sophie clark: matched data and pre-hospital risk management
DESCRIPTION
This presentation by Sophie Clark of the London Ambulance Service was delivered at the QualityWatch seminar: 'Allied health professionals: can we measure quality of care?' on 12 November 2014. Allied health professionals (AHPs) are a group of 12 distinct professions that form a critical part of health care. By 2013 AHPs had made up around 6% of the NHS workforce and accounted for an estimated £2bn of the NHS salary bill. The role that AHPs play in delivering care is likely to increase further into the future as the population ages and people live with more complex needs. Yet despite the size of the workforce and the broad scope of care, there is very little systematic information available to describe the quality of care delivered by AHPs. Find out more in a new report from the Nuffield Trust and the Health Foundation > http://www.qualitywatch.org.uk/AHPsTRANSCRIPT
Matched Data and Pre-
Hospital Risk Management
Sophie Clark
The London Ambulance Service
Patient Journey Through LAS
Data Collected on the
Telephone
Data Collected by the
Clinician on Scene
Clinician gives
data to hospital...
Hear and Treat (4%)
See and Treat (30%)
No data available....
Risks of Limited Outcome Data • No integration between
services
• No method of
corroborating the
accuracy of LAS findings
• No understanding of the
outcomes of conveyed
patients or the care
provided at A&E
• Paramedics denied
lessons about identifying
and caring for the acutely
unwell
• No method to track
patients in high risk
groups, such as patients
who die in A&E.
Lack of data = Unknown (unmitigated) Risks
Cardiac Arrest Outcomes
=
Patient Outcome Project
Responding Appropriately 43% of patients that are
discharged from A&E are
getting a response within 8
minutes.
But 29% of patients who die
in A&E do not get a response
within 8 minutes.
11% of patients that will die in
A&E are waiting over 30
minutes for an ambulance.
Non-urgent patients are over
triaged to the detriment of
acutely unwell patients.
To reduce the risk of
acutely unwell
patients waiting for an
ambulance.
Responding Appropriately
Alcohol Intoxication
Vasovagal Syncope
UTI
Minor Head Injury
Viral Gastro- enteritis
Lower Back Pain
ACS
COPD
Gastritis
LRTI
Grand Mal Epilepsy
Chest Pain Trop
Negative
Nervous System Disorder
Depression
Asthma Constipation
Consto- chondritis
Arrhythmia Other
Abdo Pain – No Cause
Wound Head
Wound Face
Mixed Overdose
Minor Head
Inj
Urinary Tract
Calculus
Allergy
Other Bone Joint
Disorder Infectious Gastro- enteritis
Reflux
CCF
AF
Broncho- Pneumonia
Epistaxis
URTI
Migraine
Cellulitis
Alcohol Dependence
Hypo No Coma
Postural Hypotension
Shoulder Dislocation
Thorax Inj
TIA
C-Spine Sprain
Acute Confusion
Face Contusion
/Bruise
NOF
Stable Angina
Knee Sprain
Catheter Problem
Alcohol Withdraw
Pneumonia
T2DM
Results Only
Palpitations
Headache
PD
Neck Muscle
Inj Dementia
Stroke
Alcoholic Gastritis
PE
Alcohol
Sciatica
Urine Retention
BP
Colic
Renal Failure
Anaemia
Infection
BPR
Schizophrenia
Lumbar Sprain
Ankle Sprain
DVT
Leg Wound
Leg Bruise
Home- less
♯ Humerus
SVT
Multiple Falls
ACS Labyrinthitis
GI Bleed
Vertigo
Tonsillitis Epilepsy
Pancreatitis
Bowel Obstruction
Sepsis
Osteo- arthritis
Pseudo- seizure
Headache Electrolyte Disorder
Arthritis
Pul- Oedema
Bruise Foot
Arm Wound
♯ Shoulder
Left Before Being Seen
Other Respiratory
Disorder
Admittance Rate
Alcohol Intoxication
Vasovagal Syncope
UTI
Minor Head Injury
Viral Gastro- enteritis
Lower Back Pain
ACS
COPD
Gastritis
LRTI
Grand Mal Epilepsy
Chest Pain Trop
Negative
Nervous System Disorder
Depression
Asthma Constipation
Consto- chondritis
Arrhythmia Other
Abdo Pain – No Cause
Wound Head
Wound Face
Mixed Overdose
Minor Head
Inj
Urinary Tract
Calculus
Allergy
Other Bone Joint
Disorder Infectious Gastro- enteritis
Reflux
CCF
AF
Broncho- Pneumonia
Epistaxis
URTI
Migraine
Cellulitis
Alcohol Dependence
Hypo No Coma
Postural Hypotension
Shoulder Dislocation
Thorax Inj
TIA
C-Spine Sprain
Acute Confusion
Face Contusion
/Bruise
NOF
Stable Angina
Knee Sprain
Catheter Problem
Alcohol Withdraw
Pneumonia
T2DM
Results Only
Palpitations
Headache
PD
Neck Muscle
Inj Dementia
Stroke
Alcoholic Gastritis
PE
Alcohol
Sciatica
Urine Retention
BP
Colic
Renal Failure
Anaemia
Infection
BPR
Schizophrenia
Lumbar Sprain
Ankle Sprain
DVT
Leg Wound
Leg Bruise
Home- less
♯ Humerus
SVT
Multiple Falls
ACS Labyrinthitis
GI Bleed
Vertigo
Tonsillitis Epilepsy
Pancreatitis
Bowel Obstruction
Sepsis
Osteo- arthritis
Pseudo- seizure
Headache Electrolyte Disorder
Arthritis
Pul- Oedema
Bruise Foot
Arm Wound
♯ Shoulder
Left Before Being Seen
Other Respiratory
Disorder
Admittance Rate
Alcohol Intoxication
Sepsis Left Before Being Seen
Closed Fracture Neck of Femur
Call Category
Telephone Chief Complaint
LAS Response time
• Linked data is not routine
practice in LAS
• This leads to a potential lack of
integration and unmitigated
risks.
• Linked data can aid
understanding and quantifying
the risks.
• Linked data can help safe
decision-making at telephone
triage and on scene.
• Defining a safe service?
Conclusion
• This is only the start…..