-----Original Message-----
From: Jeremy Mayhew [mailto:[log in to unmask]]
Sent: 17 February 2005 01:47
To: 'Accident and Emergency Academic List'
Subject: RE: Paramedics and allergy
I wasn't thinking just of the number needed to maintain competence (and
agree that this will not be the same for everyone), but as a suggestion as
to whether some paramedics are looking at different indications. To take the
case under discussion- use of adrenaline for anaphylaxis. Suppose you were
to find that most paramedics were doing it about 5 times a year. If you
picked up that someone was going 3 years without doing a single one or that
someone was doing one a week, you might want to consider whether these
individuals were using different indications. Not clear who is right or
wrong or whether it's just chance; but might be worth looking at. Only works
if your IT system collects the data properly of course, so really more
something to consider when specifying your system for most of us.
Matt Dunn
I agree 100% with your sentiments, and have been struggling to derive an
electronic system for giving simple basic stats in order to look for
outliers to the norm as part of a risk management approach to clinical
effectiveness...
It should be relatively simple, for example to routinely download data with
regard to on scene times, number of procedures attempted, medication given
for all paramedic staff on a monthly basis for example, by running some
queries on an access database...
It should even be possible to drill down into specific areas, such as
trauma, cardiac arrest, cardiac chest pain and so on.
The problems faced are numerous for example...
1. Patient report forms are paper. Although we have been scanning these
forms onto computer which does populate an access database, there are
significant concerns regarding validation. Clinical audit for example will
not use this electronic system as for example, written text is not scanned
hence the large number of tick boxes on our patient report forms.
2. Accuracy and detail of completion of report forms - an essential basic
principal for avoiding clinical negligence claims for example, although
improving is a long way from perfection in our service despite ongoing
performance improvement initiatives.
3. Lack of experience with access although we are looking to bring in this
expertise bearing in mind that such a database has 12,000 rows and over 100
columns...
So at best this would give a very rough guide, but I agree would still yield
excellent data in order to decide on personal development, training and
appraisal. If anyone has found an answer to these problems, particularly the
technical stuff, do let me know!
The closest we have come is our analysis of chest pain and prehospital
thrombolysis. All our paramedics have now been trained and as part of their
sign off they complete a chest pain audit of 10 ecgs and we check for
accuracy and completion of patient report forms, compliance with best
practice in terms of oxygen, nitrates etcetera, time to patient, time to
ecg, time to hospital and time to thrombolysis for example. From this we
have developed a service average, and staff are given their completed
assessment which shows how they vary from the mean and outliers are written
to and receive additional training where indicated. This is in the process
of being done for all our paramedic staff and has been extremely valuable ut
is detailed and time consuming.
A rough and ready rolling assessment is extremely attractive and is being
introduced (slowly) in Kent...
Jeremy Mayhew
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