Patient management (processes)

Calls sent for telephone nurse advice that are returned for an ambulance response.

Accuracy of call-taker identification of different conditions (e.g. cardiac arrest, heart attack, stroke, serious illness, low-urgency calls suitable for nurse advice) or needs. Includes:

• measures of call assessment accuracy, such as sensitivity
• appropriateness of triage decision
• risk of undertriage
• risk of overtriage.

Accuracy of dispatch decisions – includes:

• choice of response type dispatched (rapid response car, ambulance, helicopter)
• appropriateness of referral to other agencies (e.g. GP services)
• use of alternatives to ambulance dispatch (e.g. nurse advice or make own way)
• relationship between priority category and response (right resource to right call).

Accuracy of paramedic diagnosis:

• agreement of on-scene and final hospital diagnosis
• other measures of paramedic diagnosis accuracy (e.g. for specific conditions, such as stroke, trauma).

Compliance with protocols and guidelines:

• with triage protocols
• transport protocols (e.g. leave at home, alternative to ED)
• with care and treatment guidelines (fits and convulsions, heart attack, stroke).

Proportion of people with respiratory distress (breathing difficulties) receiving mechanically assisted breathing.

Proportion of people with diabetes mellitus treated at home.

Proportion of elderly people attended within scope of advanced paramedic practice (e.g. treat and leave at home).

Proportion of people receiving spinal immobilisation (splints and collars) for back/neck injuries.

Re-contact with ambulance service within 24 hours (e.g. for calls closed with advice or patients not transported).

Hospital attendance or admission (e.g. within 24 hours, 7 days, 28 days).

Re-admission within 30 days for complications (e.g. pneumonia, wound infections).

Measuring patient safety:

• adverse incidents (e.g. not recognising heart attack symptoms or leaving someone at home who needed hospital treatment)
• errors in diagnosis.

Length of stay in hospital.

Duration of life support (intubation or ventilation) in hospital.

Discharge destinations:

• home
• continuing care
• discharged needing continuing therapy (e.g. nursing care, supplemental oxygen, tube feeding, assisted breathing)
• proportion of patients living at home at 3 months.

Proportion of cases treated within time guidelines including:

• STEMI (heart attack) guidelines (90 minutes)
• thrombolysis (clot busting) (60 minutes)
• proportion FAST positive (suspected stroke) arriving at a stroke centre within 60 minutes.