Performance of the Trust against quality metrics
Ambulance services are monitored against response times for a Category 1 – 4 system (determined by clinical condition/emergency), with varying response times for each category. The table below summarises the Trust’s performance against the national response time standards for 2021/22.
Published further information for all ambulance services can be found here: www.england.nhs.uk/statistics and more detailed information relating to EEAST can be found within our Annual Report.
|Category||Definition||National standard||Average EEAST performance 2021/22
Immediately life-threatening injuries and illnesses.
|7 minutes mean response time||00:09:49|
|15 minutes 90th centile response time||00:18:22|
|C1T||Immediately life-threatening injuries and illnesses where the patient is transported to hospital.||7 minutes mean response time||00:12:21|
|15 minutes 90th centile response time||00:22:21|
|C2||Emergency.||18 minutes mean response time||00:45:42|
|40 minutes 90th centile response time||01:40:14|
|C3||Urgent calls and in some instances where patients may be treated in-situ (e.g. their own home) or referred to a different pathway of care||120 minutes (2 hours) 90th centile responses time||05:48:25|
|C4||Less urgent. In some instances, patients may be given advice over the phone or referred to another service such as a GP or pharmacist.||180 minutes (3 hours) 90th centile response time||07:04:35|
In 2021/22 there has been an expectation that we will improve our performance to reach national standards, through improvements made in a number of areas – most notably recruitment and growth of the clinical workforce. Realistically this has not been recognised and this is due to factors relating to abstraction and how the pandemic impacted on the service provisions that had been made. Predicting the demand levels and therefore requirement to fill these expectations was challenging due to the continuous changes we saw in the effect of COVID19 on the service.
In order to support progression towards delivery of performance indicators, we have in place targets for the levels of ambulance cover the Trust provided. Known as patient facing staff hours, levels were set each quarter for us to meet, to ensure that while performance times may not reach national standards, the levels of ambulance cover provided would meet an agreed level. Delivery of these hours has been dependent on a range of factors including recruitment, abstractions (such as staff members on a clinical training programme being unavailable to provide ambulance cover due to being in training), levels of overtime and the availability of private ambulance service provision. These targets were not met in year despite the extensive efforts to achieve them. The Trusts efforts remain focused on this area, via our workforce plan, skill mix analysis and the approach to retaining the incoming workforce.
The increased demand on our services and the handover delays experienced at hospitals within the year has also contributed to the delays seen in attending our patients. To improve our performance, we have worked hard with our system partners and implemented a number of actions such as, co-horting of patients at hospitals to release ambulance clinicians back into the community, close monitoring of patients waiting for an ambulance to ensure prioritisation as required, daily strategic and system calls, including members of the clinical quality directorate, to ensure patient safety remains a focus and placement of additional clinicians, including GPs, within our call centres to assist with triaging and signposting patients to other services where appropriate.
Heart attack care
Heart disease continues to be one of the UK’s leading causes of death and is the most common cause of premature death, responsible for around 63,000 deaths in the UK each year.
More than 100,000 hospital admissions each year are due to heart attacks. Because of the life-threatening risk with a heart attack, providing patients with a pre-hospital assessment for a STEMI and administering an appropriate care bundle means a significant improvement on patient outcomes, thereby supporting the NHS to reduce the number of patients dying prematurely and to help people to recover from episodes of ill-health or following injury.
STEMI care bundle
The mandatory quality indicator for ambulance services relating to this topic is theprovision of an appropriate care bundle; recording of two pain scores, giving aspirin to break down the clot, giving glyceryl trinitrate (GTN) to dilate the coronary arteries and providing pain relief. The patient care record is audited against all of these criteria and deemed to be either compliant or non-complaint. The data is reported on quarterly within the year and the table below shows our result against the national average and the best and worst scores achieved by ambulance services within England. To provide a robust comparison, the table shows our achievement against the average and upper and lower compliance levels for ambulance trusts that have been published to date (April -November 2021). The graph demonstrates our performance against the national average for each quarter (April -November 2021), both demonstrating that the Trust is well above the national average for each quarter within the year.
|Heart Attack Care||National Data (April to November 2021)|
|STEMI Care Bundle||76.8%||94.0%||61.5%||94.0%|
EEAST was the highest performing Trust for this care bundle (April - November 2021). 17.2% above the national average.
Patients conveyed to a Primary Percutaneous Coronary Intervention (PPCI) Centre
Although the time it takes to transport a STEMI patient to a specialist Primary Percutaneous Coronary Intervention (PPCI) treatment centre is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE/I and our commissioners. This ACQI contains two joint indicators for ambulance trusts and these centres both of which are measured in hours and minutes.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April -November 2021). It should be noted that the lower score is the best performing score within these outcomes.
|Heart Attack Care||Latest Data Available (April to November 2021)|
Mean average time from call to catheter insertion for angiography *
90th centile time from call to catheter insertion for angiography *
* It should be noted that this outcome is based on ‘unvalidated, preliminary data from the Myocardial Ischaemia National Audit Project (MINAP)’. Also, as hospitals do not have a deadline period for submitting their data to MINAP, outcome results will change throughout the year.
EEAST is performing better than the national average for both of these indicators.
