Performance of the Trust against quality metrics
Response Times
Ambulance services are monitored against response times for a Category 1 – 4 system (determined by clinical condition/emergency), with varying response times for each category. The table below summarises the Trust’s performance against the national response time standards for 2022/23.
Published further information for all ambulance services can be found here: www.england.nhs.uk/statistics and more detailed information relating to EEAST can be found within our Annual Report.
| Category | Definition | National standard | Average EEAST performance 2022/23 (hh:mm:ss) |
| C1 | Immediately life-threatening injuries and illnesses. | 7 minutes mean response time | 00:10:25 |
| 15 minutes 90th centile response time | 00:19:30 | ||
| C1T | Immediately life-threatening injuries and illnesses where the patient is transported to hospital. | 7 minutes mean response time | 00:13:49 |
| 15 minutes 90th centile response time | 00:25:05 | ||
| C2 | Emergency. | 18 minutes mean response time | 01:06:56 |
| 40 minutes 90th centile response time | 02:28:36 | ||
| C3 | Urgent calls and in some instances where patients may be treated in-situ (e.g. their own home) or referred to a different pathway of care | 120 minutes (2 hours) 90th centile responses time | 07:36:23 |
| C4 | Less urgent. In some instances, patients may be given advice over the phone or referred to another service such as a GP or pharmacist. | 180 minutes (3 hours) 90th centile response time | 11:40:43 |
The increased demand on our services and the handover delays experienced at hospitals within the year has also contributed to the delays seen in attending our patients. To improve our performance, we have worked hard with our system partners and implemented a number of actions such as, cohorting of patients at hospitals to release ambulance clinicians back into the community, and have worked alongside system partners to develop a consistent model across the service transferring patient care to alternative care providers from EOCs also known as ‘Access to the Stack’.
In 2022/23 the Trust established an Organisational Improvement Plan to put in place recruitment and growth of the clinical workforce in order to improve overall trust performance. In order to support progression towards delivery of performance indicators, we have in place targets for the levels of ambulance cover the Trust provided. Known as patient facing staff hours, levels were set each quarter for us to meet, to ensure that while performance times may not reach national standards, the levels of ambulance cover provided would meet an agreed level.
Delivery of these hours has been dependent on a range of factors including recruitment, abstractions (such as staff members on a clinical training programme being unavailable to provide ambulance cover due to being in training), levels of overtime and the availability of private ambulance service provision.
Heart attack care
Heart disease continues to be one of the UK’s leading causes of death and is the most common cause of premature death, responsible for around 66,000 deaths in the UK each year.
As many as 100,000 hospital admissions each year are due to heart attacks. Because of the life-threatening risk with a heart attack, providing patients with a pre-hospital assessment for a STEMI and administering an appropriate care bundle means a significant improvement on patient outcomes, thereby supporting the NHS to reduce the number of patients dying prematurely and to help people to recover from episodes of ill-health or following injury.
STEMI care bundle
The mandatory quality indicator for ambulance services relating to this topic is the provision of an appropriate care bundle; recording of two pain scores, giving aspirin to break down the clot, giving glyceryl trinitrate (GTN) to dilate the coronary arteries and providing pain relief. The patient care record is audited against all of these criteria and deemed to be either compliant or non-complaint.
The data is reported on quarterly within the year and the table below shows our result against the national average and the best and worst scores achieved by ambulance services within England.
To provide a robust comparison, the table shows our achievement against the average and upper and lower compliance levels for ambulance trusts that have been published to date (April - November 2022). The graph demonstrates our performance against the national average for each quarter (April - November 2022), both demonstrating that the Trust is well above the national average for each quarter within the year.
| Heart Attack Care | National Data (April to November 2022) | |||
|---|---|---|---|---|
| National Average | Upper | Lower | EEAST | |
| STEMI Care Bundle | 73.4% | 96.9% | 58.4% | 96.9% |
EEAST continues to be the highest performing Trust for this care bundle.
Patients conveyed to a Primary Percutaneous Coronary Intervention (PPCI) Centre
Although the time it takes to transport a STEMI patient to a specialist Primary Percutaneous Coronary Intervention (PPCI) treatment centre is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE/I and our commissioners.
This ACQI contains two joint indicators for ambulance trusts and these centres both of which are measured in hours and minutes.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April - November 2022). It should be noted that the lower score is the best performing score within these outcomes.
| Heart Attack Care | Latest Data Available (April to November 2022) hh:mm | |||
|---|---|---|---|---|
| National Average | Upper | Lower | EEAST | |
|
Mean average time from call to catheter insertion for angiography * |
02:44 | 03:16 | 02:19 | 02:52 |
|
90th centile time from call to catheter insertion for angiography * |
03:44 | 04:12 | 03:20 | 04:12 |
* It should be noted that this outcome is based on ‘unvalidated, preliminary data from the Myocardial Ischaemia National Audit Project (MINAP)’. Also, as hospitals do not have a deadline period for submitting their data to MINAP, outcome results will change throughout the year.
On average EEAST performed worse than the national average for this time period indicating the extreme system pressures experienced during the year.
However as demonstrated in the previous section, all patients received excellent care, with EEAST consistently achieving high compliance for the STEMI care bundle and being the highest performing trust within the year.
