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Abstract
Introduction Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales?
Methods The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results.
Results The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area.
Conclusions The strategies used within this CIP are recommended for further consideration.
- Quality assurance
- pre-hospital
- effectiveness
- management
- emergency ambulance systems
- nursing
- pre-hospital
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Introduction
In 2009, the Northern Division of the Ambulance Service of NSW implemented the Clinical Safety Chart clinical improvement programme (CIP) which aimed to improve patient safety and clinical quality key performance indicator (KPI) results. The question driving the study was, ‘is the Clinical Safety Chart CIP effective at improving patient safety and clinical quality KPI results within the Ambulance Service of New South Wales?’
Intervention
The Clinical Safety Chart CIP comprised the three key strategies of awareness, education and engagement.
Awareness strategies
A4 size Clinical Safety Charts—which display the latest paramedic KPI results—were distributed in colour to each ambulance station within the Northern Division on a monthly basis. The charts have the effect of making paramedics aware of what is expected of their clinical performance, as well as highlighting areas requiring improvement.
Education strategies
Paramedics were provided with information about the rationale underpinning paramedic KPIs through education sessions, staff meetings and in-service days. Reading material was also distributed to each ambulance station in the form of a Paramedic KPI Rationale Booklet.
Engagement strategies
Senior managers and clinical leaders actively participated in discussion and feedback with paramedics about the CIP by fielding email correspondence, visiting ambulance stations and by acknowledging high achieving ambulance stations through letters of encouragement.
Methods
Following discussion with the Chair of the Sydney South West Area Health Service Human Ethics Research Committee (Royal Prince Alfred Hospital branch), it was determined that this study did not require formal ethics committee review.
A retrospective, quantitative design was devised using a series of four statistical tests. Test 1 compared post-test and pre-test observations in the non-intervention group. Test 2 compared post-test and pre-test observations in the intervention group. Test 3 compared pre-test observations in the intervention group with pre-test observations in the non-intervention group. Test 4 compared post-test observations in the intervention group with post-test observations in the non-intervention group
Paramedic KPI 1.7 was selected for the study. This KPI measures the percentage of emergency cases where two full sets of vital signs were recorded on the patient healthcare record. This dataset reports on over 29 000 emergency cases per month.
Non-parametric test procedures were used as the data were not normally distributed, and the 2-tailed significance level (α) was set at 0.05.
Results
The Clinical Safety Chart CIP was associated with a statistically significant improvement in paramedic KPI results (table 1). Post-test paramedic KPI results were 6.36% (95% CI 0.0135 to 0.1074, p=0.0124) and 6.84% (95% CI 0.0306 to 0.1072, p=0.0005) higher in the intervention area when compared to pre-test results in the intervention area and post-test results in the non-intervention area, respectively. These results allowed researchers to reject the null hypothesis.
Results of statistical tests
Test procedures were repeated for other paramedic KPI datasets included in the CIP, producing similar compelling results (see data supplement online at http://emj.bmj.com/content/29/7.toc).
Discussion
The difficulties of effectively evaluating and demonstrating improvements in the quality and safety of healthcare are widely reported.1–7 This study has achieved both, within an ambulance setting.
The awareness, education and engagement strategies used within this CIP build upon approaches to improvements which have been advocated in the past.8–10 This CIP achieves improvement by making clinicians aware of areas requiring improvement and by investing in the capacity of clinicians and frontline managers who want to understand the rationale underpinning the CIP on a cognitive level, and who also want to feel engaged in the CIP at an affective level.
Conclusions
This study demonstrated that the Clinical Safety Chart CIP improves paramedic KPI results. The CIP is based on awareness, education and engagement strategies. These three strategies may be applicable within other settings as a practical way to improve the quality and safety of paramedic care.
Acknowledgments
The authors acknowledge the assistance of the Ambulance Research Institute, Ambulance Service of NSW, and the School of Nursing and Midwifery, Charles Sturt University.
Supplementary materials
Web only data
Files in this Data Supplement:
Footnotes
Funding The study was self-funded by the corresponding author as part of the Master of Health Science qualification, Charles Sturt University.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.