Safety recommendation
HSIB recommends that NHS England and NHS Improvement revise the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction to reflect each element of the call to balloon response and review this indicator alongside the critical time standards workstream.
Response:
Discussions have taken place regarding revising the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction to reflect each element of the call to balloon response and evaluate where improvements can be made.
In preparing a response to the recommendations the following clinical and operational leads have been involved – Dan Boden (Interim National Clinical Director for Urgent and Emergency Care); Anthony Marsh (National Strategic Adviser of Ambulance Services); Dr David Macklin (Clinical Advisor, NHS England and NHS Improvement); and Nick Linker (National Clinical Director for heart disease). Consideration has been given to data sources and where the data will be published. Colleagues from the critical time standards workstream have been involved in these discussions. Following on from these discussions NHS England and NHS Improvement will explore the feasibility, the associated burdens and benefits of additional data collection, and potential unintended consequences of reporting the component parts of the call to balloon time to reflect the times for call to scene, on scene, scene to door and door to balloon.
A standing item of “emerging risks and research highlighting factors impacting on effective ambulance response” has been added to the agenda of the Joint Ambulance Improvement Programme Board, where matters of concern can be raised and actioned as appropriate.
Discussions have taken place regarding revising the Ambulance Clinical Quality Indicator: Clinical Outcomes for ST-elevation myocardial infarction and the need to evaluate and review the individual components of the call to balloon response, in particular the call to door elements. Consideration has been given to data sources and where these data will be published. It is proposed to report the component parts of the call to balloon time to reflect the times for call to scene, on scene, scene to door and door to balloon and to analyse where improvements can be made to reduce the call to balloon time. We will explore the feasibility, the associated burdens and benefits of this additional data collection, and potential unintended consequences before finalising any new national data collection. Subject to these findings, improvements will be realised through supporting those trusts and local systems with the greatest challenges to improve. This work will run alongside the critical time standards work..
Further details on the critical time standards work can be found on the NHS England and NHS Improvement website https://www.england.nhs.uk/2019/10/public-back-nhs-plans-for-new-rapid-care-measures/ for https://www.england.nhs.uk/2021/05/wide-support-for-more-comprehensive-urgent-care-indicators/.
TIMELINE: Revisions to the Clinical Quality Indicator will be explored during Summer 2021. Any revisions will be taken to the Autumn 2021 Ambulance Transformation Forum meeting for approval; implementation timeframe to be determined. The critical time standards implementation time frame is currently being reviewed.
Response received on 15 June 2021.