Tag Archives: outcomes

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CaHRU research on measuring quality presented at the Larrey Society’s Future of EMS Conference

niro2Professor Niro Siriwardena recently presented on ‘Developing new ways of measuring the quality of emergency medical services’ on 21 January 2016 at the Larrey Society’s inaugural conference on the Future of EMS in London. The Larrey Society, the brainchild of its founder David Davis, is an international organisation of paramedics and NHS, independent and voluntary ambulance services with leaders from health and academic communities, formed a year ago. The society is named after Dominque Jean Larrey, an army surgeon in Napoloen’s army who developed field medicine and ambulances.

NThe meeting was chaired by Sue Noyes, chief executive of East Midlands Ambulance Services NHS Trust and included keynote lectures from Prof Andy Newton, president of the society, Prof Jonathan Benger, professor of emergency medicine at the University of West of England, Prof Siriwardena, director of CAHRU, and Prof Kevin Mackway-Jones, professor of emergency medicine. Prof Newton talked about the current state of ambulance services and the urgent need to innovate to improve care quality. Prof Benger described an innovative method of ambulance dispatch currently being introduced and evaluated in the South West. Prof Mackway-Jones discussed the causes of and potential solutions to emergency department blocking.

photo2italiccolourWORDSProf Siriwardena described work done by ambulance services in England over the past eight years developing new quality measures of ambulance service care and improving care for conditions such as heart attack, stroke, diabetes and asthma using methods such as largescale quality improvement collaboratives. He went onto describe the new indicators being developed through research programmes such as Prehospital Outcomes for Evidence Based Evaluation using method such systematic literature reviews, interviews of ambulance staff and patients, consensus methods and data linkage to derive risk adjustment measures, which provide potential for better measurement and improvement of ambulance service care.

 

 

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Discussion paper on improving care for people with asthma through patient stories published in Chest

A new paper entitled ‘Using a narrative approach to enhance clinical care for patients with asthma‘ has been published online in the journal Chest. The paper was authored by Dr Helen Owton, previously of De Montfort University and now a lecturer at the Open University, Dr Jacqueline Allen-Collinson, Reader in the School of Sports Science at the University of Lincoln, and Professor Niro Siriwardena from CaHRU.

steth4The paper describes an approach to foster better patient self-care in patients with asthma by enabling clinicians to empower individuals to take more control of their condition by enhancing patient-clinician communication and relationship through patients’ stories. This is based on previous work from Drs Owton and Allen-Collinson on patient narratives in asthma and work on the consultation from Prof Siriwardena.

The discussion paper, published in the Topics in Practice Management section of the journal, describes the history of narratives in asthma, outlines the evidence on how narratives can provide insights into how people perceive and manage their asthma, and discusses how these ideas might be applied. The paper finally discusses how these notions might be practically implemented in the clinical consultation and how this has potential to improve outcomes for people with asthma.

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Reassurance important for ambulance services users: new qualitative study published in Health Expectations

photo2italiccolourWORDSResearchers from CaHRU with colleagues from the School of Health and Related Research (ScHARR) at the University of Sheffield have published a new study: “Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study” in the journal Health Expectations. The study’s lead author was Fiona Togher, PhD student and Graduate Research Assistant in CaHRU. She was supported in the work by Alicia O’Cathain, Professor of Health Services Research at the University of Sheffield, Viet-Hai Phung, Research Assistant in CaHRU, Janette Turner, Research Fellow at the University of Sheffield and Professor Niro Siriwardena, director of CaHRU. The study is part of a five year NIHR Programme for Applied Health Research, Prehospital Outcomes for Evidence Based Evaluation (PhOEBE).

EMAS - PTS 2_750The authors aimed to investigate the aspects of emergency ambulance care that were most valued by users of the service. Fiona and Viet-Hai interviewed people (patients and carers) that had used the ambulance service for a range of different conditions such as diabetes, suspected stroke, breathing difficulties and falls. The participants had also received various types of ambulance service response i.e. ‘hear and treat’ in which the participants received enhanced clinical assessment and advice over the telephone only, ‘see and treat’ in which the participants were treated on-scene by appropriately skilled clinicians without the need for hospital admission and the more familiar, ‘see and convey’ in which the participants received pre-hospital assessment and treatment before transportation to acute care.

NThe authors found that regardless of their specific clinical problem people valued similar aspects of their emergency ambulance service experience. Participants had often been extremely anxious about their health, and they most valued the reassurance they felt from receiving appropriate advice, treatment and care from ambulance service staff. It was found that the ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service.

The qualitative interview data collected from this research is now being re-analysed as part of Fiona’s doctoral studies to develop a Patient Reported Experience Measure (PREM) for use in UK ambulance services.

 

Fiona Togher

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Carers of dementia sufferers: Empowerment and Efficacy via Education (CADS: E3)

BA team from CaHRU, led by Dr Jo Middlemass has come together with researchers from the Schools of Education (Prof Terence Karran), Psychology (Dr John Hudson) and Social Science (Despina Laparidou, Prof Niro Siriwardena, Dr Karen Windle, Dr Paul Mansfield) to conduct a study investigating quality of life and outcomes for informal caregivers of people with dementia. Dementia – which includes conditions such as Alzheimer’s – is a progressive degenerative neurological disease with no known cure. There are approximately 800,000 UK patients currently, and it is estimated that by 2050 there will be more than 100 million people suffering from the disease worldwide.

BThis study, funded by the University of Lincoln Research Investment Fund, aims to improve carer and patient outcomes by developing a psychoeducational intervention for carers of people with dementia, with an emphasis on carers undertaking a more formal monitoring role. The study, which started in August 2014, has a mixed-methods design, involving a systematic literature review and a qualitative study, including both focus groups and interviews, with caregivers of people with dementia and with health care professionals.

The anticipated end of the study is July 2015 and future plans include conducting a feasibility study and thereafter a full clinical trial to test the proposed intervention and its effectiveness and cost-effectiveness on a larger scale.

Despina Laparidou

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New study shows that one third of patients with diabetes attended by an ambulance for severe hypoglycaemia transported to hospital

EMAS - A&E 5A new study has been published in Primary Care Diabetes on ‘Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: a retrospective study’. Hypoglycaemia or low blood sugar is important because this may be linked to greater risk of death.

The study involved a new collaboration between the University of Leicester Cardiovascular and Diabetes group (Professors Kamlesh Khunti and Melanie Davies), University of Bristol (Harriet Fisher),  University of Queensland, Australia (Sanjoy Paul),University of Lincoln and East Midlands Ambulance Service NHS Trust (Mohammad Iqbal, Professor Niro Siriwardena).

The study aimed to report the characteristics, treatment and provider costs for people with diabetes requiring an emergency ambulance for severe hypoglycaemia and involved an analysis of routinely collected data on 90,435 emergency calls collected over four months by the East Midlands Ambulance Trust, UK.

There were 523 (0.6%) ambulance attendances for severe hypoglycaemia, with an incidence of 2.76 per 100 patient years: 28% of events occurred at night and 32% of those attended were transported to hospital. Those patients with a higher respiratory rate, indicating difficulty breathing, were more likely to be transported to hospital, whereas patients on treatment with insulin and those with higher blood glucose after treatment of hypoglycaemia were less likely to be transported to hospital.

Median ambulance costs were higher at £176 for individuals not transported to hospital whereas those transported cost £92 reflecting the greater time ambulance staff spent with patients who were enabled to remain at home.

The research team are planning further studies investigating longer term outcomes of prehospital care for hypoglycaemia as part of CaHRU’s Prehospital and Emergency Quality and Outcomes (PEQO) programme.