Next steps:
This will continue to be monitored through the national ACQI programme.
Stroke care
Stroke is a type of cerebrovascular disease, which is one of the leading causes of death in the UK accounting for approximately 75% of deaths from cerebrovascular diseases.
Face-arms-speech-time (FAST), is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The faster a stroke patient receives treatment (the care bundle), the better the chances are of surviving and reducing long-term disability.
Stroke diagnosis bundle
This quality metric relates to the percentage of suspected stroke patients (assessed face to face) who receive an appropriate assessment; recording of blood pressure (BP), FAST test and blood sugar levels (BM) the outcomes of which can be used to diagnose a possible stroke. As for heart attacks, the patient care record is audited against all of these criteria and must meet them all for the overall bundle to be compliant.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2022).
| Stroke Care | National Data (April to November 2022) | |||
|---|---|---|---|---|
| National Average | Upper | Lower | EEAST | |
| Stroke Diagnostic Bundle | 96.9% | 99.6% | 92.4% | 99.6% |
EEAST was the highest performing trust for this bundle achieving 100% in 2 out of the three reporting months.
April - November 2022.
Next steps:
This will continue to be monitored through the national ACQI programme.
Stroke Timeliness
Patients who are cared for in a defined stroke unit with organised stroke services are more likely to survive, have fewer complications, and return home and regain independence quicker than patients on a general medical ward.
Although the time it takes to convey a stroke patient to hospital is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE&I and our commissioners. Our performance is assessed monthly against three indicators for this ACQI: the mean average, median and 90th centile times from call to hospital arrival.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2022). The Lower level relates to the best performing trust for this outcome.
It should be noted that not all strokes are identified at the time of call due to the information provided to the call taker, or the patient may deteriorate before or after the crew arrive.
| Stroke Care | National Data (April to November 2022) | |||
|---|---|---|---|---|
| National Average | Upper | Lower | EEAST | |
| Mean average time from call to hospital arrival | 04:45 | 02:11 | 01:31 | 01:55 |
| Median average time from call to hospital arrival | 01:28 | 01:41 | 01:17 | 01:34 |
| 90th centile time from call to hospital arrival | 02:52 | 03:44 | 02:26 | 03:15 |
On average EEAST performed worse than the national average for this time period indicating the extreme system pressures experienced during the year.
However as demonstrated in the previous section and as per the STEMI ACQI, all patients received excellent care, with EEAST consistently achieving high compliance for this ACQI and being the highest performing trust within the year.
Next steps:
This will continue to be monitored through the national ACQI programme.
Cardiac arrest care
A cardiac arrest occurs when the heart suddenly stops pumping blood around the body. Someone who is having a cardiac arrest will suddenly lose consciousness and will stop breathing or stop breathing normally. Unless immediately treated by cardio-pulmonary resuscitation (CPR) and early defibrillation, this always leads to death within minutes. It is, however, possible to survive and recover from a cardiac arrest if you get the right treatment quickly. Around two-thirds of cardiac arrests outside of hospital happen in the home, but nearly half of those that occur in public are witnessed by bystanders. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10%.
This year we set out to improve the Trust’s outcomes from cardiac arrest and work towards an increase in Return of Spontaneous Circulation (ROSC) and ‘survival to discharge’ figures. However, it should be noted that the number of cardiac arrests we attended throughout the year continued to show increased numbers - an indicator of the ongoing impact of the COVID-19 pandemic.
Although the indicators displayed in the table below are not quality metrics for the Quality Account, we report our achievement on a month-by-month basis to both NHS England and our commissioners, the exception being the post-ROSC care bundle which is a quarterly requirement.
The post-ROSC care bundle contains six components, the recording and administration of: 12 lead ECG; blood glucose; end tidal CO2; oxygen; systolic blood pressure, and saline fluids for all patients who achieve a ROSC on scene which continues to hospital. Patients who had suffered a traumatic cardiac arrest, were successfully resuscitated before the arrival of ambulance staff or were aged less than 18 years are not included.
The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2022).
| Cardiac Arrest Care | National Data (April to November 2022) | |||
|---|---|---|---|---|
| National Average | Upper | Lower | EEAST | |
| Return of Spontaneous Circulation (pulse) at hospital – All patients | 26.3% | 29.5% | 12.5% | 24.3% |
| Return of Spontaneous Circulation (pulse) at hospital - Utstein patients | 47.2% | 51.5% | 25.0% | 45.7% |
| Survival to Discharge - All patients | 8.0% | 9.8% | 6.2% | 6.2% |
| Survival to Discharge - All patients | 25.2% | 34.0% | 20.9% | 22.6% |
| Post-ROSC care bundle | 79.1% | 98.2% | 53.9% | 93.2% |
Although EEAST is performing below the national average for ROSC and Survival to Discharge, it achieved the highest performing average compliance for the Post-ROSC care bundle and 14.1% better than the national average for the time period.
It should be noted that Survival to Discharge also depends on actions taken by hospitals after our staff have conveyed the patient.
Next steps:
This will continue to be monitored through the national ACQI programme.
Next Page: Achievements against local priorities for 2022/23