CaHRU contributes to international EMS quality & safety programme

Professor Niro Siriwardena recently contributed to ‘Safer, Better and Stronger: Quality Improvement for EMS Leaders’ a one-day preconference course at the North American Emergency Medical Services Physicians (NAEMSP) Annual Conference in San Diego, on January 10, 2018.

SD1Around 60 EMS physicians attended the day to learn about quality improvement methods from experts based in the US and UK led by Dr Michael Redlener, EMS and Emergency Department physician based in New York city and chair of the NAEMSP Quality and Safety Committee together with Dr Scott Bourn, president of the National Association of EMS Educators, supported by Mike Taignan, Associate Professor in the Emergency Health Services Management graduate program at the University of Maryland Baltimore County, Dr David Williams, Executive Director at the US Institute for Health Improvement, and Prof Siriwardena from CaHRU.

SD4The preconference course began with an overview of the day by Dr Scott Bourn. This was followed by Dave Williams leading a session on the science of improvement including the ‘red bead experiment’ and an outline of Deming’s theory of profound knowledge. Niro Siriwardena led a session on understanding the model for improvement and Mike Taigman helped delegates get to grips with the plan-do-study-act cycle using the coin-spinning game. The later sessions were focussed on application of these ideas to selecting a good project, identifying measures, developing a measurement strategy, managing change and understanding what changes will result in an improvement faciltated by other faculty members including  Joseph Grover MD, Jeffrey L. Jarvis, MD, MS, EMT-P, Kevin Mackey, MD, FACEP, Kim D McKenna, PhD, RN, EMT-P, and James “Tripp” Winslow, MD, MPH.

SD3The day will be followed by a year-long course for around 25 delegates from the US and Canada who will take part in monthly moderated online educational sessions on key aspects of quality improvement, read relevant articles and conduct a ‘capstone project to implement quality improvement methods to a problem in their agency or system, supported by a mentor from the course faculty to help guide their progress. Participants will present their work to colleagues and members of the NAEMSP community to share the impact of quality improvement.

The preconference has been summarised by Dr Catherine Counts, one of the delegates in a blog entitled: ‘Quick take: Quality and safety gain prominence at NAEMSP‘.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/FLYER-QI-2018.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

CaHRU receives university team award for achievement in research

CaHRU2017webThis year members of the Community and Health Research Unit received the University of Lincoln team award for Achievement in Research at the Individual Merit and Team Achievement Awards 2017. This was the team’s fifth team award over the past 6 years and the fourth time the team have received the team award for achievement in research. Members of the team include Prof Niro Siriwardena (director), Prof Graham Law, Dr Murray Smith, Dr Zahid Asghar, Dr Coral Sirdifield, Dr Stephanie Armstrong, Dr Julie Pattinson, Dr Rebecca Marples, Viet-Hai Phung, Despina Laparidou, Michael Toze, Laura Simmons, Joseph Akanuwe, Dr Nadeeka Chandraratne, Dr Ravindra Pathirathna and Sue Bowler (administrator).

ResearchTeamAward2017CertificateThe CaHRU team are striving to conduct research which will make a difference to patients and healthcare delivery. The group conducts basic and translational interdisciplinary research in collaboration with health service and academic partners.  It currently has over 30 active projects in progress across a range of research methods from systematic reviews (e.g. role of community first responders, ethics of ambulance trials), major clinical trials (investigating conditions such as hyper-acute care of stroke, prehospital pain management, ambulance hypoglycaemia pathways and primary care for insomnia), observational studies (investigating prehospital pain and seizure management), qualitative designs (community first responders, dementia carers, ethics of ambulance trials, fairness of medical licensing exams), consensus methods (ambulance indicators), and surveys (healthcare for offenders on community sentences) to quality improvement programmes (prescribing safety) and international research networks (ethics of ambulance trials). Details of current studies are available on the CaHRU website (http://cahru.org.uk/research/).

CaHRU_logotypeThis has led to over 20 publications in the past year covering research on development of new pathways and indicators for ambulance services, assessment and treatment for insomnia and use of health technology innovations, in major journals such as Resuscitation, Annals of Emergency medicine, Health Technology Assessment, Health Expectations and Lancet Psychiatry. The team have  received several major grants over the past year, particularly from the National Institute for Health Research, as well as continuing to work on studies funded by the Wellcome Trust, Health Foundation and Falck Foundation. This year we have also welcomed international fellows from the University of Colombo to the team for the first time.

Spotlight on new ambulance performance measures

photo2italiccolourWORDSTwo key articles on development and prioritization of new ambulance performance measures were published this autumn 2017 in Health Expectations. The studies come from, Prehospital Outcomes for Evidence Based Evaluation (PhOEBE), funded by a five year National Institute for Health Research Programme Grant for Applied Health Research led by Professor Niro Siriwardena from CaHRU and Janette Turner of the Centre for Urgent and Emergency care research (CURE).

EMAS - A&E 6_750The first article, ‘Prioritizing novel and existing ambulance performance measures through expert and lay consensus: a three-stage multimethod consensus study‘ involved a multistakeholder consensus event, modified Delphi study, and patient and public consensus workshop, which together identified a shortlist of ambulance outcome and performance measures important to ambulance clinicians and service providers, service users, commissioners and academics.

N0030773 Paramedic driving an ambulanceThe final set of measures included change in pain score, accuracy of call identification, average response time, proportion of patients with a serious condition who survived to 7 days post-admission, death (within 3 days) from a low risk condition, proportion of patients transported to the Emergency Department who were discharged without treatment or investigation, and the proportion of those with specific conditions treated according to current guidelines.

The public consensus workshop, ‘A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures‘, was effective for obtaining public feedback on which ambulance performance measures were most highly favoured by lay participants. These measures have been developed to be used in future by ambulance services or commissioners to benchmark care quality between services or regions or to measure performance over time.

By Prof Niro Siriwardena

First publication from the NEAT project on consent in ambulance trials

Got-Consent-Logo-2CaHRU are pleased to announce the first publication from the Wellcome Trust funded project, NEAT: Network exploring Ethics in Ambulance Trials. The article, entitled ‘Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review‘, sought to understand the main ethical considerations when conducting clinical trials involving ambulance services.

NThe review found  issues with consent were the most significant ethical issue for ambulance trials. The type of consent gained differed depending on the condition or intervention being studied, but the country in which the research took place had less influence on the type of consent. The terminology used to describe consent varied widely with multiple terms used to describe the same processes. This, coupled with the the wide range of consent types used led to the conclusion that standardisation of consent models and terminology used to describe them was warranted.

The systematic review  was published in BMC Medical Research Methodology and is available open access at the following link: http://rdcu.be/vUxW

By Stephanie Armstrong.