Clinical quality indicators were introduced on April 1 2011. They aim to make it easier for patients and the public to see the quality of care provided by ambulance services. How well ambulance services perform against these guidelines will be made regularly available.
The indicators were developed by leading health professionals. They aim to improve the quality and safety of care for patients who benefit most from rapid assessment, treatment and, in some cases, transport.
The aim of the indicators is not just to provide information. They are also meant to encourage discussion and debate among ambulance staff, NHS managers, commissioners and the public about the quality of the care being provided and how it can be improved.
You can find regular updates about the Ambulance quality indicators on the NHS England website.
What are the indicators?
Most, if not all, ambulance trusts carry out patient satisfaction surveys. Ambulance services are now required to do more than simply report the results. They must show and publish how they got the results (including results of focus groups, interviews and patient forums, rather than just patient surveys) and how they plan to act on them to improve patient care.
Outcome from acute STEMI
STEMI stands for "ST segment elevation myocardial infarction". This is a type of heart attack, the test for which is called an electrocardiogram (ECG). Patients are more likely to recover, and to recover more quickly, from many conditions if they are treated early. Early access to reperfusion (where blocked arteries are opened to re-establish blood flow) and other assessments and types of care are associated with reduced deaths from and incidence of STEMI. Measuring the outcomes of patients with STEMI will stimulate discussion about how to improve services in this area.
Outcome from cardiac arrest: return of spontaneous circulation
This indicator will measure how many patients who are in cardiac arrest (no pulse and not breathing) have a pulse on arrival at hospital following resuscitation. Providing resuscitation as early as possible to people in cardiac arrest is likely to improve their chances of recovery. Clearly, the higher the survival rate, the better.
Outcome from cardiac arrest to discharge
Ambulance services play a vital role in saving patients' lives. However, it is important to understand how effective the whole system is in managing patients who are in cardiac arrest. This indicator should show how effective the ambulance service is in responding to and treating patients in cardiac arrest when arriving at the hospital. It measures the rate of patients who recover from cardiac arrest and are subsequently discharged from hospital.
Outcome following stroke for ambulance patients
The stroke ‘Act F.A.S.T’ campaign has been very successful in raising the public's awareness of the signs of strokes and TIAs (transient ischaemic attacks, or mini-strokes). It also highlighted the importance of quick emergency treatment to reduce the risk of death and disability.
F.A.S.T stands for:
- Facial weakness – Can the person smile? Has their mouth or eye drooped?
- Arm weakness – Can the person raise both arms?
- Speech problems – Can the person speak clearly and understand what you say?
- Time to call 999 for an ambulance if you spot any of these signs.
Ambulance services are required to measure the time it takes from receiving a 999 call to getting stroke patients to a specialist stroke centre. Patients should arrive at a specialist stroke centre as soon as possible to be rapidly assessed for thrombolysis, using a CT scan, in a short but safe time frame. This has been proven to reduce deaths and improve patient recovery.
Proportion of calls closed with telephone advice or managed without transport to A&E
Ambulance trusts are good at handling and responding to 999 calls. But calling 999 does not necessarily mean that a "blue light" emergency response is the best response. Alternative healthcare options to A&E may be more appropriate for the patient. Also, as ambulance staff become increasingly skilled in treating patients at the scene, they may be able to treat the patient there and then without needing to take them to an A&E department.
This indicator should reflect how the urgent care system operates as a whole, rather than looking at ambulance services and A&E in isolation. It should reflect the availability and provision of alternative urgent care destinations and treatment of patients in the home. This will help improve urgent and emergency care services so that they offer the right treatment to patients in the right place and at the right time.
Re-contact rate following discharge of care
If patients have to call 999 a second time, it is usually because they are anxious about getting an ambulance to come or have not got better as expected. Occasionally, it may be due to an unexpected or a new problem. To ensure that ambulance trusts provide safe and effective care the first time, this indicator will monitor how many patients call the ambulance service back within 24 hours of the first call being made.
Call abandonment rate
The vast majority of people who phone 999 do so because they need emergency healthcare. If people do not get to speak to the ambulance service quickly, they may hang up or try to get the care they need elsewhere, for example by going to A&E. This indicator will ensure that ambulance trusts can take 999 calls and that people don't abandon their 999 call before a control room operator has answered.
Time to answer calls
It is equally important that 999 calls are answered quickly. This indicator will measure how quickly all 999 calls are answered. The faster ambulance services answer a call, the quicker they can establish what is wrong with the patient so that the best type of response can be given. Answering the call quickly also reassures often very anxious and scared callers.
Time until treatment by an ambulance-dispatched health professional
It is important that people wait for as short a time as possible from the 999 call to when an ambulance crew arrives. This is because urgent treatment may be needed.
Category A: eight minutes response time
In truly life-threatening situations, the speed of an ambulance arriving can make the difference between life and death. This indicator measures the speed of all ambulance responses to the scene of potentially life-threatening incidents. Importantly, it measures whether those patients who are most in need of an emergency ambulance get one quickly.
Category A19: 19 minutes transportation standard
Patient outcomes can be improved by ensuring patients with immediately life-threatening conditions receive a response at the scene, which is able to transport the patient in a clinically safe manner, if they require such a response.