Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK.
Emerg Med J. 2010 Apr;27(4):327-31. doi: 10.1136/emj.2009.072397.
There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services.
Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots.
Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008-2009 and indicators have been adopted for national performance assessment of standards of prehospital care.
The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidence-based interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services.
为了从主要基于响应时间的指标转向服务中不断变化的临床需求，迫切需要为救护车服务开发临床绩效指标。我们报告了英国救护车服务临床绩效指标国家试点的进展情况。
在五个临床领域开发了临床绩效指标：急性心肌梗死、心搏骤停、中风（包括短暂性脑缺血发作）、哮喘和低血糖。这些指标是根据常见的急性疾病确定的，符合先前发表的框架。这些指标在英格兰的救护服务中进行了试点，结果以表格和漏斗图（统计过程控制图）的形式呈现。
从 2007 年 5 月初步达成一致到 2008 年 3 月底完成试点阶段，开发、达成和试点指标的进展迅速。显示了指标基准测试的结果。试点为服务部门在 2008-2009 年决定其改进计划的重点提供了信息，并为国家院前护理标准绩效评估采用了指标。
该试点将为进一步开发临床指标、绩效基准测试以及实施特定循证干预措施提供基础，以改善确定需要改进的领域的护理。国家绩效改进登记册将能够评估和共享有效的改进方法，并增加利益相关者和公众对救护车服务提供的护理质量的信息获取。
