Background and objectives
The Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) research programme aims to develop better ways of measuring the quality of ambulance service care. Ambulance service care is often measured by the speed of the ambulance response rather than the quality of care provided or patient outcomes. Whilst response times are relevant to a small proportion of seriously ill patients, they are not clinically relevant for most people who contact the ambulance service. We identified existing and aspirational ambulance service quality and performance measures from reviews of the literature and interviews with service users and prioritised these as part of a Delphi study.
Methods
We conducted a Delphi study to prioritise ambulance service quality and performance measures. 42 people were invited to take part and 29 agreed. Of the 29 participants, 20 provided data for 2 Delphi rounds. For each round, 67 measures were scored on a 1 – 9 scale. Participants included policy makers and commissioners, clinical ambulance service and ambulance service operational groups. Outcomes were included from three categories: patient outcomes; whole service measures and clinical management. Measures with a median group score of 7 or above were classified as high scoring measures.
Results
There was little score change between the two Delphi rounds and over half of the measures scored 7 or above (13/25 patient outcomes, 9/10 clinical management measures and 18/32 whole system measures scored 7 and above).
High scoring patient outcome measures related to pain, survival, patient experience and re-contacts with emergency medical services. The highest scoring patient outcomes were: proportion of ambulance service calls referred for telephone advice who re-contact the ambulance service within 24 hours and proportion of patients given analgesia who report having pain. Low scoring measures related to re-contacts with non-EMS services, intubation and wound infection.
Nearly all of the clinical management measures scored highly. These measures related to correct categorisation of urgency, patient safety and compliance with protocols and guidelines. The highest ranking measure was: proportion of life-threatening category A calls correctly identified as category A.
The only high scoring time measures were time to definitive care and ambulance response time within 30 minutes. Other high scoring whole system measures were compliance with training and completion of patient records, whereas over triage and other time measures, for example, average time spent on scene or other response times scored <7.
Conclusion
Participants thought time to definitive care was more important than speed of response. Other important measures related to pain management, patient safety, re-contacts with EMS services and correct identification of call urgency. The public acceptability of the Delphi results will be discussed during a patient and public involvement (PPI) event, where PPI participants will have an opportunity to vote on and discuss the measures. Following this, a final shortlist of measures will be used to inform a predictive model to identify what aspects of care can predict good or poor outcomes (mortality and non-mortality) and we will use this to measure the effectiveness and quality of ambulance service car
