Pre-hospital thrombolysis (PHT) Clinical Audit Report 30 th November 2007

Transcription

1 Pre-hospital thrombolysis (PHT) Clinical Audit Report 3 th November 27 Table. Frequency of PHT by Network area Mid and West North Network South and East Total network area area Network area /7/24 3/3/ /4/2 3/3/ /4/26 3/3/ /4/27 3// Totals to date Table 2. Frequency of PHT by Locality (LHB) from /4/27 3//27 Locality Frequency Blaenau 4 Bridgend Caerphilly Cardiff Carmarthen 3 Ceredigion Denbigh Flint Gwynedd 7 Merthyr 3 Monmouth 6 Neath Newport 4 Pembroke Powys 9 Rhondda 9 Swansea 2 Torfaen 2 ale of Glamorgan 3 Wrexham Ynys Mon 8 Total 3 Karen Pitt. National Clinical Audit Manager

2 Table 3. Summary of Results from /4/27 3//27 (Breakdown by month) Frequency of Pre-hospital thrombolysis Mean call to needle time/mins (Median, max, Min) Number calls outside 6 minute call to needle time target needle time April 7 May 7 June 7 N S&E Total N S&E Total N S&E Total (, 79, 2) 4.6 (4., 67, 26) 4.3, (44, 8, 8) 7% N S&E Total N S&E Total N S&E Total 2 7% % 87.% % % 8.7% 93.8% % 83.3%! 9.8% Number calls outside 6 minute target with clinical justification needle time with clinical exceptions added to the numerator* (SaFF Target 7) Other reasons for missing 6 minute target Outcome: Information collected by WAST within few days of patient being thrombolysed. NB Patient discharged unless otherwise stated Reported adverse Clinical incidents % 7% % 93.7% % % % % % 83.3% % 9.3% 49 minutes for Paramedic to travel to scene. Technician crew 4 transferred to tertiary care 6 transferred to tertiary care 9 transferred to tertiary care patient thrombolysed inappropriately. Previous subarachnoid haemorrhage. Crew have received additional training and support. possible inappropriate thrombolysis currently under investigation. Karen Pitt. National Clinical audit Manager 2

3 Table 3 ctd Frequency of Pre-hospital thrombolysis Mean call to needle time/mins (Median, max, Min) Number calls outside 6 minute call to needle time target needle time % July 7 August 7 September 7 N S&E Total N S&E Total N S&E Total , (42., 2, 64) 46.4 (4, 2, 8) 3.6, (4, 28, 27) N S&E Total N S&E Total N S&E Total % 83% 8% 8.7% 33.3% 7% 72.2% % % 87.% 78.6% Number calls outside 6 minute target with clinical justification 2 needle time with clinical exceptions added to the numerator* (SaFF Target 7) Other reasons for missing 6 minute target Outcome: Information collected by WAST within few days of patient being thrombolysed. NB Patient discharged unless otherwise stated Reported adverse Clinical incidents % % 83% 8% 8.7% 66.7% 7% 77.8% 7% % % 92.8% Extended response time Double technician crew requested paramedic support. Extended on scene time Crew reported delay with telemetry prior to thrombolysis Paramedic on RR waited 33 minutes for ambulance. Patient subsequently thrombolysed in ambulance Extended on scene time Extended response time. Extended response time 8 transferred to tertiary care transferred to tertiary care transferred to tertiary care patient thrombolysed inappropriately. Crew have received additional training and support. Karen Pitt. National Clinical audit Manager 3

4 Table 3 ctd Frequency of Pre-hospital thrombolysis Mean call to needle time/mins (Median, max, Min) Number calls outside 6 minute call to needle time target needle time 8% October 7 November 7 Totals to date N S&E Total N S&E Total N S&E Total , (44, 9, 82) 46.6, (44, 2, 83) 46.9, (44, 2, 27) N S&E Total N S&E Total N S&E Total % 86% 88.2% 8% % 88.9% 86.4% 8% 89.3% 86.% Number calls outside 6 minute target with clinical justification 3 2 needle time with clinical exceptions added to the numerator* (SaFF Target 7) Other reasons for missing 6 minute target Outcome: Information collected by WAST within few days of patient being thrombolysed. NB Patient discharged unless otherwise stated Reported adverse Clinical incidents % % 86% 94% % % 93.2% 8% 93% 9%. delay in ambulance arrival 9 transferred to tertiary care 3. transferred to tertiary care *Compliance has been calculated as: (Number patients whose care is consistent with the criterion + number of patients whose care is consistent with any Exceptions) / Number of patients to whom the measure applies. This is in line with recommendations from NICE ( Karen Pitt. National Clinical audit Manager 4

5 Call to needle time/mins Fig. Scatter Graph to show the call to needle times for all patients who have received PHT between /4/27 and 3// APRIL MAY JUNE AUGUST OCTOBER JULY SEPTEMBER NOEMBER Month Key performance indicator In May 26a evidence based key performance indicator (KPI) was developed by WAST. (Pitt K. Charters K. Thrombolysis Key Performance Indicator: an evidence based approach. May 26). The KPI for the five months January-May 26 inclusive was calculated to be.8 +/-.6 patients per month. Adjustment was necessary for the change in JRCALC criteria that were adopted on the 22nd May, which would lead to an additional 4.3% of patients being eligible for pre-hospital thrombolysis based on age. The KPI for the five months June December 26 inclusive was calculated to be 8. +/- 6.4 patients per month. The graphs below show the performance of WAST in relation to the KPI. Karen Pitt. National Clinical Audit Manager

6 Fig Monthly KPI Target TNK KPI KPI - SD KPI + SD Number thrombolysed 2 2 Nov-6 Dec-6 Jan-7 Feb-7 Mar- 7 Apr-7 May- 7 Month Jun-7 Jul-7 Aug- 7 Sep-7 Oct-7 Nov-7 Fig 3. Cumulative KPI Target Cum TNK Cum KPI KPI - SD KPI + SD 4 4 Numbers thrombolysed Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Month TNK = Tenecteplase (administration of PHT) KPI = Key performance indicator SD = Standard deviation Cum = Cumulative Karen Pitt. National Clinical Audit Manager 6