Article on patient experiences of ambulance care published in Ambulance Today

photo2italiccolourWORDSAn 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.

NThe 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.

Study on service user involvement in a prehospital clinical trial of falls published in Trials

EMAS - PTS 2_750One of the few studies of service user involvement in a clinical trials was published this month in the journal Trials: ‘Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model. The study was part of the SAFER2 (Support and Assessment for Fall Emergency Referrals) trial led by the University of Swansea with Ambulance Services in the East Midlands, London and Wales and involving CaHRU at the University of Lincoln. The study was led by Bridie Evans and the trial lead was Prof Helen Snooks, both from Swansea University.

EMAS - A&E 5The study describes how it was planned for service users to be involved in the trial and how involvement actually occurred. The study team planned for service users to be involved at strategic level, at each study site and locally and this did take place. For example at strategic level, service users were involved in the trial management, EMAS - PTS 7trial steering, and data monitoring and ethics committees In addition, service users were also involved in study writing days and task and finish groups. Service users were also involved at study sites. Finally, service user reference groups were consulted at various points during the study.

Overall, the study showed how service users could be integrated into the activities of a clinical trial, the processes involved and facilitators and barriers to involvement at various levels.

 

Ethnicity and prehospital emergency care briefing paper published

EMAS - A&E 5_750A new briefing paper, ‘Ethnicity and prehospital emergency care provided by ambulance services‘, was published today by The Race Equality Foundation. The paper was co-authored by Viet-Hai Phung, Professor Niro Siriwardena, and Dr Zahid Asghar from CaHRU and Dr Karen Windle from the School of Health and Social Care.

EMAS - A&E 7_750It builds on work that CaHRU is undertaking on people from minority groups and their prehospital care. The briefing paper describes the inequalities in access to, as well as treatment and outcomes from, prehospital care for minority ethnic groups in the UK. It discusses how inequalities are driven by factors that include limited cultural awareness among service providers, as well as limited language proficiency and understanding of the healthcare system among these patients groups and how these inequalities manifest themselves in differences in treatment and outcomes.

EMAS - A&E 9_750The paper goes on to examine the implications arising from these inequalities for service delivery, especially since increasing ethnic diversity is raising issues of equality and equity higher up the legislative and policy agendas. It concludes by exploring potential solutions, which include: a more integrated approach to collecting patient ethnicity data; interventions that target at-risk groups in particular locations; and better cultural competency training for service providers.

Viet-Hai Phung

CaHRU to contribute to Institute for Healthcare Improvement Web and Action on Improving Prehospital Emergency Care

NProfessor Niro Siriwardena will join Dave Williams and EMS leaders from the United States and abroad, conducting pioneering work in the field of prehospital quality improvement, for an Institute for Healthcare Improvement Web and Action on Improving Prehospital Emergency Care the spring (March and April 2015). The Web and Action will consist of five sessions over the next two months.

NIn Session One, Introduction to Improving Prehospital Emergency Care Systems (Thursday, March 5, 2015, 12:00 PM – 1:00 PM Eastern Time), David Williams and Kedar Mate will introduce the agenda for the Web & Action Series, providing an overview of the history of ambulance service, the current state of the profession and improvement opportunities for prehospital care. Jerry Overton and Paul Gowens join Session Two, Early Identification of Deteriorating Patients (Thursday, March 19, 20, 12:00 PM – 1:00 PM ET), introduce the concept of early identification, resource allocation, and intervention and present the use of a prehospital early warning score to identify prehospital patients who are deteriorating (e.g., sepsis) to expedite transport, intervention, and emergency department notification.

NProf Niro Siriwardena and Jonathan Studnek present key care pathways for improving core prehospital care processes and outcomes in Session Three, Key Care Pathways – Change Package and Measurement of Time Sensitive Conditions (Thursday, April 2, 2015, 12:00 PM – 1:00 PM ET). They go on to discuss the development of a change package and measurement strategy in the NHS England Ambulance Trusts and profile case examples of improving care reliability in stroke and STEMI in the U.S. and U.K.

NIn Session Four, Prehospital Emergency Care Trigger Tool (Thursday, April 16, 2015, 12:00 PM – 1:00 PM ET), Loua Al Shaikh introduces the concept of trigger tools and the application the prehospital care ecosystem. Finally, Mike Taigman and Brenda Staffan lead Session Five, Paramedic Care in the Community (Thursday, April 30, 2015, 12:00 PM – 1:00 PM ET) where they define the emerging opportunity of utilising paramedics in the community through prevention, partnerships, intervention, and post discharge care.

CaHRU researchers present at EMS999 Research Forum Conference, Nottingham

Chiral_logoA team from CaHRU including Prof Niro Siriwardena, Fiona Togher and Viet-Hai Phung were represented at the EMS999 Research Forum Conference on Quality Improvement and Innovation Research in Prehospital Care in Nottingham on 4th February 2015. The conference, supported by the Health Foundation through their Spreading Improvement Programme, brought together the latest research and best practice in prehospital care. The conference featured several posters from ambulance services in England participating in the IMPACT-ASCQI project led by CaHRU.

Christopher Preston presentationProfessor Siriwardena kicked off the Conference with a keynote lecture on the evolution of quality improvement in prehospital care, ‘Prehospital quality improvement; past, present and future‘ which, innovatively, used some familial anecdotes to illustrate the links between principles of quality improvement and lessons for life!

Following the keynote was Richard Pilbery from Yorkshire Ambulance Service to talk about his experiences of speaking at the Paramedics Australasia Conference on the Australian Gold Coast. This was the prize that Richard won at last year’s EMS 999 Research Forum for producing the best poster. Following the first session, Matthew Booker from the University of Bristol presented his work on why ambulances are called for primary care problems followed by Mohammed Iqbal from EMAS on development of a novel pain assessment tool for improving prehospital pain management. Both presentations generated much interest, with Matthew winning the prize for best presentation at the end of the day.

photo3Just before lunch, Fiona Togher presented her poster, which showcased her doctoral study on development of patient-related experience measures for the ambulance service. The presentation was both well-delivered and well-received, with some thoughtful questions from the audience in response. In the afternoon, there was a workshop presented by Niro Siriwardena with Janette Turner from ScHARR on ‘Disseminating and Publishing Improvement Research’. This workshop was useful for all those with an interest in publishing articles, dealing with a number of themes including how to structure an article to which journals it should be pitched at.

The range and content of the posters and presentations demonstrated the continuing importance of the EMS 999 Research Forum for anyone with an interest in undertaking research in prehospital care.

Viet-Hai Phung