Ambulance clinical performance indicator pilot: indicator set
| Performance area | Inclusion (denominator) | Indicator (numerator) | Exception(s) | Anticipated outcome (potential risk) | Evidence |
| Stroke (S) | Patients with clinical diagnosis of stroke/TIA within a specified time period | S1 FAST assessment recorded | Patient unconscious Patient refusal Patient does not understand Head trauma/injury | Improved assessment and management of stroke | JRCALC 200617 National Clinical Guidelines for Stroke (http://www.rcplondon.ac.uk/pubs/books/stroke/stroke_guidelines_2ed.pdf) |
| S2 Blood glucose recorded | Patient refusal Patient does not understand Head trauma/injury | ||||
| S3 Blood pressure recorded | Patient refusal Time critical features (airway problem, reduced consciousness) | ||||
| ST elevation MI (STEMI) (M) | Patients with clinical diagnosis of STEMI within a specified time period | M1 Aspirin | Patient refusal/contraindication to drug | Improved assessment and management of STEMI Improved survival from STEMI | JRCALC 2006 NSF for CHD National Cardiac Ambulance Audit Scoping Paper 2007 |
| M2 GTN | |||||
| M3 Initial pain score | Patient refusal/patient unable/patient unconscious | ||||
| M4 Final pain score (assumed intervention) | |||||
| M5 Analgesia given M5i Morphine M5ii Morphine and/or entonox | Patient refusal/patient not in pain/contraindication to drug(s) | ||||
| M6 Prehospital thrombolysis (PHT) <60 min or delivered to hospital within 30 min | PCI triage patients excluded | ||||
| Cardiac arrest (presumed cardiac in origin) (C) | Patients with clinical diagnosis of cardiac arrest (presumed cardiac) within a specified time period | C1 ROSC on arrival at hospital | ROLE; patient dead; DNAR order; exclude history of trauma, overdose or drowning | Improved response to and outcome from cardiac arrest | JRCALC 2006 National Cardiac Ambulance Audit Scoping Paper 2007 |
| C2 Paramedic in attendance | Doctor on scene | ||||
| C3 Time to respond to a cardiac arrest (mean, SD and proportions in the following ranges 0-(<)1 min; 1-(<)2 min etc. | History of trauma, overdose or drowning | ||||
| Asthma (A) | Patients with clinical diagnosis of asthma within a specified time period | A1 Respiratory rate recorded | Improved assessment and management of asthma (inappropriate management of COPD with high dose O2) | JRCALC 2006 British Guideline on the Management of Asthma 2003 updated (NICE/SIGN) | |
| A2 PEFR recorded (before treatment) | Patient refused/patient unable/patient unconscious/patient does not understand | ||||
| A3 SpO2 recorded (before treatment) | |||||
| A4 Beta-2 agonist given | Patient refused contraindication to drug | ||||
| A5 Oxygen administered | |||||
| Hypoglycaemia (H) | Patients with clinical diagnosis of hypoglycaemia within a specified time period | H1 Blood glucose before treatment | Patient refusal | Improved assessment of hypoglycaemia Improved management of hypoglycaemia (increased inappropriate blood glucose measurement and intervention) | JRCALC 2006 |
| H2 Blood glucose after treatment | |||||
| H3 Treatment for hypoglycaemia recorded (oral carbohydrates, glucagon, iv glucose) |
*FAST: Face, Arm, Speech, Time
†JRCALC: Joint Royal Colleges Ambulance Liaison Committee
‡GTN: Glyceryl Trinitrate
§NSF for CHD: National Service Framework for Coronary Heart Disease
¶PCI: Percutaneous Coronary Intervention
**ROSC: Return Of Spontaneous Circulation
††ROLE: Recognition of Life Extinct
‡‡DNAR: Do Not Attempt Resuscitation
§§PEFR: Peak Expiratory Flow Rate
¶¶COPD: Chronic Obstructive Pulmonary Disease
***NICE/SIGN: National Institute for Health and Clinical Excellence/Scottish Intercollegiate Guidelines Network