 |
Regional Activity Each regional group will
report their current clinical effectiveness
activity on these pages.
South
East (SEACAG) - click
here for seacag website http://www.seacag.org
Last updated 21/02/01
|
Collaborative
Cardiac Arrest Audit
The services of SEACAG are currently engaged in data
collection for a collaborative cardiac arrest audit based
on the out-of-hospital Utstein template. An update on the
project is available HERE or check out the
website http://www.seacag.org
SEACAG
E-Group
SEACAG have set up their own e-group discussion page at [email protected] .
SAMIP
(Sussex Acute Myocardial Infacrtion Project)
Details of this project looking at pre-hospital
thrombolyisis can be found by clicking HERE -
updated new site
LAS
CLINICAL AUDIT & RESEARCH BULLETIN -ISSUE 9 - AUGUST
2000
Results from the
Telephone Advice Study published
The despatch of emergency ambulances to patients not
in need of urgent care may result in inappropriate care,
delayed treatment for genuine emergency patients and
unnecessary use of NHS resources.
Therefore the Telephone Advice Study set out to:-
1. Investigate the efficiency, safety and acceptability
of telephone assessment and advice to non-urgent 999
ambulance service callers as an alternative to
despatching an ambulance.
2. Compare the efficiency, safety and acceptability of
nurses and paramedics as providers of telephone advice to
non urgent callers. Design and Methods - The trial
took place over 12 months and involved two Ambulance
Services, London and The West Midlands. During 3-4 hour
‘intervention’ sessions, trained nurses or
paramedics using TAS assessed patient needs and offered
appropriate advice. Ambulances were despatched as usual
but, following the advice, the opportunity to decline the
ambulance was given. Results - Those patients who
declined an ambulance 6% attended A&E by other means,
52% visited their GP, 39% carried out self care and 3%
reported other care. None of the patients who attended
A&E were admitted and the treatment provided would
have been available from their GP’s.
Paramedic assessment concluded that 44% of calls for
emergency ambulance were unnecessary whilst 58% was
assessed by a nurse. A follow-up survey indicated that
patient satisfaction levels were generally high.. Conclusions
- Findings indicated that provision of telephone
assessment and advice using TAS is safe and acceptable
and could lead to improved response times for patients
with critical or life threatening needs. More
Conclusions Paramedics appeared more cautious than
nurses when identifying patients need of an emergency
ambulance. Results indicate that both groups safely
provide telephone advice. Winter Pressures Telephone
advice provided by personnel during the winter pressure
period was registered by the Department of Health as a
Category C pilot. During the period 246 calls were given
advice of which 35% did not require an ambulance. What
next? Following this study the LAS are considering
providing telephone advice as an alternative to ambulance
response for patients to whom it is deemed appropriate.
Further information available from Chris Hartley-Sharpe
on 020 7921 5266
Cardiac Update - The Clinical
Audit and Research Unit made two presentations at
Resuscitation 2000 held in Antwerp.
Out-of-Hospital Cardiac Arrest in a UK metropolitan
area. Dr Patricia Clarke worked from data collected
for the LAS cardiac database of 1997. Results revealed
survivors of cardiac arrest were more likely to have
– a) Arrested in front of Ambulance Crew, b)
Received bystander CPR c) Have an initial rhythm of VF/VT
d) Been defibrillated. Evidence has led to the
development of priority despatch telephone advice. Also
increased bystander CPR from 26% to 44% in certain areas
of London. Cardiac Study All data from 1998 and
from January to June 1999 has been collected. Currently
awaiting information from National Statistics Office for
survivors of one year post hospital discharge. Resulting
information to be published shortly. Questionnaire Following
results of a crew feedback questionnaire in 1999, John
Knights, Cardiac Research Assistant, gave a presentation
on Understanding crew behaviour on arrival at the
scene of an out-of-hospital cardiac arrest.
Results showed that crews were more likely to carry a
defibrillator to calls passed as ‘cardiac
arrest’ than ‘unconscious’. Following an
emergency call two thirds of crews stated that
defibrillators were not carried on every call because of
the weight and awkwardness, but findings indicated that
crews were three times more likely to carry oxygen. Also
indicated was the need to standardise the terminology
used to pass details of calls to ambulance crews which
ultimately influences the decision on whether to take a
defibrillator to the patient. The questionnaire also
showed that more emphasis should be placed on the
importance of the defibrillator for cardiac patients.
