Tag Archives: Emergency Medical Services

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CaHRU attends 999 EMS Research Forum conference 2018 in Stirling

999EMSpreconferenceThis year’s annual EMS 999 Research Forum, ‘Research for impact in 999 Emergency Care’ was held in the University of Stirling’s picturesque campus from 26-27 March 2018 and was attended by members of CaHRU, Viet-Hai Phung, Laura Simmons, Greg Whitley and Professor Niro Siriwardena. The preconference sessions included two workshops: Professor Rowena Murray from the University of the West of Scotland led a session on how to write a peer reviewed paper; the other session involved CaHRU’s Professor Niro Siriwardena, with Professor Helen Snooks from the University of Swansea and Roy Norris from Service Users for Primary and Emergency Care Research (SUPER), leading a session on designing and planning research projects and getting them funded.

999EMSShona Robison, the Cabinet Minister for Health and Sport in the Scottish Government introduced the start of the second day. This started with presentations on research that makes a difference and the links between prehospital research and Out-of-Hospital Cardiac Arrest (OHCA). There then followed a series of four oral presentations, which included a sensitive one from Kelly Hird and Fiona Bell from Yorkshire Ambulance Service about suicide among ambulance staff, and Belinda Flanagan, from the University of the Sunshine Coast in Australia, who presented her work on unplanned births in paramedic care.

vhp2There was a CaHRU representation in the post-lunch poster session with Viet-Hai Phung presenting on the ‘Perceptions and experiences of community first responders on their role and relationships: qualitative interview study’, Rob Spaight from East Midlands Ambulance Service NHS Trust presenting work led by Dr Murray Smith on ‘Modelling of patient outcomes after emergency treatment for out-of-hospital cardiac arrest by paramedics and community first responders’ and Prof Niro Siriwardena presenting an interview study led by Dr Stephanie Armstrong of paramedics’ perceptions of the ethics of ambulance-based trials. Last year’s prize winner, Dr Edward Duncan, from Stirling University, subsequently recounted his experience of presenting at the Paramedic Australasia International Conference.

999EMSpanelThe final substantive session of the conference was a lively and thought-provoking panel discussion which included Janette Turner from the University of Sheffield and Professor Niro Siriwardena, on future priorities for prehospital research. The conference closed with a prize giving session for some excellent presentations and posters that were given throughout the conference.

By Viet-Hai Phung

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CaHRU/LIH seminar: Quality Improvement Collaboratives – theory design and effects

CaHRU_logotypeThe latest in the CaHRU and Lincoln Institute for Health Improvement Science and Research Methods seminar series was given by Professor Siriwardena on ‘Quality Improvement Collaboratives (QICs): theory design and effects on 28 February 2018. The CaHRU team have led three large scale collaboratives over the past 12 years, including Resources for Effective Sleep Treatment (REST), the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and most recently Scaling up PINCER (a pharmacist and information technology intervention to reduce potential clinically important prescribing errors in general practice.

niro2QICs are an organised, multifaceted approach to quality improvement involving five essential features: a specified topic; clinical experts and experts in quality improvement provide ideas and support for improvement; multi-professional teams from multiple sites participate; using a model for improvement (measurement, change, feedback); and a collaborative process involves series of structured activities. The talk described how QICs have been used to implement healthcare interventions at scale and referred to a recent systematic review suggesting that over 4 out of 5 reported improvement in one or more outcomes although the quality of studies was variably poor.

QICs were described in terms of their common features: a logic model and theory of change; the complex (pragmatic) contexts of the intervention, setting and participants; and the variation in effects and changes that the intervention can or will undergo during the process of the collaborative. It was proposed that there were different types of collaborative based on their purpose which could be for intervention development, increasing reliability of evidence based processes, or scaling up evidence based complex interventions. It was argued that reviews of QICs should consider these different purposes when describing the outcomes and effects of QICs.

