Press release

Statistical press notice: Ambulance Quality Indicators – monthly update

This news article was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Monthly Ambulance System Indicators statistics were released today by the Department of Health

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 October 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 July 2011.

 The main findings for Ambulance System Indicators for October 2011 were:

• The proportion of Category A calls resulting in an emergency response arriving within 8 minutes was 76.0% nationally, ranging from 77.6% to 74.3% across different ambulance trusts. Two Trusts; Yorkshire and East Midlands failed to achieve the standard for 75% of Category A calls to receive an emergency response within 8 minutes. Performance on emergency responses within 8 minutes has improved from 75.5%, in September, to 76.0% in October.
 
• The proportion of Category A calls resulting in an ambulance arriving at the scene within 19 minutes was 96.6%, ranging from 99.2% to 91.0%. Two Trusts; East Midlands Ambulance Service and East of England Ambulance Service failed to achieve the standard for 95% of Category A calls to receive an ambulance vehicle capable of transporting the patient within 19 minutes of the request for transport being made. Performance has remained the same as last month at 96.6%.

• The proportion of calls abandoned by the caller before the call was answered by the ambulance service was 1.1%, which is an improvement of the position when compared to 1.3% in September.

• The re-contact rate following discharge of care has two components:
- Re-contact following discharge of care by telephone, where 14.2% of such calls resulted in the patient re-contacting the Ambulance Service within 24 hours. This has deteriorated from last month’s position of 13.8%.
 - Where the discharge of care was from face-to-face treatment by the ambulance service at the scene, 5.8% of such patients re-contacted the Ambulance Service within 24 hours, which is an improvement in performance over the figure of 5.9% in September 2011. The range this month was 8.3% down to 1.6%.

• 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, 0.9% 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. For those Trusts that were able to supply both a numerator and denominator the corresponding figure was 1.9%.

• 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 identical to last month’s figure of 4.8%. The highest, Isle of Wight, achieved 8.1%, but with a very low volume of calls. For the remainder of trusts the range was 2.0% to 7.5%.

• Of those emergency 999 calls that received a face-to-face response, 33.0% 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 worsened - the previous month’s figure was 33.7%. This month’s performance ranged from 46.1% to 19.3%.

• Data on the median, 95th and 99th percentiles were collected, at Ambulance Trust level, for both Time to Answer Calls and Time to Treatment. However, 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 3 seconds. The 95th percentile ranged from 1 to 43 seconds and the 99th percentile had a range of 8 to 100 seconds.

• The median time to treatment ranged from 4.9 minutes to 6.3 minutes, the 95th percentile ranged from 12.3 to 22.7 minutes and the 99th percentile had a range of 18.6 to 42.0 minutes.

•  In October 2011 there were 409,352 emergency journeys compared to 389,802 in September 2011.

The main findings for Ambulance Clinical Outcomes for July 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. This is a fall in performance from June 2011 where the corresponding figure was 23.8%.  Performance ranged from 29.6% to 11.9% across all ambulance trusts.
- 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), 42.8% had ROSC on arrival at hospital where resuscitation was commenced or continued by ambulance personnel. Again, this was a slight fall compared to the previous month where performance was 46.4%. On mainland England performance ranged from 60.0% to 28.6%.

• 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 ambulance staff commenced/continued resuscitation, 6.9% were discharged from hospital alive. This is an improvement over the 6.6% reported last month. For those Trusts that were able to submit data for this line, performance ranged from 11.7% to 3.2% (this excludes data for the Isle of Wight). One Trust, South East Coast Ambulance Trust, is still not in a position to report data on survival rates.
- 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, 20.7% were discharged from hospital alive, compared to 24.0% last month, a deterioration in performance. This indicator is characterised by small numbers. Performance percentage figures derived from these figures are likely to be subject to large variation, within and across months. This month performance ranged from 28.0% to 7.7%. This figure again excludes the Isle of Wight. South East Coast Ambulance Trust is not in a position to report data on survival rates.

• Of those patients with an initial diagnosis of ‘definite myocardial infarction’ receiving thrombolysis where the first diagnostic ECG was performed by ambulance personnel, 52.8% received the thrombolysis within 60 minutes of the call being connected to the ambulance service. In June, this figure was 47.2%, so there has been an improvement in performance. As with the previous indicator, very small numbers were returned across those Trusts that are reporting data for this line. Five Trusts do not return this data and have confirmed that this indicator is not applicable to them, as their clinical pathway does not include thrombolysis, only PPCI. These trusts are Great Western, South Central, North East, East of England and London.

• 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 89.1% of all such patients that fulfilled this criteria, a slight improvement in performance compared to 87.5% in June 2011. Performance, on mainland England, ranged from 100% to 81.9%.

• 74.4% of patients with a pre-hospital diagnosis of suspected ST-elevation myocardial infarction received the appropriate care bundle. This is an improvement on last month, where 71.7% received the appropriate bundle. Performance on mainland England ranged from 93.4% to 59.6%.

• 67.6% 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 86.7% to 56.0% on mainland England. This is an improvement compared to June 2011 where performance for this indicator was 65.7%.

• Of the suspected stroke patients assessed face to face, 93.2% received an appropriate care bundle, showing a better performance than the 92.7% reported in the previous month. Performance ranged from 100.0% to 72.7%.

More information can be found on the Department of Health website.