The term ‘clinical governance‘ refers to the way in which healthcare organisations safeguard the care given to their patients. The Essex and Herts Air Ambulance has a robust clinical governance system ensuring that the advanced clinical care on offer is continuously monitored, enhanced and developed so that patients receive the very best emergency and life-saving treatment.
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Education & Training
Our doctor-paramedic teams have specific training for dealing with emergencies of all sorts in the pre-hospital phase, bringing treatments normally only available in hospital to the scene of an incident. Whilst our clinicians come to us with a wealth of skills and experience, before full sign-off by the Senior Clinical Team they undergo further specialised training in critical care, major incident management, crew resource management and human factors to name just a few. Training and education continue throughout their tour of duty by various means including training scenarios, bespoke courses, portfolio building and review, Death & Disability meetings and Clinical Governance Days.
Weekly ‘Death and Disability’ meetings
Once a week, our doctors and paramedics come together at one of our airbases in order to discuss cases, update on specific training needs and to review the previous week’s work. One of our experienced consultant doctors leads discussions around decision-making and treatments given. Cases are chosen at random and approximately one hour is spent reviewing each one with every aspect being scrutinised. The team share learning points in an open and honest environment to ensure ongoing improvements in quality. This process is vitally important in keeping the whole team abreast of current treatments, novel approaches and in sharing the ideas and experiences of our experienced team. Our death and disability meetings (D&D) are often attended by local ambulance crews, medical students and hospital doctors.
During our weekly meetings we usually run simulated training scenarios, rehearsing for cases which may arise and preparing the team for the spectrum of cases which they can expect to deal with.
Monthly Clinical Governance Day
On the third Tuesday of each month we hold our clinical governance day (CGD). The whole day is spent reviewing cases, listening to lectures on specific topics and external expert speakers are invited to talk on topics related to pre-hospital emergency medicine. Governance days are open to all interested clinicians. The audience is generally made up of doctors, paramedics, nurses, students, military personnel and other emergency services personnel.
We ask clinicians and emergency services workers to book in for a Clinical Governance Day by contacting Geraldine.Wash@ehaat.uk.com with your name, job title, organisation name or university and the date of the Clinical Governance Day you wish to attend. Your email should come from a recognised institution email address such as your work or university email, not your personal email.
Clinical Governance on scene
The cases we attend are often extremely challenging – we treat the most seriously ill and injured patients in the region. Sometimes, whilst advanced treatments are initiated, our senior doctors and paramedics may wish to share their decision-making with another senior clinician. For this purpose, there is always another senior doctor on call and available to discuss treatment plans with.
Our on-call doctors are amongst the most experienced pre-hospital consultants in the country. They are all ‘hands on’ pre-hospital consultants who have many years’ experience and can support the team remotely. Having access to an additional opinion is an important part of clinical governance. Our team of pre-hospital consultant doctors are also available to debrief any difficult or challenging cases once the team have carried out their work.
Frequently asked questions
Does EHAAT have gold standards for the delivery of care?
Yes. Gold standards are very important. For example in the management of cardiac arrest, EHAAT have established key performance indicators (KPI) for the treatment which patients can expect to receive from our team. These particular standards have been developed by our team and adopted by other healthcare providers. Another example of gold standards is in the management of patients with severe head injury – our team have clinically relevant targets to achieve which are scrutinised through the clinical governance process.
How does EHAAT audit its work?
There are several ways in which audits take place. Case review at D&D, longitudinal audits; where each aspect of a particular case is scrutinised against accepted standards during a clinical governance day and through specific projects utilising our bespoke database of cases. We also undertake audits of our governance work which are presented and available to our trustee board and partner organisations.
Are there nationally set standards of care in pre-hospital medicine?
Yes. There is guidance relating to ‘high performing air ambulances’ (www.aoaa.org.uk) which covers many of the ‘systems’ aspects of our work. For the clinical standards, there are guidelines from organisations such as the Association of Anaesthetists of Great Britain and Ireland (www.aagbi.org) regarding the delivery of pre-hospital anaesthesia. Some of our doctors have been involved in the development of these guidelines.