Researchers 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).
The 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.
The 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.
It was a pleasure to attend the European Congress on Emergency Medicine in the beautiful environs of Westerpark, Amsterdam from Sunday 28th September – Wednesday 1st October. I had been invited to give a three-minute presentation on the systematic review that I had been working on for two years, ‘Barriers, facilitators, disparities and consequences for people from minority ethnic groups accessing prehospital care: systematic review and narrative synthesis’.
Prior to going to Amsterdam, I had rehearsed the presentation many times. This carried on right through to an hour before the Monday afternoon Lightning Session I was due to present in. The ‘Lightning Session’ itself was due to last 90 minutes with 23 presenters summing up their research. I was 18th up so at least I could get a feel for what to expect. I was nervous, but not shaking, as I made my way up to the podium, without notes. Before I started, I familiarised myself with how to work the slideshow to avoid any embarrassments, which previous presenters suffered. I knew exactly what I was going to say on each slide. There were minor departures from what I had planned to say, but I got the underlying message across to the audience. I felt I answered the question from the chair about uneven translation service provision in the UK competently. And that was that. Thorough preparation had made a seemingly daunting task manageable.
There were other interesting lightning presentations on prehospital care from around the world, but the conference focused more on clinical and emergency department research. However, I gained another valuable professional skill and spent some time in lovely Amsterdam. Which were no bad things at all!
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.