Myocardial Ischaemia National Audit Project - University College ...

issues or problems within the EMAS care processes enabling usto put in place steps to improve our service to patients.This practice has led to several joint educational initiativesbeing developed. It was noted that MIs weren’t always beingidentified from ECGs and therefore a series of ECG recognitionworkshops for ambulance clinicians were developed by aparamedic who is also one of the Trust’s quality improvementleads. These are co-delivered by a consultant cardiacnurse from one of the local hospital trusts. The workshopsemphasise MI recognition, identification of reciprocal changesand the need to keep on-scene times to a minimum to ensurethe patient has quick access to appropriate interventions.Information leaflets were also produced which can be given topatients’ relatives. One primary PCI centre contacted the Trustto commend paramedic Claire Hill on her quick thinking andskilled treatment which had certainly saved the patient’s lifeand led to an extremely good prognosis; Claire commented,”Clinical decision making is a vital element of the paramedicrole, I feel that the excellent foundations laid down by AlunRoebuck and Mark Hall during the ECG cardiac workshops,provided me the confidence and knowledge to ‘think out of thebox’ whilst making a clinical decision that was ‘the correctone’ and, more importantly, right for the patient. Additionally,being able to provide a primary PCI information leaflet tothe patient’s anxious daughter enabled me to leave scenepromptly, knowing that the daughter had a point of contact.”A project aimed at reducing on-scene times for chestpain patients is also in progress in one division of EMAS.Ambulance clinicians attend quality improvement workshopsand use process mapping and cause and effect diagrams toidentify causes of on-scene delays and solutions for reducingor eliminating those delays. Interventions will be developed,trialled and measured to see whether they do reduce timeon scene. A spread process will be used to trial the mosteffective interventions in other areas of the Trust to seewhether the improvements are reproduced. The intention willbe to establish the most effective interventions into the careprocesses across the whole trust.These are just some of the positive effects on patient carewhich involvement in MINAP is having in EMAS.5. Reducing the delay to reperfusion by calling999 - Primary Care Acute Chest Pain AwarenessProject in South West WalesAlison Turner - MINAP/Call to Reperfusion ImprovementFacilitator, South Wales Cardiac NetworkMarc Thomas - Information, Communications & ProjectManager,South Wales Cardiac NetworkThe Primary Care Acute Chest Pain Awareness Projectaddressed the evidence demonstrated by analysis of theMINAP database that people in Wales are more likely thantheir English counterparts to call their GP than dial 999directly. In conjunction with the British Heart Foundation,resources were developed to support a systematic approachto raising awareness, in both primary care and the public, ofthe need to respond to chest pain by dialling 999 rather thancalling surgeries by telephone or attending in person.Questionnaires performed before and after educationalsessions in primary care and the provision of printedinformation, demonstrated that there was an increase inthose STEMI patients contacting 999 directly (8.7%) with acorresponding reduction in those being admitted after seeingtheir GP.Data for a similar region in England and a neighbouringregion in Wales were compared. The greatest improvementwas demonstrated where both resources and primary careeducation had been provided.Alun Roebuck and Paramedic Hannah Coppack studying anECG during one of the workshops.Concerns that the project would create a significantly higherworkload for the Welsh Ambulance Service were allayedby the analysis of all chest pain calls pre and post projectimplementation. There was no increase in these calls, leadingto the conclusion that the calls would have been made to the999 system eventually; but were now being made in a moretimely way.86 MINAP How the NHS cares for patients with heart attack