Abstract
BackgroundPre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs) to audit PHEA quality. The aim of this study was to develop KPIs for use in our service and evaluate their impact.MethodsUsing the AAGBI 2017 document as a guide we developed a list of ten auditable domains. Data for each case was extracted from the Electronic Patient Record (EPR) and a score assigned to each of the domains; one if the domain is achieved and zero if the domain is not achieved or if data is missing, giving a total score out of ten. This analysis is then presented as a colour-coded matrix alongside the score. Data were analysed monthly at our case review and governance meeting. The process was refined during the year and after 12 months a formal review of the KPI process occurred.ResultsEighty-two cases were analysed. Domains with the highest percentage of achievement were: Indication 96%; Tube position confirmed 94% and Full AAGBI monitoring and Grade of view < 3 both 89%. The amount of missing data declined throughout the year. The results of the clinician survey showed that almost all respondents found the TVAA PHEA review process useful.ConclusionThe KPI process has demonstrated areas of good quality practice and led to improvements in equipment, processes and documentation and therefore patient care. We offer suggestions to other organisations considering implementing KPIs for PHEA.
Highlights
Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform
Outcome: position of tracheal tube maintained and confirmed using waveform capnography; adequate anaesthesia maintained during transfer; cardiovascular stability maintained; ventilation titrated to end-tidal CO2
Study design The domains suggested by the AAGBI guidelines were considered by an expert panel of NHS consultants in Anaesthesia and Emergency Medicine, all of whom work regularly with Thames Valley Air Ambulance (TVAA)
Summary
Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs) to audit PHEA quality. Pre Hospital Emergency Anaesthesia (PHEA) is widely regarded as one of the highest risk interventions that Pre Hospital physicians perform. The process is complex and carries a significant risk of morbidity and mortality and it can be difficult to objectively measure and monitor performance of a Pre Hospital Care team delivering PHEA. The AAGBI updated this guidance in 2017 “AAGBI: Safer pre-hospital anaesthesia 2017” [2] and it suggests developing Key Performance Indicators (KPIs) for PHEA. The following items were suggested for use as KPIs in the AAGBI 2017 guidance [2]: Structure/system: routine use of a standard operating procedure and checklist for PHEA; all team. Outcome: position of tracheal tube maintained and confirmed using waveform capnography; adequate anaesthesia maintained during transfer; cardiovascular stability maintained; ventilation titrated to end-tidal CO2
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