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National Clincal Audit of AMI
including prehospital thrombolysis

This page last updated - 24 June 2002.

AIM
The aim of the proposal is to establish and implement a core dataset and carry out a nationwide audit to assess the quality of care for acute myocardial infarction by ambulance services. The audit will meet the standards set for ambulance services for the care of acute myocardial infarction as specified in the National Service Framework for Coronary Heart Disease (NSF - CHD).

IMPORTANT NEWS - AMBEX 28 JUNE 2002 >>>

Updates: Quick Links:
24/06/02 NICE Techology Appraial - early thrombolysis >>> DOWNLOADS >>>
24/06/02 Link to Modernisation Agency CHD website >>> PUBLICATIONS >>>
18/06/02 JRCALC Prehospital Thrombolysis Survey 2002 published >>> SEMINARS >>>
21/05/02 DoH announce funding to treat heart attack victims >>> MISCELLANEOUS >>>
18/03/02 Pre-hospital Thrombolysis Pilot, East Midlands - report added >>> USER GROUP >>>
08/03/02 Frequently Asked Questions added >>> FAQ's >>>
08/03/02 Seminar Slides added >>> CONTACT >>>
11/02/02 Email User Group established >>>  
28/01/02 Hospital Codes updated >>>  
15/01/02 Seminar Programme added >>>  
09/01/02 All Seminar dates confirmed >>>  
08/01/02 ASA/JRCALC CHD Audit Seminar - dates announced >>>  
06/12/01 Letter from Chairman of JRCALC >>>  

Coming soon:

Patches for database version 1; Updated documentation; Interim Report  
Downloads  
Welcome Pack - list of documents required for installation version 1 (268k pdf)
South East Ambulance Clinical Audit Group consensus data set and database for prehospital coronary heart disease version 1 (115k pdf)
Core Data Set version 1 (107k pdf)
Application Notes version 1 (162k pdf)
Installation Notes version 1 (253k pdf)
Opening the database in Access 97 (270k pdf)
Archiving and Exporting the database version 1 (280k pdf)
Installation Contract version 1 (251k pdf)
Hospital Codes (January 2002) (18k pdf)
  Hospital Codes (January 2002) Excel Speadsheet     (59k xls)
Publications  
Audit for NSF - letter from the Chairman of JRCALC 03/12/01 (192k pdf)
Pre-hospital Thrombolysis Pilot (East Midlands Ambulance Service)     (461k pdf)
Comparison Review of Pre-Hospital Thrombolysis Pilot Times In A\par Rural / Urban Area Of The East Midlands     (112k pdf)
  JRCALC Prehospital Thrombolysis Survey 2002     HTML
Seminars  
  The presentations from the seminars held in January and February 2002 are published in both PowerPoint and PDF format for download. A ZIP file is also available to download containing all the presentations together.  
     
  Introduction pdf ppt  
  National Audit of Benzyl Penicillin and Opiate Analgesia pdf ppt  
  Background to South East Ambulance Clinical Audit Group pdf ppt  
  SEACAG CHD Audit Database Development pdf ppt  
  National CHD Audit Database Development pdf ppt    
  Installation and Implementation of the Database pdf ppt  
  Local and National Reports pdf ppt    
  Future Developments of the Audit and Database pdf ppt    
       
  Full seminar - zip file (1,819k) >>>    
       

National electronic Library for Health - Special CHD site here>>>

MINAP - The project is part of a collaboration with the Royal College of Physician's (London) Myocardial Infarction National Audit Project ( more details >>>).

CCAD - Central Cardiac Audit Database >>> 

NICE Technology Appraisal
Myocardial Infarction - early thrombolysis treatment

Appraisal Consultation Document: Drugs for early thrombolysis in the treatment of acute myocardial infarction
http://www.nice.org.uk/article.asp?a=33716
Home page
http://www.nice.org.uk/cat.asp?c=20315

Modernisation Agency CHD websites:

Thrombolysis Bulletin
http://www.modernnhs.nhs.uk/serviceimprovement/1337/ThrombolysisBulletin2.pdf
Home page
http://www.modernnhs.nhs.uk/scripts/default.asp?site_id=23&id=5363

