Key performance indicators for pre hospital emergency Anaesthesia - a suggested approach for implementation

Abstract

Background 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. The aim of this study was to develop KPIs for use in our service and evaluate their impact. Methods Using 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. Results Eighty-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. Conclusion The 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.

Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury

“…For example, Iran’s emergency organization has introduced 16 indicators at the national level and 13 indicators at the university level, to evaluate the performance of PEC [ 53 ]. Various studies conducted in other countries are limited to developing general indicators, and specific indicators in the field of traffic accidents were less considered [ 25 , 33 , 54 ]. It should be noted that the aim of this study was not to develop a separate set and analysis system for RTIs indicators.…”

“…Through a scoping review study, Howard et al (2018) investigated the characteristics and development methods of the QIs in the field of PEC, who identified 331 QIs by the article review and 15 by the website review [29]. Similarly, there are several published studies [25,[30][31][32][33] that develop indicators for measuring the performance of PEC.…”

Developing clinical performance indicators for pre‐hospital blood transfusion: The Thames Valley Air Ambulance approach

“…TVAA introduced CPIs for Pre‐Hospital Emergency Anaesthesia (PHEA) in March 2017 following recommendations in the AAGBI document “Safer pre‐hospital anaesthesia 2017.” Following the success of this process, it was decided to develop performance indicators for pre‐hospital blood transfusion.…”

“…Thames Valley Air Ambulance (TVAA) has been using CPIs for Pre‐Hospital Emergency Anaesthesia (PHEA) since early 2017 and subsequently has seen improvements in record keeping, guideline compliance, identification of equipment issues and engagement with the governance process. The introduction of CPIs for pre‐hospital blood transfusion was a logical next step.…”

Evaluation of Key Performance Indicators (KPIs) for Sustainable Postgraduate Medical Training: An Opportunity for Implementing an Innovative Approach to Advance the Quality of Training Programs at the Saudi Commission for Health Specialties (SCFHS)

“…Key performance indicators (KPIs) serve as a way of gently guiding clinicians in the right direction to improve clinical practice and is being used in different fields of medicine [5][6][7]. Santana et al [8] identified nine measurements that KPIs should meet.…”