Ten out of twelve trusts showed a significant improvement in either the stroke or AMI care bundle, and five out of twelve showed significant improvements for both AMI and stroke. Based on data from Cycle 8 of the national Clinical Performance Indicators we have exceeded our aims. Performance for the care bundle for AMI had increased from 43 percent to 79 percent, and for stroke 83 percent to 96 percent.

Outcomes from the case study evaluation

National quality improvement collaboratives are rarely undertaken due to their complexity Analysis of the data shows a number of clear themes.

  • Time One of the main barriers to collaborative working was time. Time required for the organisation,construction and provision of workshops, seems to outweigh the amount of time that QI Fellows were allocated. Participants too found it difficult to contribute on a regular basis owing to their working patterns.
  • Connectivity: time relates closely to the theme of connectivity. The national collaborative seems to have benefited from cross pollination of ideas, strategies, and other work processes through teleconferencing face to face meetings and the Huddle.
  • QI Methods: Many respondents voiced the benefits of quality improvement methods. For most it was the first time that they had applied these approaches to monitor their care provision Despite a few teething problems, the methods were seen as a positive addition to the ambulance service’s way of understanding and addressing facilitators and barriers to providing quality care for their patients.

Outcomes from qualitative study to develop patient reported outcome and experience measures

A qualitative research design was employed to obtain rich and detailed data to explore and compare participants rsquo; experiences of emergency prehospital care for AMI and stroke. We conducted 33 semistructured interviews with service users and clinicians and one focus group with five clinicians.

Four main themes emerged:

  • Communication
  • Professionalism
  • Treatment of condition
  • Transition from home to hospital


"I didn’t feel anxious...from the moment they picked me up from the house until I was handed over, they explained it all.”(Participant 16)

Patients focused on both personal and technical skills and together these skills contributed to a perception of professionalism in ambulance personnel. Patients’ experience was enhanced when physical, emotional and social needs were attended to and they emphasised effective communication within the clinician–patient relationship to be the key. There was however, a difference between paramedics’ perceptions of patients rsquo; expectations and patients’ lack of knowledge of the paramedic role. We hope that our findings can contribute to the development of patient experience measures for prehospital care.

Project Impact

The methods we used have proved successful, leading to significant improvements in delivery of both care bundles overall and in many individual ambulance trusts and this is likely to improve patient outcomes in the longer term. We have also succeeded in building teams in most trusts with greater skills and knowledge of quality improvement (QI). This has enabled clinicians to gain an understanding of QI in a meaningful way which has led to more effective improvements and transferable skills to be applied to other problems.

Improvements beyond the scope of the project

The skill and knowledge developed is now being applied to improve care for patients beyond the scope of the original project. Many trusts have reported adapting the ASCQI initiative to improve the delivery of other care bundles.

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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).