Ambulance service puts too much emphasis on response time to detriment of overall care, says National Audit OfficeBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3672 (Published 10 June 2011) Cite this as: BMJ 2011;342:d3672
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The National Audit Report on 'Transforming NHS Ambulance Services'
reinforces efforts to refocus ambulance services on what really matters to
patients and staff: rather than response time targets, this is the real
performance of clinicians at the front line in their delivery of high
quality care to patients.
An important omission in the report is the work that English
ambulance services have undertaken to measure and improve the quality of
clinical care being provided to patients by ambulance services. This has
been the result of ambulance service representatives meeting regularly
over the past five years, agreeing indicators for clinical domains advised
by clinical directors and developing and refining a national measurement
A set of clinical indicators was developed, piloted and incorporated
into national regulatory frameworks in 2007. We believe this to be the
first national clinical indicator set for ambulance services to be used
for national benchmarking, improvement and regulation of prehospital care.
The indicators continue to be measured in all 11 (12 including the
Isle of Wight) regional services, gaps in performance have been
identified using control (funnel) plots, interventions to improve areas of
underperformance have been implemented and the results of these efforts
have been discussed and shared across services. One impact has been the
observed improvement in measured performance in the majority of clinical
Ambulance services have been building on these results by using a
quality improvement collaborative approach with plan-do-study-act cycles,
process mapping and interventions (such as opinion leadership, feedback
and sharing information on what works) to improve care for heart attack
and stroke as part of he Ambulance Services Cardiovascular Quality
Initiative (ASCQI) which pre-empts the approach advocated by the Kings
Fund for improving quality of care in general practice.
1. National Audit Office. Transforming NHS Ambulance Services. 2011.
London, The Stationery Office.
2. Siriwardena AN, Shaw D, Donohoe R, Black S, Stephenson J:
Development and pilot of clinical performance indicators for English
ambulance services. Emerg Med J 2010, 27: 327-331.
3. Shaw D, Siriwardena AN. Report on National Ambulance Service
Clinical Performance Indicators: Cycle 4 November 2009 - March 2010.
2011. Nottingham, East Midlands Ambulance Service.
4. Shaw D, Spaight A, Stephenson J, Siriwardena AN: Impact of
National Clinical Performance Indicators on clinical care provided by
ambulance services in England. Presented at the International Forum on
Quality and Safety in Healthcare, Nice, April 2010.
5. Kings Fund. Improving the quality of care in general practice.
Competing interests: ANS is associate clinical director at East Midlands Ambulance Service NHS Trust and chairs the National Ambulance Research Steering Group. He is co-lead for the Ambulance Services Cardiovascular Quality Initiative (ASCQI) which is funded by the Health Foundation.