives the following aspects were audited :
For more details about this unique and commendable pilot study please contact Robin Lawrenson, National Clinical Audit Manager, Scottish Ambulance Service, 4 Maitland Street, Glasgow. G4 OHX. Tel: 0141 353 6001 Fax: 0141 353 6359
Northern & Yorkshire Patient Report Form
Tees, East & North Yorkshire Ambulance Service NHS Trust (TENYAS) together with North East Ambulance Service NHS Trust (NEAS) are working jointly on a collaborative Patient Report Form (PRF).
Since the merger of the three services in TENYAS there was a need for a single PRF to allow for trust-wide audit. NEAS use the same scanning system as TENYAS and have donated the design of their PRF to be used jointly with TENYAS.
This will allow for cross-Trust comparison of clinical audit data including collaborative projects. It is hoped that other services in the region will be interested in this initiative and lead to the development of a region-wide PRF.
Similarly, within the Welsh Ambulance Service NHS Trust the former PRFs of the constituent parts are being discarded and a national PRF is being introduced. Who knows, maybe this collaborative work is the shape of things to come in light of mergers and closer working arrangements with our neighbours ? Will other regions follow suit ? What odds for a National PRF ?