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…..

Questions?

Thank you for listening