Category Archives: News

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University of Lincoln with EMAS and National Ambulance Groups shortlisted for HSJ Awards 2012

A national quality improvement project led by East Midlands Ambulance Service NHS Trust and the University of Lincoln in collaboration with the National Ambulance Services Clinical Quality Group and National Ambulance Research Steering Groups has been shortlisted for the prestigious Health Service Journal Awards 2012: Enhancing Care with Data and Information Management.

The Ambulance Services Cardiovascular Quality Initiative (ASCQI), funded by the Health Foundation, was a quality improvement collaborative involving all twelve English ambulance trusts, the first time all services have been involved in a national project. The aims was to improve pre-hospital care for cardiovascular disease by using a care-bundle approach to ensure that every patient presenting with heart attack or stroke received each element of optimal care.

The care bundle for suspected heart attack included aspirin, glyceryl trinitrate, pain scoring before and after treatment and pain relief. The suspected stroke bundle included the face-arm-speech test (FAST), and recording blood glucose and blood pressure. The project involved measuring and benchmarking performance, analysing barriers and facilitators to improvement, and using quality improvement methods to improve the quality of services.

ASCQI achieved statistically significant improvements in ten out of twelve trusts in either the stroke or heart attack care bundle, with five out of twelve trusts showing significant improvements for both heart attack and stroke. Overall performance for the care bundle for heart attack increased nationally in Englandfrom 43 to 79 percent and for stroke from 83 to 96 percent.

ASCQI achieved its aim of applying quality improvement methods to improve care for patients presenting to ambulance services inEnglandwith heart attack or stroke.

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ENACT study presented in Gothenburg at European Forum

A recently completed study,  ‘Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and multiprofessional primary health care perspectives’ was presented by Prof Niro Siriwardena in the e-health session of the fourth biannual conference of the European Forum for Primary Care: The Future of Primary Healthcare in Europe IV held in September in Gothenburg’s Museum of World Culture in Sweden.

The study authors also included Jo Middlemass, Dr Zowie Davy, Dr Kate Cavanagh, Dr Conor Linehan, Professor Kevin Morgan and Professor Shaun Lawson. The study was funded by the EPSRC Healthcare Partnerships programme and is the first study in a wider project, ‘Exploring social Networks to Augment Cognitive behavioural Therapy (ENACT)’.

ENACT aims to design and test a novel mode of delivery of treatment for sleep problems including mobile phone technology, electronic assessment of sleep and computerised cognitive behavioural therapy for insomnia (CCBT-I). The study involved interviews and focus groups with service users and health professionals to elicit beliefs and intentions that might facilitate or create barriers to the uptake and adherence to CCBT-I.

The study is due to be presented at the Society for Academic Primary Care in Glasgow and to be published in the British Journal of General Practice later this year.

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Women and men doctors differ in their knowledge of sex-specific complaints during general practice training

A new study from the University of Lincoln and the Royal College of General Practitioners (RCGP) Applied Knowledge Test Development Group reveals that women doctors have greater knowledge about women’s medical problems than men doctors during their training to become general practitioners. The study entitled, ‘Comparing performance among male and female candidates in sex- specific clinical knowledge in the MRCGP‘, was published in the British Journal of General Practice this month and is the first to look at sex-specific clinical knowledge in a medical licensing examination. The Applied Knowledge Test is a component of the Membership of the Royal College of General Practitioners, which doctors training to be GPs need to pass to be deemed fit for independent practice.

Many female patients choose to see a woman doctor, because they feel more at ease with their communication style or feel more confident in their knowledge of women’s medicine. This study shows that on average women doctors know more about women’s medicine than men at a similar stage of training and after taking other factors into account – so women may be justified in choosing a woman doctor on this basis. Conversely male doctors in training did not appear to know more about men’s problems.

The reason for this difference is a matter for speculation. Women doctors are much more likely to see more female patients during training and might be encouraged to learn more about women’s problems as a result of this greater exposure as well as through their own personal experience. The implication for GP training schemes is that they should ensure that male GP trainees are enabled to see more women patients or learn more about women’s medicine so that patients consulting male trainees are not disadvantaged.

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ASCQI presented at International Forum on Quality and Safety in Health Care in Paris, April

In April 2012 Professor Niro Siriwardena and Fiona Togher travelled to Paris with colleagues, Nadya Essam, Debbie Shaw (East Midlands Ambulance Service [EMAS]) and David Francis (East of England Ambulance Service) to attend the 17th International Forum on Quality and Safety in Healthcare.

The team presented work undertaken as part of the Ambulance Service Cardiovascular Quality Initiative (ASCQI) a two year nationwide project involving all 12 ambulance trusts in England and the University of Lincoln funded by the Health Foundation.

From the 2,000 poster submissions that were originally received, around 900 were selected for display following a two stage peer review process. Fiona, Nadya and Debbie were all invited to present their work during the poster presentation session held. This provided a brilliant opportunity to talk to interested delegates from around the world about the quality improvement work and research that is being undertaken at the University and East Midlands Ambulance Service.

Fiona Togher

Fiona represented the IS-PROVE team, which also includes Professor Siriwardena and Dr Zowie Davy. Their poster entitled “The importance of qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital and emergency care of stroke and heart attack” attracted attention from French, Swedish and American delegates that were keen to find out more. Nadya Presented on ergonomic redesign to improve care for heart attack and Debbie presented on ‘Joining the dots’ and the use of annotated control charts for quality improvement in ASCQI.

Debbie Shaw

With a tough act to follow from last years’ excellent event in Amsterdam, Paris was just as enjoyable,  thought provoking and inspiring. The key note speakers were again outstanding and captivated the audiences with their motivational reflections on working in health care and how to improve the quality of care provided to patients.

The opening keynote by Maureen Bisagnano from the Institute for Healthcare Improvement focused on goal oriented patient care, ‘what matters to patients’ and the redesign of services for patients. We heard about leadership from Dr David Williams, a Canadian professor of surgery who has been an astronaut and now leads a regional health organisation in Toronto.

Another highlight of the conference was the session entitled “Delivering better care to rural communities inAfrica” which focused on the application of quality improvement methods including Plan, Do, Study, Act cycles, to reducing asphyxia in newborn babies and mortality rates in children under the age of five. The success of the initiatives was amazing, more so because of the limited resources of equipment and manpower available.

Nadya Essam

One of the most inspiring speeches was given by Dr. Nancy Snyderman, who is not only a paediatrician and an ENT surgeon but also chief medical editor for NBC news in America – and an award winning journalist! Her speech focused on the importance of listening to patients and hearing what they are actually saying as opposed to what health care professionals presume they are saying. This central message resonated with what we are aiming to achieve through the patient experience studies that we are conducting in prehospital care in Lincoln and EMAS.

The take home message from this conference was that the application of quality improvement methodologies makes a real difference to the standard of care that is provided to patients; there were hundreds of examples of fantastic successes from around the world and in some instances the evidence translated to a significant contribution of quality improvement projects to saving lives.

Fiona Togher and Niro Siriwardena