|Project title||Ambulance Service Cardiovascular Quality Initiative (ASCQI)|
|Funding body||The Health Foundation|
|Overarching aim||The aim was to improve delivery of prehospital cardiovascular care through collaboration with frontline clinicians, by ensuring all patients presenting with a heart attack (i.e. Acute Myocardial Infarction (AMI)) or stroke receive critical-to-quality care.|
|Objectives||Our objectives were to improve the delivery of care bundles for AMI to at least 70% and more than 90% for stroke by April 2012.|
Peer reviewed publications and conference presentations.
Peer reviewed publications
Siriwardena AN, Shaw D, Essam N, Togher FJ, Davy Z, Spaight A, Dewey M (2014) The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England. Implementation Science, 9 (17): 1-9.
Togher FJ Davy Z, Siriwardena AN (2013) Patients’ and ambulance service clinicians’ experiences of prehospital care for acute myocardial infarction and stroke: a qualitative study. Emergency Medicine Journal, 30 (11). pp. 942-948.
Siriwardena led the team that developed the first clinical performance (quality) indicators used by English ambulance services. The UK regulator, the Care Quality Commission, adopted several of these clinical indicators for their performance assessment of services using ambulance quality indicators. ASCQI was a landmark in English ambulanc e services using quality indicators to benchmark and improve care.
ASCQI has contributed to improving the delivery of critical-to-quality pre-hospital care nationwide.Nationally, the delivery of the AMI care bundle increased from 43% to 79% (ranging from 54.5% to 100% across trusts) and for stroke, delivery has increased from 83% to 96% (range 92% to 100%). To illustrate the benefits, 1,065 more AMI patients are now being given aspirin. The ‘International Study of Infarct Survival’ (ISIS-2) found patients who received aspirin within the first five hours of onset of cardiac chest pain had a 13% reduced risk of mortality, compared to those who were given aspirin between 5-12 hours after onset. We estimate an additional 138 patients’ lives per year are being saved following the improvements achieved through ASCQI by just increasing the administration of aspirin.We calculated 4,266 more stroke patients are having their blood glucose levels assessed by ambulance clinicians before arrival at hospital.
Through ASCQI we have successfully created an environment which facilitates on-going shared learning and cross-fertilisation of ideas between ambulance trusts. QI methodologies have been received enthusiastically by frontline clinicians. The introduction to, and sustained usage of, QI tools and SPC charts have proved effective in identifying gaps, developing solutions and measuring effects.Their usage has spread to improve other areas of clinical care, such as asthma, hypoglycaemia and cardiac arrest. Similar methods are now being applied to improve other areas such as reducing on-scene times and usage of e-PRFs.
This work featured in a national report on progress in the quality of ambulance services, ‘Taking healthcare to the patient 2’