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Improving the Quality of Pre-Hospital Care for Emergencies

Hundreds of stroke and heart attack sufferers have received improved care from frontline ambulance crews following research from the University’s Community and Health Research Unit.

The programme, led by Professor Niroshan Siriwardena, aimed to advance the quality of urgent and emergency care, particularly pre-hospital care provided by ambulance services.

It has led to evidence of inconsistencies in service quality, initiatives to address these and improvement in management of heart attack, stroke, asthma and diabetes across all ambulance services in England.

The research, which has included cross-sectional, qualitative, time series and controlled studies, has informed policy and improved practice in the ambulance service and out-of-hours care for emergencies.

Health practitioners and service users have been involved in the conception, design and dissemination of the work which was undertaken in collaboration with East Midlands Ambulance Service NHS Trust and all ambulance services in England.

Standards also improved in the delivery of ‘care bundles’. These are groups of best practice indicators which set out how ambulance crews should treat patients where conditions such as a heart attack (acute myocardial infarction, or AMI) or stroke is suspected.

Overall performance for the care bundle for AMI increased nationally in England from 43 to 79 per cent and for stroke from 83 to 96 per cent during the first 18 months of the project. This achievement received national recognition from the Department of Health as well as being shortlisted for a Health Service Journal award.

The group has addressed barriers to better pain assessment and reduction of infections through interventions such as raising awareness of deficiencies in care, improving care for pain, and pre-hospital cannulation (intravenous needle insertion) through quality improvement initiatives.

The research has changed national policy and benefitted national practice, by contributing to better understanding of deficiencies in care and both developing and testing methods which have improved delivery of pre-hospital care.

"As a result of our research we've had significant changes in front line care, particularly for heart attack and stroke, but also other conditions. We've had changes in policy, in terms of how ambulance services are being measured."

The group developed the first national clinical indicator set for ambulance services which has enabled better regulation and has raised the standard of performance, as evidenced in the latest report of National Clinical Indicators.

The significance of this work was also recognised in a national report published on behalf of the Association of Ambulance Chief Executives.

The research has led to changes in the attitudes and behaviours of ambulance service providers nationally, where they have adopted quality improvement methods as a means of improving care. As a result of this work more patients receive a high standard of care from ambulance services across England.

The group is now leading a programme of work in collaboration with East Midlands and Yorkshire Ambulance Services and Sheffield and Swansea Universities to evaluate the impact of ambulance service care. The research involves systematic reviews, qualitative and consensus methods and the creation of an information dataset to measure ambulance service care by linking routine pre-hospital, hospital, primary care and mortality data to predict mortality and non-mortality outcomes.