BOX 7

Combined measures from reviews 1 and 2: operational measures

Service/operational

Call numbers and caller types:

  • demographic (e.g. age, sex) characteristics of service population
  • call volumes (numbers)
  • call volumes by incident types
  • geographical differences in use of emergency number.

Call management characteristics (numbers and proportions):

  • calls assigned to different urgency categories
  • calls directed for nurse advice
  • calls closed with nurse advice
  • calls receiving paramedic response
  • calls abandoned before answered
  • ambulances cancelled.

Utilisation (frequency of ambulance use):

  • utilisation by age groups/ethnic group/sex/poverty/incident types
  • utilisation per 1000 population
  • unit-hour utilisation (use of resources).

Number of patients transported to hospital:

  • transport rates for serious calls
  • transport rates for non-serious calls.

Proximity of services:

  • % of operational area reachable within a specified time (e.g. 10 minutes, 20 minutes, 30 minutes, 1 hour)
  • % of population who can reach a major trauma centre within 45–60 minutes
  • scene-to-hospital distances.

Proportion of calls treated by most appropriate service (whole 999 population).

Completeness and accuracy of patient records.

Frequency with which ambulance staff administer treatments (e.g. inserting breathing tubes, heart monitoring, oxygen therapy, defibrillation).

Service costs:

  • cost per urgent call
  • cost per non-urgent call
  • cost per patient
  • mean cost of treatment (whole episode).

Ambulance service workforce characteristics:

  • age – average and proportions by group
  • attrition (staff turnover)
  • compensation claims.

Types and numbers of patient transportations:

  • transport rates (numbers and proportions transported and not transported to hospital)
  • numbers and proportions transported to alternatives to ED (e.g. minor injury unit)
  • numbers and proportions to different destination types (whole 999 population).

Ambulance staff training:

  • disability equality training
  • communication skills.

Volume and nature of complaints.

Overtriage rates and undertriage rates:

  • by category of urgency
  • advice only
  • condition specific [e.g. major trauma, stroke, STEMI (heart attack)].

STEMI, ST-elevation myocardial infarction.

From: Appendix 1, Systematic searches and summary of identified measures

Cover of Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme
Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme.
Programme Grants for Applied Research, No. 7.3.
Turner J, Siriwardena AN, Coster J, et al.
Southampton (UK): NIHR Journals Library; 2019 Apr.
Copyright © Queen’s Printer and Controller of HMSO 2019. This work was produced by Turner et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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