Following the success seen in the improvement of call to hospital for stroke patients following a monthly review and feedback process for the time spent on scene, from April 2022, the clinical audit department will be collating this data on a quarterly basis for STEMI patients, this information will be disseminated to all operational teams with the purpose of reducing this time and improving our overall call to PPCI centres.
Stroke is a type of cerebrovascular disease, which is one of the leading causes of death in the UK accounting for approximately 75% of deaths from cerebrovascular diseases.
Face-arms-speech-time (FAST), is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The faster a stroke patient receives treatment (the care bundle), the better the chances are of surviving and reducing long-term disability.
Stroke diagnosis bundle
This quality metric relates to the percentage of suspected stroke patients (assesseface to face) who receive an appropriate assessment; recording of blood pressure (BP), FAST test and blood sugar levels (BM) the outcomes of which can be used todiagnose a possible stroke. As for heart attacks, the patient care record is auditedagainst all of these criteria and must meet them all for the overall bundle to be compliant. The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2021).
|Stroke Care||National Data (April to November 2021)|
|Stroke Diagnostic Bundle||97.9%||99.4%||94.4%||99.1%|
EEAST is the second highest performing Trust for this bundle.
NHSE&I have advised that this ACQI will be removed during 2022/23 due to the high level of performance across all ambulance trusts.
Patients who are cared for in a defined stroke unit with organised stroke services are more likely to survive, have fewer complications, and return home and regain independence quicker than patients on a general medical ward.
Although the time it takes to convey a stroke patient to hospital is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE&I and our commissioners. Our performance is assessed monthly against three indicators for this ACQI: the mean average, median and 90th centile times from call to hospital arrival.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2021). The Lower level relates to the best performing trust for this outcome.
In April 2019 we began a comprehensive monthly audit of all stroke times providing all operational teams with their average times for: response; time spent on scene; journey to hospital, and overall cycle time with a continuous focus on the time spent on scene in these cases with a drive to reduce this to ten minutes. Although an ambitious target and not one that we will be able to meet for all patients due to other factors such as difficult extrication from the premises, the Trust saw an improvement and is currently performing better than the national average. Due to the improvements seen, the audit was suspended from 01 October 2021 with a plan to review March data in early spring to see if there has been any reduction in performance since the audit stopped.
It should be noted that not all strokes are identified at the time of call due to the information provided to the call taker, or the patient may deteriorate before or after the crew arrive.
|Stroke Care||National Data (April to November 2021)|
|Mean average time from call to hospital arrival||01:39||01:53||01:29||01:38|
|Median average time from call to hospital arrival||01:23||01:39||01:14||01:24|
|90th centile time from call to hospital arrival||02:37||03:26||02:15||02:33|
EEAST is performing better than the national average for all stroke timeliness indicators for the period April – November 2021.
Undertake a review of March ‘time spent on scene’ data in early spring to determine whether there has been any reduction in this improved target.
Cardiac arrest care
A cardiac arrest occurs when the heart suddenly stops pumping blood around the body. Someone who is having a cardiac arrest will suddenly lose consciousness and will stop breathing or stop breathing normally. Unless immediately treated by cardio-pulmonary resuscitation (CPR) and early defibrillation, this always leads to death within minutes. It is, however, possible to survive and recover from a cardiac arrest if you get the right treatment quickly.
Around two-thirds of cardiac arrests outside of hospital happen in the home, but nearly half of those that occur in public are witnessed by bystanders. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10%.
This year we set out to improve the Trust’s outcomes from cardiac arrest and work towards an increase in Return of Spontaneous Circulation (ROSC) and ‘survival to discharge’ figures. However, it should be noted that the number of cardiac arrests we attended throughout the year continued to show increased numbers -an indicator of the ongoing impact of the COVID-19 pandemic.
Although the indicators displayed in the table below are not quality metrics for the Quality Account, we report our achievement on a month-bymonth basis to both NHS England and our commissioners, the exception being the post-ROSC care bundle which is a quarterly requirement.
The post-ROSC care bundle contains six components, the recording and administration of: 12 lead ECG; blood glucose; end tidal CO2; oxygen; systolic blood pressure, and saline fluids for all patients who achieve a ROSC on scene which continues to hospital. Patients who had suffered a traumatic cardiac arrest, were successfully resuscitated before the arrival of ambulance staff or were aged less than 18 years are not included.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2021).
|Cardiac Arrest Care||National Data (April to November 2021)|
|Return of Spontaneous Circulation (pulse) at hospital – All patients||25.4%||30.3%||20.7%||23.8%|
|Return of Spontaneous Circulation (pulse) at hospital - Utstein patients||44.9%||59.9%||25.0%||47.5%|
|Survival to Discharge - All patients||9.2%||11.3%||7.1%||8.5%|
|Survival to Discharge - All patients||26.5%||38.8%||22.0%||27.0%|
|Post-ROSC care bundle||76.9%||93.8%||60.5%||93.5%|
Although EEAST is performing below the national average for ROSC and Survival to Discharge (All patients), for Utstein patients it is the third highest performing Trust.
It is also the second highest performing Trust for the Post-ROSC care bundle and 16.6% better than the national average