# ePCR Hospital Outcome Feedback

## Overview

Pre-hospital care quality is hard to improve when the ambulance service never sees what happened after handover. A crew may know they transported a STEMI or a stroke, but not whether reperfusion targets were met, whether the patient was admitted, or whether a 30-day outcome changed the clinical picture. Without that feedback loop, governance teams measure process but not outcome.

The Hospital Outcome Feedback module closes that loop by bringing downstream hospital outcomes back into the ePCR environment. Ambulance services can connect the field record to discharge status, diagnosis, readmission, mortality, and other outcome markers so training, audit, and service redesign are informed by what happened after the patient left pre-hospital care.

```mermaid
flowchart TD
    A[ePCR Encounter and Handover] --> B[Receiving Hospital Link]
    B --> C[Outcome Retrieval]
    C --> D[Disposition and Diagnosis]
    C --> E[Readmission and Mortality Signals]
    D --> F[Encounter Outcome Timeline]
    E --> F
    F --> G[Clinical Audit and KPI Review]
    F --> H[Pathway Improvement and Research]
```

**Last Reviewed:** 2026-04-22
**Last Updated:** 2026-04-22

## Key Features

- **Post-Handover Outcome Retrieval**: Pull key downstream outcomes from the receiving hospital after the original ePCR handover so the ambulance record does not stop at the ED door.

- **Disposition and Diagnosis Feedback**: Capture whether the patient was admitted, discharged, transferred, or died, alongside the downstream diagnosis context needed for clinical review.

- **Outcome Measures for Time-Critical Pathways**: Support review of care episodes such as STEMI, stroke, cardiac arrest, and thrombolysis cases where the pre-hospital contribution needs to be assessed against hospital outcome.

- **Readmission and Mortality Signals**: Let governance teams understand whether a case later re-presented or deteriorated after initial pre-hospital management.

- **Service-Level KPI Loop Closure**: Connect operational handover and transport workflows with downstream outcomes so services can measure whether field decisions aligned with later hospital reality.

- **Idempotent Refresh Model**: Allow services to refresh outcomes over time without duplicating the record, which is important when downstream status evolves after the first poll.

- **Best-Effort Resilience**: Treat hospital outcome retrieval as an enhancement to governance and quality workflows rather than something that can block frontline documentation.

## Use Cases

- **STEMI Service Review**: A governance lead reviews ambulance STEMI encounters against downstream reperfusion outcomes to see whether field recognition and destination decisions supported the best result.

- **Stroke Pathway Assurance**: A stroke programme correlates pre-hospital assessment with admission diagnosis and treatment timing to improve destination routing and clinician education.

- **Cardiac Arrest Outcome Tracking**: A service monitors whether pre-hospital ROSC translated into sustained downstream outcome and uses that feedback in training and debrief.

- **Non-Conveyance Safety Review**: A governance team looks for later deterioration or readmission signals that might indicate a pathway needs tighter safeguards.

- **Clinical Audit with Real Outcome Data**: Audit officers no longer rely only on documentation completeness; they can compare field judgement to what happened after hospital receipt.

## Integration

- **Electronic Patient Care Report Clinical Workspace**: Outcome feedback appears as an extension of the encounter rather than as a separate clinical governance system.

- **Hospital Pre-Alert and Handover Workflows**: The same hospital relationship used for pre-alert and handover becomes the basis for downstream feedback.

- **KPI and Quality Dashboards**: Outcome measures can feed service-level reporting, pathway audit, and governance reviews.

- **Research and Improvement Programmes**: Services can use downstream outcomes to support pathway redesign, training priorities, and approved evaluation work.

## Open Standards

- **HL7 FHIR R4**: downstream hospital outcomes are retrieved using the same open healthcare interoperability model used for pre-alert and clinical exchange.

- **LOINC**: outcome-related observation markers can be carried in a standard coded form that supports comparison across hospitals and review programmes.

- **SNOMED CT**: discharge diagnoses and coded clinical outcome context can remain interoperable across pre-hospital and hospital systems.

- **OAuth 2.0**: hospital-side access follows a standards-based delegated authorisation pattern for secure clinical system integration.

- **ISO 8601**: admission, discharge, and outcome timestamps remain portable and machine-readable across partner systems.