New publication highlights vital marginal gains for EHAAT patients in our collaboration with the Essex Cardiothoracic Centre

When a patient suffers a cardiac arrest, our clinicians often refer to the chain of survival as being crucial in ensuring the best outcome possible for patients.

Through our Centre for Excellence, our clinicians are undertaking groundbreaking initiatives to ensure that every part of the chain is of the highest quality for anyone who collapses because their heart suddenly stops, for whatever reason.

This blog focuses on the work that we’re doing with specialists at the Essex Cardiothoracic Centre (CTC) in Basildon, in a vital, game-changing component of the chain. A joint publication in the Emergency Medical Journal has highlighted the significance of the work we do together to review the care of every patient that we treat.

In the precious minutes following a cardiac arrest, our team will arrive on scene and deliver some of the most advanced care in the world to our patients. Then, with time being of the essence, some of our patients will be transferred to the highly specialised team at Basildon Hospital to undertake interventions such as the insertion of stents, and sometimes even heart bypass surgery.

Vitally, as part of this collaboration, our publication highlights how, after the time-critical phase has passed, we work together to review every detail of the patient journey to establish whether anything could have been done differently, or to imagine opportunities for future innovation. For our clinicians, this ‘feedback loop’ is critical in learning from each and every patient episode.

Initially developed by critical care doctor, Matthew Snowsill, now a Consultant in Emergency Medicine, the project known as ‘PHEM feedback’, was designed to ensure that clinicians who work in PHEM (Prehospital Emergency Medicine) and hospital-based specialists have ample opportunities to share learning from their experiences.

Dr Snowsill said, ‘Only a few years ago, ambulance teams and helicopter clinicians would hand their patient over to the hospital team and perhaps never be able to find out how things had gone. This has obvious implications for learning. The PHEM feedback process provides a structured way of sharing information so that clinical care can continually improve. We’re so pleased that we have been able to describe this process in a journal so that others can perhaps mirror what we have been able to achieve’.

Our doctor-paramedic teams often work under the incredible pressure of time to undertake interventions that until recently were only available in hospital, such as invasive monitoring of the physiology of our patients, even looking at the blood pressure generated during each chest compression to make sure that every compression matters. This is done through small drips deliberately inserted into the arteries of a patient, attached to a pressure monitor. We know that such attention to detail is vital in improving outcomes.

Associate Medical Director at Essex & Herts Air Ambulance, Dr Gareth Grier said, ‘With such an intense focus on every stage of the process while on scene, our clinicians are often desperate to find out the outcome for their patient, which until PHEM Feedback, could be very difficult to do. We now have an excellent process for exploring the impact of everything that we did at the scene, knowing how important this is for patients and their families’.

As part of this vital collaboration, EHAAT regularly undertakes comprehensive joint case review days with our colleagues at the Essex Cardiothoracic Centre. Hosted at our North Weald Airbase and attended by multiple specialists from across the chain of survival, we’re able to intensively review every intervention to make sure it was appropriate and carried out correctly.

Professor Thomas Keeble, Consultant Cardiologist at the Essex Cardiothoracic Centre, said ‘Working with EHAAT to discuss the care we jointly delivered to our patients is vital for our education and for future innovation. We really want to offer our patients the best possible chance of survival and our joint enthusiasm is crucial in achieving this. Our recent paper highlights the opportunities to work together even more’.

At EHAAT, we undertake a great deal of work with our patients and their families long after the sudden event has occurred. Our Patient and Family Liaison Team (PFLT) regularly helps support patients and their families, whatever the outcome. We know that our patients would expect us to interrogate and scrutinise the care that we delivered and we do this in a number of ways. The PHEM feedback process enables us to explore and understand the impact of our interventions more deeply and more thoroughly.

Dr Marco Mion, Principal Clinical Psychologist at the Essex Cardiothoracic Centre said, ‘During recovery, many patients find reassurance in knowing that every aspect of their care has been carefully considered, and that clinicians across services have had the opportunity to review what happened. Through strong communication with our hospital partners, we are often able to fill in gaps in memory for patients and families and address questions about the care they received. This understanding can be an important part of recovery.’

At EHAAT, we’re hugely ambitious for what we might be able to achieve for all our patients in the future. We are investing resources in a programme of innovation around cardiac arrest, so that we can continue to offer our patients the best chance when the unthinkable happens. We rely on the public both for their role in learning CPR and defibrillation, and in the support they give us financially to support these initiatives.

Everyone can learn

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We know the difference that this support makes. We are on duty day and night, aiming to respond as quickly as we can to the people of Essex and Hertfordshire. We know that we can continue to make a difference with your support. Thank you to everyone who supports us.

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