'Training and equipment for paramedics will save 3,000 lives a year' - Department of Health announcement (21/05/02)
Press release
>>>
ASA Response
>>>
BBC News
>>>

Any queries regarding the project should be directed to:

Stuart Nicholls
National Clinical Effectiveness Programme Manager
Ambulance Service Association
Friars House
157-168 Blackfriars Road
London
SE1 8EU
Tel: 020 7928 9620
Fax: 020 7928 9502
Email:
[email protected]

This email group will allow users of the ASA/JRCALC CHD Audit to share best practice, solve problems, ask advice on using and developing the software etc. You can send messages using [email protected] but to receive replies and view other messages you must subscribe to the group.

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ASA/JRCALC CHD AUDIT

Frequently Asked Questions

Updated 08/03/02

Clinical - Benzyl Penicillin
Q:

A:

 

 

Q:

A:

What should I do with PRF’s for patients who have been administered Benzyl Penicillin?

Remove any patient identifiable data and send a copy of the PRF or electronic data to the ASANCEP Manager. This audit data  is required by the Medicines commission.

 

How will you deal with this as numbers escalates?

The ASANCEP Manager will have to advise you if this happens

 

Q:

 

A:

How will we capture patients that should have been, but were not administered benzyl penicillin?

Firstly in audit these patients are extremely difficult to identify.  It is beyond the scope of this audit but Trusts could locally elect to do further audit working with A/E’s to gain outcome data and retrospectively track patients.

 

Q:

A:

Has the efficacy of Benzyl Penicillin been proven in the pre hospital setting?

Yes, limited research does exist to support its use; however more evidence is required so an RCT would be beneficial.

 

Clinical - Morphine
Q:

A:

 

 

Q:

A:

What should I do with PRF’s for patients who have been administered Morphine in trauma?

Remove any patient identifiable data and send a copy of the PRF or electronic data to the ASANCEP Manager.  The audit of Morphine is required by the Medicines commission

 

How will you deal with this as numbers escalates?

The ASANCEP Manager will have to advise you if this happens

 

Q:

 

A:

What should I do with PRF’s for patients in Chest pain who have been administered Morphine?

They must be put in the CHD database regardless of their initial rthymn. The audit of Morphine is required by the Medicines commission

Clinical - CHD
Q:

A:

What patients should be included in the dataset?

The minimum is 100% of patients presenting with chest pain and ST segment elevation

Q:
A:
Who / how was ST segment elevation decided upon for inclusion criteria?

See letter from Chairman JRCALC 3/12/01

Q:

A:

How many leads should ST segment elevation be seen in to be included in this audit?

Two adjacent leads

Q:

 

A:

If we already collect our outcome data from hospitals and know which patients have been thrombolysed can we enter them directly into the database?

Yes

Q:

 

A:

If data comes back from the hospital comfirming a patient has had an MI but the PRF does not identify an initial rthymn – how should I show this?

Record rthymn as ‘not specified’ – these patients will be picked up through the hospital outcome field

Hospitals  
Q:

A:

Some of our hospital aren’t listed – what should I do?

An update list of hospitals has just being added to the database, if your hospitals, including small cottage hospitals, are still missing let me know so that MINAP can be informed.

Reporting  
Q:

A:

When will the first National audit report be published?

August 2002

  Times – CAT A
IT issues  
Q:

A:

Can I add fields to the database?

Yes but you MUST not take anything away or recode any existing fields

Q:

A:

Which AMPDS codes are used for inclusion criteria?

None – see inclusion criteria.  You can if you choose to report on your AMPDS codes by including it as an additional field see above

Q:

A:

 
Q:

A:

 

Q:

A:

 

Q:

A:

When will version 2 be available?

 

 

Do I need version 2 before submitting data to the National audit?

No, none of the Mandatory fields will be affected by the changes

 

When will the Access 2000 version be available?

   
Resources  
  Input times
Long term  
Q:

 

A:

How long until automatic links will be established with MINAP & CCAD for direct data input and retrieval of outcomes?

Extensive talks are being held, however it is unlikely that a short term solution will be found

 

Support  
Q:

A:

When will the user group be established?

As soon as these seminars are complete and I have the contact details of anyone wishing to be added to it