A new book, ‘Quality Improvement in Primary Care: the essential guide‘ has recently been published by Radcliffe. The book is co-authored by Dr Steve Gillam (Cambridge University) and Professor Niro Siriwardena (Director of CaHRU, University of Lincoln). The content was developed from the authors’ work on quality improvement over many years and on quality improvement and implementation science research conducted by CaHRU. The text provides the foundations of knowledge for health and social care practitioners and students to improve the quality of care they provide.
The first section of the book ‘Managing for quality’ leads readers though fundamentals of improvement including patient perspectives, leadership and management, regulation and commissioning. The middle section focuses on quality improvement tool and techniques covering topics such as improvement frameworks, processes, measurement, systems, safety, spreading improvement and financial incentives. The final part of the book covers evaluating improvement, understanding evidence and applying this learning to individual and group quality improvement projects.
Quality is a watchword across the health and social care sector. Quality Improvement in Primary Care will be a text for students embarking on the new course module, ‘Quality Improvement, Implementation and Safety Science’ which forms part of the new Master’s in Social Research at the University of Lincoln. It will provide readers with the tools to convert challenges and opportunities for improvement into meaningful and useful change.[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/10/Quality-improvement-in-primary-care.pdf” height=”1600″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
Viet-Hai Phung, researcher at CaHRU, recently attended the College of Paramedics national conference at Warwick University on 6-7th October 2014. This organisation, formerly the British Paramedic Association, represents the professional interests of prehospital clinicians in the UK. Viet-Hai was one of the few health researchers attending the conference, albeit one with an interest in prehospital care. He presented a poster entitled, ‘Leadership, innovation and engagement in quality improvement in the Ambulance Services Cardiovascular Quality Initiative: cross sectional survey’ which showcased the team’s work exploring leadership and innovation through the Ambulance Service Cardiovascular Quality Initiative (ASCQI). Delegates were interested in the collaboration between the University of Lincoln and East Midlands Ambulance Service (EMAS), so from that point of view, CaHRU did indeed raise its profile.
The College’s Chair, Andy Newton, opened the proceedings on both days. There were a number of enlightening presentations from the UK, including the problems the ambulance service faces in delivering an effective response to mental health issues and how it deals with end-of-life care. Professor Keith Willett, who is leading the review into urgent and emergency care in England, outlined the future challenges for prehospital care in the UK.
As well as the domestic picture, delegates learned more about how ambulance services operate in countries as diverse as the USA, South Africa, Australia, Austria and Switzerland. Professor Jerry Overton highlighted that the USA, like the UK, is focusing too much on outputs rather than outcomes. Kai Kranz, from the Swiss Paramedic Association, emphasised the fragmented nature of their ambulance service, arising from regional and linguistic differences. It was a well-organised, informative conference, giving all delegates much to think about. Looking forward to the next one in 2015!
Researchers in CaHRU and East Midlands Ambulance Service NHS Trust (EMAS) have published a new study: “Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study” in BMC Emergency Medicine. The study’s lead author was Deborah Shaw of the Clinical Audit and Research Department at EMAS and visiting fellow at CaHRU. She was supported in the work by Prof Niro Siriwardena, director of CaHRU and associate clinical director at EMAS.
The authors aimed to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence, acknowledging variations in prehospital care for asthma. The investigators interviewed paramedics and managers and their analysis identified that guidelines should be made more relevant to ambulance service care; barriers to assessment; conflicts between clinicians’ and patients’ expectations; complex ambulance service processes and equipment; and opportunities for improved prehospital education, information, communication, support and care pathways for asthma.
The service has already used these findings to improve prehospital care for people with asthma and other chronic respiratory conditions.
Novel treatments for stroke are increasingly being tested and delivered in the ultra-acute period during initial presentation to ambulance services. In the first feasibility trial of nitroglycerin (glyceryl trinitrate) in ultra-acute stroke (RIGHT) there were early indications of improvements in outcomes and disability at three months. The research team was led by Prof Philip Bath and his team at Nottingham University, together with Sandeep Ankolekar, Prof Niro Siriwardena from CaHRU and researchers at East Midlands Ambulance Service NHS Trust.
A nested qualitative study entitled ‘Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: qualitative data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT)‘ explored facilitators and barriers to paramedic involvement in clinical trials. The fieldwork was conducted by Dr Sandeep Ankolekar and the team. Barriers to participation included the pressure of the emergency setting, difficulties obtaining informed consent, institutional support for research, the steep learning curve for research naive staff and relative rarity for individual paramedics of clinical conditions seen, and difficulty in attending training sessions.
Suggestions for improvement included a simple diagnostic tool for stroke, use of assent and proxy consent on behalf of patients (as in the trial), and simpler trial processes.Recruitment became easier with each new randomisation attempt. Paramedics in the study were motivated to participate in research. Treatment of acute stroke in the out-of-hospital environment was feasible, but important barriers needed to be addressed.
The results of a national Quality Improvement Collaborative study, the Ambulance Services Cardiovascular Quality Initiative (ASCQI) were published this week in the international academic journal Implementation Science. The article entitled The effect of a national quality improvement collaborative on prehospital care for acute myocardial infaction and stroke in England showed large and significant improvements in the quality of care provided by 11 ambulance services (out of 12) in England for people with heart attack and stroke. Members of the CaHRU team involved in the study included Professor Siriwardena, Dr Zowie Davy and Fiona Togher together with visiting fellows at CaHRU who are members of the research team at EMAS including Anne Spaight, Debbie Shaw and Nadya Essam. Professor Michael Dewey, chair in epidemiological statistics in London was the statistician on the project.
The project has been part of a programme of work, Prehospital and Emergency Quality and Outcomes, developed through collaboration between academics from the Community and Health Research Unit and ambulance services across the United Kingdom, particularly East Midlands Ambulance Service NHS Trust (EMAS). This collaboration has enabled a strategic partnership between the University of Lincoln and EMAS to undertake research which is relevant to ambulance services, focusing on health issues of regional and national importance, and conducted with ambulance staff in order to increase the impact of the research by improving prehospital care for emergencies.
The study examined the period between January 2010 and February 2012. Across England overall, the percentage of emergency cases where care bundles (packages of essential care) were delivered in full increased from 43% to 79% for heart attack and from 83% to 96% for stroke. ASCQI supported frontline staff, and their management, to introduce improvements using checklists, aide memoires, individual and group feedback and sharing of information within and between different trusts to improve the reliability of care for people with heart attack and stroke. The project was shortlisted for an HSJ award in 2012.