INFORMATION STANDARDS GOVERNANCE PROCESS INFORMATION STANDARD DEVELOPMENT PROPOSAL FOR NEW OR CHANGED INFORMATION STANDARD Emergency Ambulance to A&E Handover Monitoring Information February 2008 DRAFT SUBMISSION
INFORMATION STANDARD DEVELOPMENT PROPOSAL FOR NEW OR CHANGED INFORMATION STANDARD This document should be completed using the GUIDANCE ON COMPLETING THE INFORMATION STANDARD DEVELOPMENT PROPOSAL SUBMISSION TEMPLATE REVISION HISTORY Date of this revision: Version no. Revision date Summary of Changes Changes marked 01 13 Feb 2008 Created None 02 14 Feb 2008 Updated post policy and project team None review 03 14 Feb 2008 Updated data item references None 04 15 Feb 2008 Updated operational fit None SUBMITTED BY: Document completed by: Jason Bradley Role & organisation: Consultant, Information Services Division FEEDBACK TO BE PROVIDED TO: Feedback will be provided on the Proposal within 10 days of the WIGSB meeting. If the feedback is to be directed to another nominee please provide the name and contact details below. Name: Email: informationstandards@wales.gsi.gov.uk SUBMISSION PURPOSE Proposal submitted for: Draft Proposal If this Proposal submission is not for formal approval then please state the specific aspects on which you would like more detailed comments. Specific Areas for WIGSB to comment on when not submitting for formal approval at the Proposal stage This proposal is submitted as draft as there outstanding details to be confirmed as indicated in the text. Page: 2 of 10
SECTION 1: BACKGROUND 1. Information Standards Reference Number [From Information Services Division] IGRN 2008 / 007 2. Name of Information Standard Emergency Ambulance to A&E Handover Monitoring Information 3. Type of change a) Introduction of new standard 4. Type of standard a) Operational 5. Introduction WHC (2007) 076 introduced the Annual Operating Framework 2008/2009 including a new national target for the handover of patients from an emergency ambulance to A&E target 19, in the domain Safety. A new information standard is required to support the introduction of data collection required for performance monitoring of this target both at local and national levels. 6. Sponsor Simon Dean Director of Service Delivery and Performance Management Directorate of Performance & Operations, Department of Health and Social Services, Welsh Assembly Government 7. Developer Jason Bradley on behalf of Information Services Division 8. Implementation Date April 2008 Page: 3 of 10
SECTION 2: BUSINESS JUSTIFICATION 9. Purpose WHC (2007) 076 introduced the Annual Operating Framework 2008/2009 including a new national target for the handover of patients from an emergency ambulance to A&E target 19, in the domain Safety. The NHS Wales: Annual Operating Framework 2008/2009 (AOF) sets out the Welsh Assembly Government s requirements for the NHS to deliver in 2008/2009. All organisations are required to achieve the delivery of the Annual Operating Framework in its entirety, within the resources available. A new information standard is required to support the introduction of data collection required for performance monitoring of this target both at local and national levels. The AOF target for 2008/9 states: NHS organisations will achieve a handover* of patients from an emergency ambulance to accident and emergency (in a major A&E department) within 15 minutes. (*the handover period starts from when the A&E staff are notified by the ambulance crew that a patient has arrived and needs to be seen within the A&E Department, and ends when the patient has been transferred into the clinical care of A&E staff and the ambulance crew are free to return to the ambulance). [Target date: 31 March 2009] The rationale for the target is as follows: To improve clinical governance and patient experience by ensuring that patients transported to A&E by ambulance are transferred into the care of A&E staff in a timely manner, and that ambulance resources are freed to respond to life threatening 999 calls. This target will support the achievement of two other national targets, namely the A&E 4-hour wait and the achievement of an ambulance first response to Category A calls of 65% across Wales and 60% in each Local Health Board area. The target is owned jointly by the Welsh Ambulance Trust, Local Health Boards and NHS Trusts. For all patients transported by ambulance, the handover period starts from the time when the A&E staff are notified by the ambulance crew that a patient has arrived and needs to be seen within the A&E Department. Handover takes place when the patient is transferred into the clinical care of A&E staff and the ambulance crew are free to return to the ambulance To meet this target NHS Trusts should provide efficient and effective A&E services to meet the needs of patients. LHBs should commission appropriate services and educate patients to make best use of all the services available. The Welsh Ambulance Trust should ensure that protocols are in place to enable patients who access the 999 ambulance service, but do not require the services of an A&E Department, to be directed to an alternative pathway of care. 10. Scope The scope of the information used for monitoring the AOF target is: All patients arriving at A&E departments (NHS Wales Hospital Trusts) by Emergency Ambulance By definition this target excludes non-emergency ambulance journeys. 11. Funding No funding has been identified for this new data collection. Page: 4 of 10
12. Support This proposal is supported by the Performance Management Policy Development, Waiting Times and Emergency Care Branch / of the Welsh Assembly Government. The target is a Ministerial priority with regards to the clinical safety of patients. Page: 5 of 10
