The following statistics were released today by the Department of Health:
Ambulance System Indicators; Category A 8 minute response time, category A 19 minute response time, call abandonment rate, re-contact rate following discharge of care, time to answer call, time to treatment, ambulance calls closed with telephone advice or managed without transport to A&E, ambulance emergency journeys; for period July 2011.
Ambulance Clinical Outcomes; Outcome from cardiac arrest - return of spontaneous circulation, outcome from acute ST-elevation myocardial infarction (STEMI), outcome from stroke for ambulance patients, outcome from cardiac arrest - survival to discharge; for period April 2011.
The main findings for Ambulance System Indicators for July 2011 were:
- The proportion of Category A calls resulting in an emergency response arriving within 8 minutes was 76.4% nationally, ranging from 77.7% to 74.8% across different ambulance trusts. One Trust, East of England Ambulance Service, failed to achieve the 75% standard. In June, the national position was that 75.3% of calls resulted in an emergency response within 8 minutes.
- The proportion of Category A calls resulting in an ambulance arriving at the scene within 19 minutes was 97.1%, ranging from 99.8% to 93.0%. Two Trusts; East Midlands Ambulance Service and East of England Ambulance Service failed to achieve the 95% standard. Performance has improved from last month’s national performance of 96.8%.
- The proportion of calls abandoned by the caller before the call was answered by the ambulance service was 1.1%, which is an improvement compared to 1.4% last month. One Trust did not report this data.
- The re-contact rate following discharge of care has two components:
- Re-contact following discharge of care by telephone, where 14.4% of such calls resulted in the patient re-contacting the Ambulance Service within 24 hours. This is an improvement on last month’s figure of 15.2%.
- Where the discharge of care was from face-to-face treatment by the ambulance service at the scene, 5.4% of such patients re-contacted the Ambulance Service within 24 hours, which is an improvement over the figure of 5.6% in June 2011. The range this month was 9.6% down to 2.7% on mainland England. On the Isle on Wight, only 0.9% of patients discharged at the scene recontacted the service within 24 hours, but this was from a very low volume of calls.
- There is a separate element on those re-contacting the Ambulance Service and that deals with those for whom there is a locally agreed frequent caller procedure in place. Nationally, 0.7% of patients for whom a frequent caller handling procedure is in place re-contacted the ambulance service within the month; however, frequent caller procedures are locally determined and protocols will vary across ambulance services. Six Trusts were not able to identify frequent callers.
- Where ambulance calls were closed with telephone advice or managed without transport to A&E then 4.8% of emergency 999 calls that received a telephone or face to face response were resolved by telephone advice, which is an improvement over last month’s figure of 4.7%. The highest, Isle of Wight, achieved 14.8%, but again with a very low volume of calls. For the remainder of trusts 6.7% was the highest and 2.2% the lowest.
- Of those emergency 999 calls that received a face to face response, 34.3% were either discharged at the scene, transferred to a destination other than a Type 1 or Type 2 A&E, or were referred to an alternative care pathway. Performance has remained stable - June’s figure was 34.4%. This month’s performance ranged from 52.5% to 20.1% .
- Data on the median, 95th and 99th percentiles were collected for both Time to Answer Calls and Time to Treatment. Due to the collection method, it is not possible to produce a national median/95th/99th percentile.
- For the time to answer a call the median ranged from less than a second to 5 seconds. The 95th percentile ranged from 1 to 42 seconds and the 99th percentile had a range of 7 to 115 seconds.
- The median time to treatment ranged from 5 minutes to 7 minutes, the 95th percentile ranged from 11.8 to 21 minutes and the 99th percentile had a range of 17.5 to 34.6 minutes.
- In July 2011 there were 401,367 emergency journeys compared to 385,349 in June.
The main findings for Ambulance Clinical Outcomes for April 2011 are shown below. This return runs with a 3 month lag on the Systems Indicators as this time is required in order for those patients transported by ambulance to have their outcomes resolved.
- The Return of Spontaneous Circulation (ROSC) is calculated for two patient groups: The overall rate measures the overall effectiveness of the urgent and emergency care system in managing care for all out-of-hospital cardiac arrests; the rate for the Utstein comparator group provides a more comparable and specific measure of the management of cardiac arrests for the subset of patients where timely and effective emergency care can particularly improve survival (e.g. 999 calls where the arrest was not witnessed and the patient may have gone into arrest several hours before the 999 call are included in the figures for all patients, but are excluded from the Utstein comparator group figure).
- Of those patients who had an out-of-hospital cardiac arrest, 21.1% had ROSC on arrival at hospital where resuscitation was commenced or continued by ambulance personnel. On mainland England performance ranged from 28.7% to 11.9%.
- For those patients who had an out-of-hospital cardiac arrest that was witnessed, and where the patient had a heart rhythm that was suitable for defibrillation (i.e. the Utstein comparator group), 38.9% had ROSC on arrival at hospital where resuscitation was commenced or continued by ambulance personnel.
- As with the Return of Spontaneous Circulation, survival to discharge following cardiac arrest is reported separately for all patients, and for the subset of patients in the Utstein comparator group.
Of those who suffered an out-of-hospital cardiac arrest, where resuscitation was commenced/continued by ambulance staff, 6.0% were discharged from hospital alive. For those Trusts that were able to submit data for this line, performance ranged from 12.0% to 2.2%.
- For those patients who had an out-of-hospital cardiac arrest that was witnessed, and where the patient had a heart rhythm that was suitable for defibrillation and resuscitation was commenced or continued by ambulance personnel , 16.5% were discharged from hospital alive. Figures returned for this indicator were very low across all Trusts. So performance variation will be affected greatly by this aspect. Performance ranged from 33.3% to 0%.
- Of those patients with an initial diagnosis of ‘definite myocardial infarction’ receiving thrombolysis where the first diagnostic ECG was performed by ambulance personnel, 66.0% received the thrombolysis within 60 minutes of the call being connected to the ambulance service. As with the previous indicator, very small numbers were returned across those Trusts that are reporting data for this line. Performance ranged from 0% to 100%. Not all Trusts return this data. East of England, London and North East Ambulance Services have confirmed that this indicator is not applicable to them, as their clinical pathway does not include thrombolysis, only PPCI.
- Those patients for whom a primary angioplasty occurred within 150 minutes of the call being connected to the ambulance service following the first diagnostic ECG being carried out by ambulance personnel, represented 90.8% of all such patients that fulfilled this criteria. Performance, on mainland England, ranged from 97.6% to 82.3%.
- 70.2% of patients with a pre-hospital diagnosis of suspected ST-elevation myocardial infarction received the appropriate care bundle. Performance across trusts ranged from 86.2% to 55.0%.
- 66.2% of FAST positive patients, who were assessed face to face, arrived at a hyperacute stroke centre within 60 minutes of the call being connected to the ambulance service. Performance ranged from 90.9% to 46.6% on mainland England.
- Of the suspected stroke patients assessed face to face, 91.3% received an appropriate care bundle. Performance ranged from 100% to 84% across all trusts in England.
The full details of statistics for Ambulance Quality Indicators can be found on the Department of Health website.