What outcome measures should be developed for pre-hospital care?: results of a consensus event

Abstract

Background: The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted 2 systematic reviews to identify potential measures and held a consensus event to prioritise these measures. Methods: Actual or potential measures or indicators for assessing ambulance service performance or quality of care were identified from two systematic reviews and categorised as clinical management, operational or patient based measures. Time measures were considered separately. We held a consensus event with participants representing clinicians, ambulance operations, commissioners, policy and academic research. Three small group discussion sessions were held and after each session we used turning point software for participants to electronically vote whether they thought each potential measure was essential, desirable or irrelevant. Results: 42 participants took part and discussed and voted on 52 different measures. They could also add measures. The top 5 ranked operational measures were concerned with completeness and accuracy of records; accuracy of triage; appropriateness of service; ambulance training and ambulance utilisation. Top 5 clinical measures were accuracy of dispatch decisions, accuracy of problem identification, compliance with end of life care plans; patient safety and compliance with protocols. The top 5 patient measures were measurement and relief of pain; patient experience; return of spontaneous circulation; complications from care and survival. Conclusions: Accuracy of different types of decision making and compliance with management protocols predominated as essential with pain management the most important patient measure. Management of end of life care was identified by participants. The electronic voting system which provided instant real time feedback was well received by participants. The next stage is a Delphi survey to further refine these measures and include time interval measures.