Cardiovascular disease, including heart attack and stroke, is the major cause of death in the United Kingdom (UK). Early effective treatment of Acute Myocardial Infarction (AMI) and stroke prevents death and has an important effect on long-term health and future disability. Ambulance services provide early interventions for AMI and stroke but there have been wide variations and gaps (shortfalls) in care.
We aimed to improve prehospital care for AMI and stroke using a national Quality Improvement Collaborative. Our objectives were to improve the delivery of care for AMI and stroke using a care bundle approach, in which every patient presenting to ambulance services with AMI or stroke should receive each element of optimal care in a consistent and reliable way. Our secondary objectives were to spread quality improvement methods throughout English ambulance services, to develop patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) for AMI and stroke and to understand how large scale collaboratives can be designed to work more effectively.
As part of the Quality Improvement Collaborative we educated ambulance staff in quality improvement methods including plan-do-study act cycles, process maps, and critical-to-quality trees and we provided feedback with statistical process control charts to improve care. The Quality Improvement Collaborative aimed to spread learning from collaborative members between services and thereafter throughout services.
We achieved statistically significant improvements in eight (of twelve) participating trusts for the stroke care bundle and in seven trusts for the AMI care bundle within two years. Overall performance for the care bundle for AMI has increased nationally in England from 43 to 79 percent and for stroke from 83 to 96 percent. This project has therefore achieved its aim of applying quality improvement methods to improve care for patients presenting to ambulance services in England with AMI or stroke.
Our e-learning programme is designed as an introduction for health and social care professionals interested to learn more about the science and practice of quality improvement (QI).