By Professor Niro Siriwardena[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/03/QICs_Siriwardena.pdf” width=”660″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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Dr Pradeep Ratnasekare joins CaHRU as an international visiting fellow

sigiriya2Dr Pradeep Ratnasekare joined CaHRU this January 2018 as our third international visiting fellow from the University of Colombo’s Postgraduate Institute of Medicine. Pradeep graduated as a bachelor of Medicine and bachelor of Surgery in 1996 from the faculty of Medicine, University of Ruhuna and then completed postgraduate studies at the University of Colombo, Sri Lanka, in the fields of respiratory medicine and then in medical administration where he gained his master’s in 2011 and MD in 2016.

davHe has worked for over four years as a primary care medical officer, and six years as a medical officer in respiratory medicine, health system manager and health care researcher. As a health system manager he developed experience in various fields of hospital and public health programme management. He has worked as a hospital director in many secondary and tertiary care hospitals in Sri Lanka and worked as deputy director of the Medical Research Institute, the premier national level reference and referral medical laboratory and medical research centre for public and private sectors in Sri Lanka for last 18 months. His main interests are in health technology assessment and management, modern hospital planning and architecture, health system research and quality improvement in health care. Pradeep has several publications into his credit in the Journal of Medical Administrators Sri Lanka and Sri-Lanka journal of Health Policy and Management mainly on interventions carried out to improve health systems. He is a member of several academic associations in Sri Lanka including the College of Medical Administrators of Sri Lanka and Sri Lanka Medical Association. He is a member of research evaluation committee of the Medical Research Institute.

lilypondWhile at CaHRU he plans to: study the prehospital care system in the UK with a view to adapting it to develop a suitable model for Sri Lanka; to study the primary health care system in the UK National Health Service (NHS) of United Kingdom with respect to quality improvement and clinical governance; to study the systems and methods in place for Health Technology Assessment (HTA) and Health Technology planning in the United Kingdom; to learn about hospital design and planning; and to actively contribute to CaHRU’s research programme in primary and prehospital care. Listening to classical music, singing and playing cricket are his favourite hobbies.

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Prof Siriwardena gives invited lecture at North American EMS conference, San Diego

Prof Niro Siriwardena of CaHRU attended the North American Emergency Medical Services Physicians (NAEMSP) annual conference in San Diego, California from 10-12 January 2018 to deliver an invited lecture on ambulance quality measures and improvement.

SD2The conference opened with a keynote address, ‘The patient as a mission with a very critical outcome, how to get that right – the first time and every time’ given by Dr Story Musgrave, child labourer, mechanic, farmer, scientist, doctor, pilot, astronaut, artist and university professor. This was followed by Dr Dave Williams of the Institute for Health Improvement in the US who spoke on ‘Improvement science and safety in EMS’ including an example from CaHRU of development of prehospital indicators and their use for quality improvement.

SD6The following day included session on the Canadian Prehospital Evidence-Based Practice Project, National Model EMS Clinical Guidelines and Ethical Challenges in EMS, simulation, cognitive bias and medical error. The afternoon sessions focussed in quality included ‘Mission: Quality – Can Mission Lifeline Help Your Performance Improvement Program?’ presented by Dr Jeremy Cushman MD. He described how a the programme Mission: Lifeline is designed to transform care for patients with myocardial infarction, stroke, and cardiac arrest using national performance benchmarks, and sharing best practices to enhance provider feedback through hospital outcome information.

Niro_EMAS4Prof Siriwardena then spoke on how new quality measures for ambulance services have been developed and implemented over the past decade in England in his lecture entitled ‘Developing Ambulance Quality & Performance Measures that Make a Difference to Patients’. This was based on research conducted by Prof Siriwardena with UK ambulance services and academic institutions as part of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) program. There was discussion of the successes as well as the barriers to development of new quality measures, and the underpinning research and quality improvement initiatives that have been vital to progress in this field.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/NAEMSP2018_Siriwardenav3.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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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]