Skip to main content
Article thumbnail
Location of Repository

Development and pilot of clinical performance indicators for English ambulance services

By A Niroshan Siriwardena, Debbie Shaw, Rachael Donohoe, Sarah Black and John Stephenson


Introduction: There is a compelling need to develop\ud clinical performance indicators for ambulance services in\ud order to move from indicators based primarily on\ud response times and in light of the changing clinical\ud demands on services. We report on progress on the\ud national pilot of clinical performance indicators for English ambulance services.\ud Method: Clinical performance indicators were developed\ud in five clinical areas: acute myocardial infarction, cardiac\ud arrest, stroke (including transient ischaemic attack),\ud asthma and hypoglycaemia. These were determined on\ud the basis of common acute conditions presenting to\ud ambulance services and in line with a previously\ud published framework. Indicators were piloted by\ud ambulance services in England and results were\ud presented in tables and graphically using funnel\ud (statistical process control) plots.\ud Results: Progress for developing, agreeing and piloting of\ud indicators has been rapid, from initial agreement in May\ud 2007 to completion of the pilot phase by the end of\ud March 2008. The results of benchmarking of indicators\ud are shown. The pilot has informed services in deciding\ud the focus of their improvement programme in\ud 2008 and 2009 and indicators have been adopted for\ud national performance assessment of standards of\ud prehospital care.\ud Conclusion: The pilot will provide the basis for further\ud development of clinical indicators, benchmarking of\ud performance and implementation of specific evidencebased\ud interventions to improve care in areas identified\ud for improvement. A national performance improvement\ud registry will enable evaluation and sharing of effective\ud improvement methods as well as increasing stakeholder\ud and public access to information on the quality of care\ud provided by ambulance services

Topics: B990 Subjects Allied to Medicine not elsewhere classified, A300 Clinical Medicine
Publisher: BMJ Publishing
Year: 2010
DOI identifier: 10.1136/emj.2009.072397
OAI identifier:

Suggested articles


  1. (2009). 999 EMS Research Forum. What are the highest priorities for research in pre-hospital care? Results of a review and Delphi consultation exercise (accessed 13
  2. (2004). A Delphi study to identify performance indicators for emergency medicine. Emerg Med J doi
  3. (2006). Colleges Ambulance Liaison Committee, Ambulance Service Association. UK ambulance service clinical practice guidelines. London: Ambulance Service Association, doi
  4. (2001). Crossing the quality chasm. doi
  5. Developing evidence-based clinical indicators: a state of the art methods primer. doi
  6. (2001). Developing indicators for emergency medical services (EMS) system evaluation and quality improvement: a statewide demonstration and planning project.
  7. Development and use of clinical performance indicators for ambulance and prehospital care: a discussion paper for a clinical quality improvement framework for ambulance services. Nottingham: East Midlands Ambulance Service,
  8. (2003). Emergency calls not requiring an urgent ambulance response: expert consensus. Prehosp Emerg Care
  9. (1966). Evaluating the quality of medical care. doi
  10. (2008). Evidence-based performance measures for emergency medical services systems: a model for expanded EMS benchmarking. Prehosp Emerg Care doi
  11. (2001). Expert consensus on the desirable characteristics of review criteria for improvement of health care quality. Qual Health Care doi
  12. (2005). Health. Taking healthcare to the patient. Transforming NHS ambulance services.
  13. (2001). Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia. doi
  14. (2009). Indicator listings for ambulance trusts e new national targets 2007/08. London, UK: Healthcare Commission,
  15. (1992). Joint Commission on Accreditation of Healthcare Organizations. Primer on indicator development and application: measuring quality in health care.
  16. (1999). Measuring quality and effectiveness of prehospital EMS. Prehosp Emerg Care doi
  17. (2005). Paramedic response time: does it affect patient survival? Acad Emerg Med doi
  18. (2008). Plotting basic control charts: tutorial notes for healthcare practitioners. Qual Saf Health Care doi
  19. (2006). Releasing the potential of health services: translating clinical leadership into healthcare quality improvement. Qual Prim Care
  20. (2010). Retention of information by emergency department staff at ambulance handover: do standardised approaches work? Emerg Med J doi
  21. (1994). System implications of the ambulance arrival-to-patient contact interval on response interval compliance. Prehospital Disaster Med
  22. (2001). The advantages and disadvantages of process-based measures of health care quality. doi
  23. (2007). Trauma: who cares? A report of the National Confidential Enquiry into Patient Outcome and Death.
  24. (2006). Treating the clock and not the patient: ambulance response times and risk. Qual Saf Health Care doi
  25. (2005). Using statistical process control (SPC) chart techniques to support data quality and information proficiency: the underpinning structure of high-quality health care. Qual Prim Care
  26. (2005). Working Party on Performance Monitoring in the Public Services. Performance indicators: good, bad, and ugly.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.