The CaHRU team spent a December awayday at Lincolnshire’s Branston Hall, reflecting on past and ongoing work, discussing current challenges and exploring future opportunities for the research centre. Over the past year the centre has continued to build on its strong collaborations with health service and academic partners (both internal and external to the university), which has led to increasing success in attracting external funding, achieving publications and securing research funding.
In the next year CaHRU will begin new projects on the ethics of ambulance trials (funded by the Wellcome Trust), pain management in ambulance services (funded by the Falck Foundation, Denmark) and evaluation of a new pathway for care of people with diabetes presenting with low blood sugar (hypoglycaemia) to ambulance services (funded by the East Midlands Collaboration for Leadership in Applied Health Research and Care). The centre will continue its work on ambulance trials (RIGHT2 funded by the British Heart Foundation) and service delivery (Variation in Ambulance Non-conveyance funded by the NIHR), prescribing safety in primary care (Scaling up PINCER funded by the Health Foundation) and regional networks such as the East Midlands Network for Quality Improvement Research and Education (ENQuIRE, funded by the East Midlands Academic Health Science Network and Health Foundation).
The awayday provided an important opportunity for CaHRU staff to have their say on future developments. Next year the centre will continue to expand with the appointment of two postdoctoral staff who will join the team including a qualitative researcher and health economist. The awayday was supported by funding from the University of Lincoln team achievement award for research which CaHRU won in 2015 for a consecutive year.
An international team of researchers led by Prof Niro Siriwardena with statistician Dr Zahid Asghar from CaHRU has been awarded funding from the Falck Foundation to study prehospital pain management. The study involves collaboration between CaHRU at the University of Lincoln, with East Midlands, East of England and South Central Ambulance Service NHS Trusts, together with the Universities of Swansea, Hertfordshire and the Sunshine Coast (Australia).
The study, ‘Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain: cross sectional study (ExPLAIN)’ aims to identify how patient factors such as age, gender, ethnicity and the cause of pain together with clinician factors such as sex or role seniority affect pain assessment and use of analgesic drugs by ambulance staff. The study builds on previous research conducted by members of the team in the area of prehospital pain management and the findings will be used to inform recommendations to improve the rate and quality of acute pain relief provided by ambulance staff and to reduce unintended variations in care.
The study is part of CaHRU’s ongoing research as part of its Prehospital and Emergency Quality and Outcomes (PEQO) workstream which involves collaboration with other ambulance services in England and which has already led to new measures and improvements in the quality of ambulance service care provision.
If you have used the ambulance service in the previous 12 months and are happy to take part in an interview for a new study we would like to hear from you.
This study is part of doctoral research being undertaken by Fiona Togher, Graduate Research Assistant at CaHRU, to develop a Patient Reported Experience Measure (PREM), a brief questionnaire for measuring experiences of ambulance service users. This will enable NHS ambulance services and their commissioners to routinely assess differences in patient experiences between and within organisations and to stimulate positive changes to the experiences of ambulance service users through feedback, training and education to clinicians; it could also be an opportunity to identify the strengths of ambulance service care and provide evidence of good practice.
The purpose of this study is to try to understand how people interpret the questions that have been developed so that we can improve them. In order to do this we are conducting interviews with ambulance service users, showing them the latest version of the questionnaire, and asking them to respond to the questions and share their thoughts and opinions of the questions.
If you would like to take part please contact Fiona Togher on firstname.lastname@example.org or 01522 837731.
A new book, Ambulance Services: Leadership and Management Perspectives by Professors Paresh Wankhade and Kevin Mackway-Jones, features a chapter on equality and diversity in prehospital care, co-authored by Viet-Hai Phung and Prof Niro Siriwardena of CaHRU together with Dr Karen Windle of the School of Health and Social Care. The new volume also refers to CaHRU’s work in developing indicators and processes for measuring and improving the quality of care provided by ambulance services.
The chapter, Responding to diversity and delivering equality in prehospital care: statutory responsibilities, best practice and recommendations, explores the impact of increasing diversity in the UK population and NHS workforce on prehospital care delivery. As public sector organisations, ambulance services are bound by The Equality Act 2010, which obliges them to promote equality and outlaw discrimination, harassment and victimisation of people with protected characteristics such as age, disability, race, gender and sexual orientation. Ambulance services use the Equality Delivery System (EDS), a voluntary toolkit that provides guidance about how they can achieve their duties set out in The Equality Act 2010. Building on the original EDS, the new EDS2 framework encourages organisations to flexibly reflect local sensitivities.
There are still significant variations in the quality of data that ambulance services possess for different protected characteristic groups, which also makes progress towards greater equality difficult to measure. The chapter summarises the current policy, problems in delivering this and potential solutions to overcome these.
An article entitled, ‘Feeling reassured: the glue that holds together patients’ experiences of ambulance service care’ was published in the autumn (September) issue of Ambulance Today. The article by Prof Niro Siriwardena and Fiona Togher, based on work undertaken as part of the National Institute for Health Research funded five-year Programme for Applied Health Research co-led by Prof Siriwardena together with doctoral research by Fiona Togher, describes findings from a recent paper published in Health Expectations.
The article, ‘Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study’, describes how healthcare quality incorporates the important of patient experience as well as safe and effective clinical care and what patients feel contributes to a good experience. The original study involved 22 patients who had recently experienced care from the ambulance service together with eight spouses. The interviews revealed that the ability of ambulance staff to reassure patients was the ‘glue’ that held together patients’ experiences: if patients did not feel reassured during their care this adversely affected their overall experience.
[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2015/09/Siriwardena-Togher-Feeling-reassured-AT-2015.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]Patients expected the clinical care delivered by ambulance staff to be safe and effective, but what affected their experience and their feeling of being reassured were other aspects of care such as professionalism (demeanour and conduct), good communication (sensitive to the needs of patients and their relatives), responsiveness (timeliness that met needs rather than simply a rapid response), and continuity (effective handover to hospital or community pathways). The research is part of the Prehospital and Emergency Quality and Outcomes (PEQO) workstream at CaHRU and has contributed to Fiona’s doctoral research on the development of a Patient Reported Experience Measure (PREM) for use in NHS ambulance services.