Statistical press notice: Ambulance Quality Indicators – monthly update
Ambulance Quality Indicators statistics for August 2011 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 August 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 May 2011.
The main findings for Ambulance System Indicators for August 2011 were:
- The proportion of Category A calls resulting in an emergency response arriving within 8 minutes was 77.4% nationally, ranging from 80.8% to 74.4% across different ambulance trusts. One Trust, East Midlands Ambulance Service, failed to achieve the standard for 75% of Category A calls to receive an emergency response within 8 minutes. Performance on emergency resposnses within 8 minutes has improved from 76.4%, in , to 77.4% in August.
- 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 92.3%. Two Trusts; East Midlands Ambulance Service and East of England Ambulance Service failed to achieve the 95% standard for 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.
- The proportion of calls abandoned by the caller before the call was answered by the ambulance service was 1.1%, which is the same as last month. One Trust did not report this data.
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The re-contact rate following discharge of care has two components:
- Re-contact following discharge of care by telephone, where 13.9% 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 14.4%.
- Where the discharge of care was from face-to-face treatment by the ambulance service at the scene, 6.2% of such patients re-contacted the Ambulance Service within 24 hours, which is a reduction in performance over the figure of 5.4% in 2011. The range this month was 12.1% down to 3.3% on mainland England. On the Isle on Wight, only 2.6% 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 4.9% of emergency 999 calls that received a telephone or face to face response were resolved by telephone advice, which is a slight improvement over last month’s figure of 4.8%. The highest, Isle of Wight, achieved 12.7%, but again with a very low volume of calls. For the remainder of trusts the range was 2.5% to 7.1%.
- Of those emergency 999 calls that received a face to face response, 34.2% 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 - ‘s figure was 34.3%. This month’s performance ranged from 54.1% to 20.0% .
- 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 4 seconds. The 95th percentile ranged from 1 to 47 seconds and the 99th percentile had a range of 6 to 117 seconds.
- The median time to treatment ranged from 4.7 minutes to 6.1 minutes, the 95th percentile ranged from 11.7 to 21.9 minutes and the 99th percentile had a range of 18.1 to 37.6 minutes.
- In August 2011 there were 387,090 emergency journeys compared to 401,367 in July 2011.
The main findings for Ambulance Clinical Outcomes for May 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.
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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).
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Of those patients who had an out-of-hospital cardiac arrest, 24.1% had ROSC on arrival at hospital where resuscitation was commenced or continued by ambulance personnel. This is an improvement in performance from April 2011 where the corresponding figure was 21.1%. Performance ranged from 32.9% to 13.3% across all ambulance trusts.
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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), 48.8% had ROSC on arrival at hospital where resuscitation was commenced or continued by ambulance personnel. Again this was an improvement compared to the previous month where performance was 38.9%. On mainland England performance ranged from 67.6% to 30.8%.
- 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.
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Of those who suffered an out-of-hospital cardiac arrest, where resuscitation was commenced/continued by ambulance staff, 7.8% were discharged from hospital alive. This is an improvement over the 6.0% reported last month. For those Trusts that were able to submit data for this line, performance ranged from 15.3% to 5.5% (this excludes data for the Isle of Wight, where data were reported for six patients, of which none survived).
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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, 25.2% were discharged from hospital alive, compared to 16.5% last month, again an improvement. This indicator was 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 46.4% to 14.3%. One Trust is still 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, 59.3% received the thrombolysis within 60 minutes of the call being connected to the ambulance service. In April this figure was 66.0%, so there has been a slight worsening of the situation. As with the previous indicator, very small numbers were returned across those Trusts that are reporting data for this line. Not all Trusts return this data. Great Western, South Central 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 86.9% of all such patients that fulfilled this criteria, a reduction in performance compared to 90.8% in April 2011. Performance, on mainland England, ranged from 93.5% to 78.8%.
- 68.9% of patients with a pre-hospital diagnosis of suspected ST-elevation myocardial infarction received the appropriate care bundle. In April 2011 this figure was slightly better at 70.2%. Performance on mainland England ranged from 82.4% to 54.2%.
- 65.7% 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 88.3% to 56.5% on mainland England. This is a slight worsening over April 2011 where performance for this indicator was 66.2%.
- Of the suspected stroke patients assessed face to face, 90.4% received an appropriate care bundle, giving slightly worse performance to 91.3% reported in the previous month. Performance ranged from 99.3% to 77.3% across all trusts in England.
The Ambulance Quality Indicators statistics can be found on the Department of Health website.