Cardiovascular disease (CVD) is the commonest cause of death in the United Kingdom (UK) accounting for almost two-thirds of premature deaths. People suffering from CVD often present acutely to emergency services with symptoms of a stroke or heart attack. A heart attack is also known as AcuteMyocardial Infarction which includes ST-elevation Myocardial Infarction (STEMI).

The evidence for best clinical practice for AMI and stroke care by ambulance services has been translated into clinical performance indicators. Clinical indicators are measures of elements of clinical care which may when assessed over time, provide a method of assessing the quality and safety of care at a system level Using these clinical performance indicators, we have published evidence identifying and quantifying the gaps in clinical quality. The indicators developed are shown in the care bundle below.

A care bundle is a set of evidence based clinical actions (or indicators), for a specific clinical condition, which are deemed to be ‘critical to quality’ and which should therefore be reliably delivered to every patient with that condition.

The Problem

Response times have dominated ambulance performance measures for many years. However, evidence shows that only in a few conditions did the 8 minute response make significant difference to outcomes.

The Department of Health are now encouraging ambulance services to adopt a much broader ‘outcome-led’ performance regime. The baseline performance for patients receiving the full care bundle for AMI was just 43% and for stroke was 83%.


"Like most front-line clinicians I was becoming increasingly frustrated with the focus on time-driven targets as an outcome measure I was more interested in the process of what happens when the clinician arrives on scene.” (QI Fellow, Trust 8)

Our Objectves

  • To improve the delivery of care bundles for AMI from 43% to over 70% within two years of the project
  • To improve delivery of care bundles for stroke from 83% to over 90% within two years of the project
  • To increase diffusion of quality improvement methods to frontline staff in ambulance services.

A secondary aim was to improve patient reported outcome measures (PROMS) and patient reported experience measures (PREMs) for AMI and stroke.

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