NHS Performance Statistics - January 2018

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

NHS to consider routine use of ‘drunk tanks’ to ease pressure on A&Es

NHS England Chief Executive Simon Stevens has announced that the NHS will decide this year whether “drunk tanks” should routinely be used take pressure off hard-pressed A&E departments and 999 ambulance services during the seasonal holiday period.

Supervised areas where revellers who have over-indulged can be checked and even sleep it off if necessary, rather than being taken to casualty, are already used in some areas such as Newcastle, Bristol, Manchester and Cardiff.

NHS performance statistics - December 2017

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

Performance of the NHS provider sector for the month ended 30 September 2017

This report from NHS Improvement finds that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care. However, the combined end of year deficit for hospitals in England will be an estimated £127 million worse than planned.

Addressing ambulance handover delays: actions for local A&E delivery boards

Ambulance handover will be a key indicator for both winter monitoring and on an ongoing basis through publication of performance data.

This letter from NHS Improvement outlines its expectations and guidelines for management.

Combined Performance Summary - October 2017

This publication from NHS England summarises the data around NHS performance for October 2017. It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Combined Performance Summary - August 2017

This publication from NHS England summarises the data around NHS performance for August 2017. It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Not enough specialist support for people with dementia

Most of the healthcare received by people in the later stages of dementia is provided by GPs or emergency services, with little support from specialist healthcare professionals.

The researchers, from the Marie Curie palliative care research department at University College London, found that GPs were the main providers of medical care, with 96% of people with advanced dementia seeing a GP in their last month of life. Paramedics also played a major role in assessment and healthcare towards the end of life, suggesting a reactive rather than planned response to patients’ needs – nearly one in five (19%) were seen by a paramedic in the month prior to their death.

Signal: Use of public defibrillators linked to out-of-hospital cardiac arrest survival

Providing a shock using a defibrillator to people with out-of-hospital cardiac arrest before the arrival of emergency medical services increases their chance of survival.

The UK survival rate is around 8%, which is lower than in other developed countries. This review found that bystander assistance through cardiopulmonary resuscitation and attaching a defibrillator increased it to 32%, compared to 12% for police or firefighters. Survival rates were even higher for people who had a rhythm that could be treated by a shock from the defibrillator, at 53% following intervention by bystanders. The higher survival rate seen following bystander assistance was probably due to the shorter time response time, although time to intervention was not reported by the researchers.

Whether it was the speed of first response or cause of cardiac arrest that accounted for these differences, it is clear that members of the public have an important role to play. Although this review did not examine training, pilot studies are investigating the potential of medical dispatch alerts for public first aiders.

Overall, the review findings support the current installation of publicly available defibrillators so members of the public can assist those with cardiac arrest until emergency medical services arrive.

From NIHR Dissemination Centre

Prehospital finger thoracostomy in patients with traumatic cardiac arrest

Tension pneumothorax is a cause of traumatic cardiac arrest that must be considered and rapidly treated if suspected. Finger thoracostomy can be performed quickly and with a low rate of complications. It appears acceptable for use as a method of chest decompression in the pre-hospital environment. Further research is required to evaluate its use by non-HEMS crews, with consideration to integrating ultrasound detection into the clinical decision making where feasible.

Combined Performance Summary - May 2017

This publication from NHS England summarises the data around NHS performance for May 2017.

It contains a summary of the monthly performance statistics on:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

NHS needs more advanced paramedics to ease A & E pressure, says NICE

NICE is recommending the NHS provides more advanced paramedic practitioners (APPs) to relieve pressure on emergency departments, in new draft guidance.

Evidence reviewed by NICE shows that using APPs can reduce hospital admissions by 13% compared with standard paramedics.

Monthly performance statistics, March 2017

Performance statistics for March 2017 have been published by NHS England. These cover the following:

• NHS 111
• ambulance quality indicators
• A&E attendances and emergency admissions
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
• delayed transfers of care; and
• early intervention in psychosis

Prehospital Care of Spinal Cord Injuries in India

Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation32(S1):S165 · April 2017

Study/Objective: Prehospital Care of Spinal Cord Injuries in India.

UHCW Research: Chris Turner

Model Hospital expanding to ambulance, specialist acute, community and mental health trusts

As part of our work to implement Lord Carter’s hospital productivity recommendations, the Model Hospital online information system is expanding to include early benchmarking data for ambulance, specialist acute, community and mental health trusts.

The data will go live on Monday 17 April and you can access it via the Model Hospital website. This letter provides a full overview.

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Resuscitation to Recovery

A National Framework to improve care of people with out-of-hospital cardiac arrest (OHCA) in England

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period. This report from the Nuffield Trust finds that the service seems to steer people away from emergency services, though there is great variability across England. In some areas, NHS 111 is likely too risk averse, as it is connecting more people to the ambulance service than sending people to A&E – which is the reverse of the usual pattern of NHS use.

Can the value of end tidal CO2 prognosticate ROSC in patients coming into ED with an out of hospital cardiac arrest (OOHCA)?

New from BestBETs

A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.

Current literature suggests that: 1) Our current ETCO2 aim of 10-20mmHg may be inadequate and should be modified to 25mmHg. 2) A 3-5 minute ETCO2 level of ≤10mmHg is associated with bad prognosis and as such, it may be beneficial to consider stopping patient resuscitation should this be the clinical case. 3) It is important to see the trend of ETCO2 rather than making a decision solely on one specific value, as sometimes an abrupt increase in ETCO2 could be a sign of impending ROSC. 4) More robust prospective data on the optimal ETCO2 value that is associated with ROSC would be helpful in defining a more accurate future target for intervention.

Man or machine? An experimental study of prehospital emergency amputation

Emerg Med J 2016;33:641-644 doi:10.1136/emermed-2015-204881

Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation.

UHCW Research: C Leech. Published June 2016, Revised October 2016

New draft guideline AAGBI Guidelines: Safer pre-hospital anaesthesia

A new draft guideline on pre-hospital anaesthesia is in its final draft stage and comments are invited from members. Please read the draft below and submit comments to workingparties@aagbi.org.