Local Improvement Following National Clinical Audit Participation

1. Local Improvement Following NationalClinical Audit Participation Georgina Jones

2. National Project • Ambulance Service Cardiovascular Quality Initiative (ASCQI) • University of Lincoln • East Midlands Ambulance Service • National Ambulance Research Steering Group

3. ASCQI Project Aims • Improve delivery of pre-hospital care for cardiovascular disease • Spread quality improvement methods • Engage pre-hospital clinicians in clinical audit

4. National Standards Best clinical practice NSF Coronary Heart Disease National Stroke Strategy Guidelines Joint Royal Colleges Ambulance Liaison Committee (JRCALC) National clinical performance indicators National Ambulance Research Steering Group

5. London Ambulance Service 3,651 clinicians • Paramedic lead local clinical audit project STROKE 8,500 patients STEMI 3,000 patients

6. Standards of Care • JRCALC clinical practice guidelines • Optimal care defined by care bundle: Heart attack care bundle

7. Data Collection 84% 97% CARE BUNDLE 42% 92% 49%

8. Root Cause Analysis Lack of a pain assessment tool Evidence for Entonox use Language barriers Analgesia guidance Analgesia training Clinicians’ beliefs regarding patients' pain

9. Implementing Change

10. Implementing Change

11. Spreading change

13. Evaluation

14. Thank you