Rapid review published on effectiveness of different models of delivering urgent care

TEMAS - A&E 5he NIHR commissioned rapid evidence review to assess the nature and quality of the existing evidence on delivery of emergency and urgent care services and to identify gaps for future research was published last week: Phung V-H (2015) Chapter 6 – Delivery of emergency department services in Turner J, Coster J, Chambers D, Cantrell A, Phung V-H, Knowles E, Bradbury D, Goyder (eds.). What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res 2015;3(43). The team, from the School of Health And Related Research (ScHARR) at the University of Sheffield with Viet-Hai Phung, research assistant and doctoral researcher at CaHRU, undertook five separate literature reviews linked to themes in the NHS England review in 2013, which latter drove the need for this rapid evidence review. The review, which took six months to complete, incorporated findings from 45 systematic reviews and 102 primary research studies across all five reviews

vhp2

Viet-Hai Phung wrote the review in Chapter 6 on the Delivery of Emergency Department (ED) services. This review included literature from 2009 to 2015. Nine papers were included in the review: two systematic reviews, which included 28 individual papers, and seven additional papers. Of the 35 included studies, there were only five randomised control trials and many uncontrolled before-and-after studies, which cannot control for other system effects.

NThere were three themes to this part of the review: Managing ED flow; Workforce; and managing the frail and the elderly in EDs. In the first review, interventions that aimed to increase access to primary care and ED cost-sharing were found to be effective in reducing ED use. For the Workforce review, the evidence suggested that supplementing existing ED staff with NPs can help to manage demand more effectively, especially in high-volume EDs. For the final review, there was mixed evidence about the effectiveness of Comprehensive Geriatric Assessment (CGA): CGA did not have a significant impact on outcomes nor mortality, while other studies suggested that use of CGA to inform interventions could reduce functional decline.

Viet-Hai Phung

 

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.

East Midlands Universities Association (EMUA) Student Conference 2015: Impact & Collaboration

fionaOn Thursday 3rd September 2015 I was fortunate enough to attend the EMUA Student Conference hosted by The Graduate School at the University of Lincoln. The annual conference provides an excellent opportunity for postgraduate students across the region to network and present their research to their peers in a supportive, inquisitive and encouraging environment.

There was representation from the Universities of Lincoln, Loughborough, Leicester, Derby, Nottingham and De Montfort University, Leicester. The multi-disciplinary nature of the conference meant that students were able to learn about research that could be similar to their own work in terms of subject but also could be completely different in topic and methodology.

The morning began with a fascinating key note from Dr Helen Zulch from the School of Life Sciences at the University of Lincoln. Dr Zulch talked about ‘scholarship and the many faces of impact’ and drew upon her own research expertise in veterinary behavioural medicine as an example of how academic research can impact on both society and individuals. One of the key messages of the presentation was that ‘whatever our motivation, the knowledge and experience that we gain through our research has the potential to impact on others’. Dr Zulch highlighted the fact that even if our research legacy is simply that we instilled an interest and motivation in others to pursue a research career then this is something to be proud of.

IMAG0510Throughout the day there were parallel sessions of oral presentations given by the student delegates. I attended some really interesting talks around subjects as diverse as ‘The gay tree of life: an interdisciplinary approach to homosexuality research’ to ‘Stakeholder perspectives of collaborative working and street works management’. I gave a presentation entitled: ‘Engaging with patients and NHS staff to develop a Patient Reported Experience Measure (PREM) for use in NHS ambulance services’. The theme of the conference ‘impact and collaboration’ enabled me to concentrate on an element of the research process that I hadn’t previously considered in much detail. The opportunity to focus in on this within my presentation will be beneficial during those crucial thesis writing days!

The conference concluded with four finalists (at university level) of the three minute thesis competition presenting to the whole delegation. The aim of the competition is for students to effectively explain their research in ‘language appropriate to a non-specialist audience’. It draws upon their communication skills and ability to ‘cut to the chase’. The presentations were outstanding and the way in which the students drew the audience in with their engagement skills was fantastic.

Overall, I came away from the conference having made several new contacts, gained renewed confidence in my work and an optimistic view of PhD life in the East Midlands. The Graduate School here at the University of Lincoln did a great job of organising the day and ensuring that everything ran smoothly so thank you graduate school! I look forward to next year’s conference…

Fiona Togher

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.

 

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.