Benefits of the use of Automatic External Defibrillators
is backed by the Department of Health who have released 1
million pounds for Ambulance Services to ensure this
equipment is available on every ambulance.
For more information on the Cardiac Study – contact
Jon Knights
Barts City Lifesaver and 12 lead ECG
Paula Ross from Barts City Life Saver spoke on The
importance of an efficient communication system in a
first responder scheme. Mark Whitbread, Royal London
Hospital reported on the 12 Lead ECG initiative
undertaken by crews at Poplar ambulance station which is
to be expanded to other stations.
LAS Research Wins Award at 999 EMS
Research Forum An award was won for Most Original
Research which covered The Operational Development
Unit’s work on older fallers. Mary Halter, Clinical
Audit Co-ordinator, gave the winning presentation which
followed a pilot study to assess individuals who called
999 after a fall but who were not subsequently conveyed
to A&E. The Forum, part of the Clinical Showcase
Theatre at Ambex 2000, aims to encourage, promote and
disseminate research and evidence-based policy and
practice in 999 healthcare. A number of posters were also
presented
- Understanding how to best achieve
change: a survey of ambulance staff views on the
impact of an audit of asthma care
- Acceptability of telephone advice
for emergency (999) callers triaged in ambulance
control as neither life-threatening nor urgent
- Variation in recording prehospital
cardiac arrest survival in UK Ambulance Services
- Audit of the emergency prehospital
care of hypoglycaemic patients
All work presented will be published in
the BMJ. Photocopies available for Hasna Sinancevic in n
the Clinical Audit & Research Unit.
999 Minor Injuries Unit Study (MIUs)
The unit aims to compare the care and satisfaction of
patients with minor injuries taken to MIUs (intervention
group) with similar patients taken to A&E as normal
(Control group). Those Ambulance crews taking part in the
trial are:LAS in Wembley, Surrey Service in Woking,
Haslemere, Godalming and Knaphill. Data collection
commenced on May 15th 2000 and will continue
for 12 months. In the first month 81 patients were
identified to receive follow-up questionnaires; 35 in the
intervention group and 46 in the control group. The team
aims to follow-up approximately 20 patients per week.
Identification of suitable patients to be included in the
study will come from information supplied by CAC and
study protocols. The systems appears to be working well.Benefits
- Potential benefits to be gained from transporting
appropriate patients to MIUs are:
- Shorter waits for patients at MIUs
than A&Es, therefore greater patient patient
satisfaction.
- Quicker turnaround times for
ambulances
- Ambulances available sooner to
deal with other 999 calls.
- Better use of public money as MIUs
and ambulances are being fully utilised.
- Greater satisfaction for crews as
they are allowed to use their judgement to make
decisions about appropriate patient care.
More details about MIU Project
available from Theresa Foster (MIU researcher) on 020
85630214
Crew’s Views Lee Bevan,
paramedic from Poplar Ambulance Service discusses the 12
lead ECG initiative.In 1996 the LAS was approached by the
Royal London Hospital regarding the participation of a
project to record pre-hospital 12 lead dianostic ECGs and
the indentification of ST Elevation suggesting a
myocardial infarction. Knowing that Coronary Artery
Disease was a large killer and that Tower Hamlets had a
large number of such patients, it was considered a
positive move. Staff were released for training and were
taught to identify ST Elevation, other abnormalities and
how to record a 12 Lead ECG together with the value this
information would have on the patients and improvement of
care. Further assessments to indicate the ability to
interpret the 12 Lead ECG’s and assessments were
compated to A&E SHOs. Outcome showed that staff were
equal to SHOs. Initial study showed that patients who had
received a pre-hospital 12 Lead ECG had a ‘door to
needle time’ of 20 to 30 minutes, a reduction in a
time to treatment of approximately 30 minutes. Lee Bevan
considered that this was a good initiative undertaken by
the LAS and felt that ambulance staff can make a
difference in patient care and quality of life. Clearly
pre-hospital 12 Lead ECG will be part of the overall
cardiac care to be offered to the people of London. It is
assumed from Professor Chamberlain’s presentation on
the role of the 12 Lead ECG and pre-hospital thrombolytic
treatment, at Ambex 2000, that this is a rapidly
expanding area which will involve all Ambulance Services.
FURTHER INFORMATION CAN BE OBTAINED
FROM LONDON AMBULANCE SERVICE
|
