Context: A consensus event to discuss and prioritise ambulance service care outcome measures was held with 43 participants from a range of professional backgrounds including Commissioners; Policy makers; clinicians; managers; academics and patient and public representatives.
Problem: Ambulance services in England manage 8 million emergency calls per years and treat 6.5 million people. Services are currently unable to ascertain whether the care they provide is safe, effective and of good quality as they receive no information about patients once they have been discharged from their care. The lack of robust patient focussed outcome measures for ambulance care means there is no opportunity for identifying and sharing good practice, identifying problems and measuring the impact of service developments and innovations.
Assessment of problem and analysis of its causes: Historically ambulance service performance has been measured using response time as a proxy measure for quality. Although the limitations of this measure are recognised there is a lack of consensus on which outcome measures are important and little opportunity to measure alternatives due to poor information on what happens to patients after their ambulance service contact. The PhOEBE NIHR research programme aims to develop a linked ambulance service and secondary care dataset and to assess quality of care in this patient group using outcome measures identified from the literature and in consultation with different stakeholder groups. This means that for the first time the ambulance service will be able to assess the quality of care they provide to patients, rather than just how quickly the ambulance arrived.
Intervention: Potential outcome measures identified from 2 systematic reviews were categorised into 1 of 3 headings (Service/operational, patient management and patient outcomes) and participants were pre-allocated to a discussion group. All discussion groups contained participants representing a range of stakeholder view points. Participants took part in small group themed discussions relating to a number of pre-specified outcome measures. They were also able to add to the list of measures. Directly following the discussion participants voted on the importance of the outcome measures in relation to ambulance service care quality. This was done using Turning Point software. Participants rated each outcome measure as either ‘Essential’, ‘Desirable’ or ‘Irrelevant’ using individual key pads. The voting was done independently and anonymously. Real time results were displayed following each vote.
Study design: We used an interactive voting system coupled with a modified nominal group technique for the prioritisation of potential ambulance service outcome measures.
Strategy for change: Following on from this study the top ranking outcome measures will be further refined as part of a Delphi study, before using the outcome measures to assess ambulance service quality of care in our linked data sample. The methods for linking the ambulance service data to other health care information and the identified outcome measures will enable all UK ambulance services to assess the quality of care they provide to patients and the impact of any service changes on care quality and patient outcomes.
Measurement of improvement: The results from the outcome prioritisation voting exercise were ranked based on the highest proportion of ‘Essential’ rated measures. Where over 50% of participants rated a measure as ‘Essential’ these were taken forward and considered in further consensus studies.
Effects of changes: From undertaking the consensus event we have prioritised potential ambulance service outcome measures.
Lessons learnt: We have established that it is possible to incorporate voting technology into consensus methodologies and provide real time results to participants.
Message for others: This research prioritised ambulance service outcome measures. Out of the 40 number of measures considered, the top 5 measures were Accuracy of dispatch decisions; Completeness and accuracy of patient records; Accuracy of call taker identification of different conditions; pain measurement and symptom relief and Patient experience