SECTION 3: HEALTH INFORMATION STRATEGIC AND OPERATIONAL FIT 13. Strategic Fit Developments in this area need to relate to: - The Emergency Department Data Set developments. - Ongoing Ambulance Service system developments - Target for patients spending no longer than 4 hours in a major A&E department 14. Operational Fit Currently patient arrival time at A&E departments is recorded on Hospital Trust A&E systems. Welsh Ambulance Services Trust staff capture ambulance arrival and clear times. It is assumed that clinical handover times are captured manually but not generally recorded on electronic systems. There are questions as to whether times recorded by different staff / systems (e.g. A&E and WAST) for the same event are synchronised. Previously systems (terminals / software) were installed in Emergency Departments and MAU departments in some hospitals in South Wales as a pilot scheme to support early notification of ambulance arrival and to support the measurement of ambulance turnaround times. There were a number of issues with the implementation of the terminals which will need to be considered and addressed by the new proposals. 15. Known standards in use nationally and internationally SITREPS This reporting mechanism captures data in support of the monitoring of the target for patients spending no longer than 4 hours in a major A&E department. A&E data standards The NHS Wales Data Dictionary defines data items such as Accident and Emergency Attendance Administrative Arrival Time Ambulance Response Times Data on ambulance response times from the time of the call to arrival of vehicle is captured by WAST and submitted to HCW and WAG. -------------------------------------------------------------------------------------------------------------------------------- England No relevant references have been identified at this stage but will be investigated further. Scotland No relevant references have been identified at this stage but will be investigated further. Page: 6 of 10
SECTION 4: THE PROPOSAL 16. Proposed Solution The proposed solution builds on the current processes for capturing arrival times in A&E and the roll out of ambulance arrival terminal screens to A&E departments. Two options are being pursued which may not be mutually exclusive i.e. both could be implemented. The first, more immediate solution, proposes using data collected by A&E departments and the second, medium term solution, using data from ambulance arrival terminals. Hospital Trust data In addition to the capture of the defined data item Accident and Emergency Attendance Administrative Arrival Time, a new data item will be introduced called Accident and Emergency Clinical Handover Time. This will be recorded by A&E staff and systems / processes will need to be put in place to capture this data item. The supporting definitions have already been developed as part of the work of updating definitions to support changes to the 4 hour A&E target. This will require changes to Hospital Trusts A&E systems to capture new fields. The length of handover will be calculated as Accident and Emergency Clinical Handover Time minus Accident and Emergency Attendance Administrative Arrival Time. (NB In certain circumstances these could be the same time and therefore the resulting length of handover would be zero). A revised definition for Arrival Time and a new definition for Clinical Handover Time have been developed and are due for final consultation with the NHS in Wales and agreed changes will be published in a DSCN. Monitoring information on length of handover time will be reported via SITREPS, via upgraded software to be developed by HSW, with the requirements specified by the Performance Management Policy Development, Waiting Times and Emergency Care Branch. SITREPS will be routinely completed by NHS Trusts. The time period of reporting is to be defined, but could be daily / weekly / monthly as per 4 hour target reporting. [NB Arrangements for the SITREPS development are to be discussed with HSW.] The process for analysing, reporting and publishing the data will be discussed with the Health Statistics Analysis Unit and the Corporate Analysis Team. It is assumed that data will be reported in monthly performance management reports. Ambulance terminals This solution is being developed by WAST building on previous piloting of ambulance arrival terminals based in A&E departments. It will facilitate the recording of the key times from ambulance arrival through to ambulance clear time. It has been discussed with 7 Hospital Trusts (so far) who are supportive of this approach. 17. Fitness for Purpose The definitions will be developed with the prime suppliers and users of the data i.e. relevant policy leads and NHS Trusts (via DSCN sub group and DSCN consultation processes). 18. Testing / Pilot To be arranged. Page: 7 of 10
19. Information Governance This is aggregated data so therefore there are no information governance issues. Assurance mechanism for data quality will need to be developed. 20. Commercial Considerations None known. Page: 8 of 10
SECTION 5: IMPACT ASSESSMENT 21. Impact Assessment An impact assessment will be undertaken and will cover the following areas: - Current recording of clinical handover time. - Future recording of clinical handover time. - System changes that may be required. - Changes to documentation processes - Training implications - Cost implications This impact assessment will be targeted at NHS Trusts IM&T staff. Further discussions will take place with WAST with regards to impact of the use of terminals to collect data. Page: 9 of 10
SECTION 6: DEVELOPMENT PLAN 22. Development plan Current and proposed actions at this draft stage are: The development of relevant data standards is being progressed by HSW in conjunction with ISD and the DSCN sub group. The scope will be clarified i.e. definition of Emergency Ambulance. SITREPS will be developed to deliver the required flow of information timescales to be agreed. The NHS Wales Data Dictionary is expected to be updated with the relevant definitions in March 2008 with associated publication of a DSCN and will include a definition for A&E Clinical Handover Time. Impact assessment will be undertaken with NHS Trusts to understand the impact on A&E systems Plans for the roll out of ambulance terminals will be developed Consideration will need to be given to the capability of NHS Wales of implementing solutions for April 1 st 2008. Page: 10 of 10