• The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England

    by Alan Batt. Last modified: 08/02/14

     
    Siriwardena AN, Shaw D, Essam N, Togher FJ, Davy Z, Spaight A, Dewey M; ASCQI Core Group. The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England. Implement Sci. 2014 Jan 23;9(1):17. PMID: 24456654.

    Fulltext (free): http://www.implementationscience.com/content/9/1/17

    Abstract

    BACKGROUND: Previous studies have shown wide variations in prehospital ambulance care for acute myocardial infarction (AMI) and stroke. We aimed to evaluate the effectiveness of implementing a Quality Improvement Collaborative (QIC) for improving ambulance care for AMI and stroke.

    METHODS: We used an interrupted time series design to investigate the effect of a national QIC on change in delivery of care bundles for AMI (aspirin, glyceryl trinitrate [GTN], pain assessment and analgesia) and stroke (face-arm-speech test, blood pressure and blood glucose recording) in all English ambulance services between January 2010 and February 2012. Key strategies for change included local quality improvement (QI) teams in each ambulance service supported by a national coordinating expert group that conducted workshops educating staff in QI methods to improve AMI and stroke care. Expertise and ideas were shared between QI teams who met together at three national workshops, between QI leads through monthly teleconferences, and between the expert group and participants. Feedback was provided to services using annotated control charts.

    RESULTS: We analyzed change over time using logistic regression with three predictor variables: time, gender, and age. There were statistically significant improvements in care bundles in nine (of 12) participating trusts for AMI (OR 1.04, 95% CI 1.04, 1.04), nine for stroke (OR 1.06, 95% CI 1.05, 1.07), 11 for either AMI or stroke, and seven for both conditions. Overall care bundle performance for AMI increased in England from 43 to 79% and for stroke from 83 to 96%. Successful services all introduced provider prompts and individualized or team feedback. Other determinants of success included engagement with front-line clinicians, feedback using annotated control charts, expert support, and shared learning between participants and organizations.

    CONCLUSIONS: This first national prehospital QIC led to significant improvements in ambulance care for AMI and stroke in England. The use of care bundles as measures, clinical engagement, application of quality improvement methods, provider prompts, individualized feedback and opportunities for learning and interaction within and across organizations helped the collaborative to achieve its aims.

    References

     
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    Siriwardena AN, Shaw D, Essam N, Togher FJ, Davy Z, Spaight A, Dewey M; ASCQI Core Group. The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England. Implement Sci. 2014 Jan 23;9(1):17. PMID: 24456654.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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