Tag Archives: prehospital

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Ambulance Services Cardiovascular Quality Initiative findings published in Implementation Science

EMAS-PTS2_750The 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.

EMAS - A&E 9The 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.

EMAS - A&E 6bThe 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.

 

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SAFER 2 (Support and Assessment for Fall Emergency Referrals) trial protocol published

The SAFER 2 study is a randomised controlled trial of the clinical and cost effectiveness of new protocols for emergency ambulance personnel to assess and refer older people who fall to appropriate community based care.  The protocol for the study, led by Prof Helen Snooks at Swansea University and including Prof. Niro Siriwardena of the CaHRU and East Midlands Ambulance Service NHS Trust as a collaborator, has recently been published in BMJ Open:

Snooks H, Anthony R, Chatters R, Cheung WY, Dale J, Donohoe R, Gaze S, Halter M, Koniotou M, Logan L, Lyons R, Mason S,  Nicholl J, Phillips C, Phillips J, Russell I, Siriwardena AN, Wani M, Watkins A, Whitfield R, Wilson L. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open 2012;2: e002169. doi:10.1136/bmjopen-2012-002169

The study measured the costs and benefits of a novel protocol implemented by emergency ambulance paramedics caring for older people who had fallen, allowing the paramedic to assess and refer appropriate patients to a community based falls service. The study involved ambulance services in London,Wales,East Midlands. Stations were randomly allocated to implement the new protocol (intervention) or continue to provide care according to their standard practice (control).

Paramedics based at the stations selected for the intervention group received additional training, protocols and clinical support to enable them to assess older people and decide whether they need to be taken to the Emergency Department (ED) immediately, or whether they could benefit from being left at home, with a referral to a community falls service. The study compared costs, processes and outcomes of care (particularly subsequent 999 calls and ED attendances for falls) at 1 and 6 months for patients aged 65 or over who had fallen together with other quantitative and qualitative data.

The study was recently been completed and, currently in the final data collection phase, is due to be published next year.

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New study published investigating patient experiences of using the ambulance service for suspected stroke and heart attack

A study by members of the CaHRU team, Fiona Togher, Dr Zowie Davy and Professor Niroshan Siriwardena, to better understand the elements of care that are most important to patients with stroke and heart attack accessing the ambulance service, has been published in the Emergency Medicine Journal http://emj.bmj.com/cgi/content/full/emermed-2012-201507.

The qualitative study involved interviewing both patients and clinicians about their experiences of either receiving or providing care prehospital care for stroke or heart attack. Four main themes emerged:

  • communication
  • professionalism
  • treatment of condition
  • transition from home to hospital.

The technical knowledge and relational skills of clinicians’ together contributed to patients’ perceptions of professionalism in ambulance personnel. We found that the patient experience was enhanced when physical, emotional and social needs were attended to. Effective clinician–patient communication was also found to be a key component of high quality patient care.

Fiona Togher, who was lead author for the study, has recently been awarded a PhD studentship at Lincoln. The findings will be used to inform her doctoral research, which will examine the potential for developing a generic patient reported experience measure (PREM) for routine use in ambulance services in the UK

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ASCQI presented at International Forum on Quality and Safety in Health Care in Paris, April

In April 2012 Professor Niro Siriwardena and Fiona Togher travelled to Paris with colleagues, Nadya Essam, Debbie Shaw (East Midlands Ambulance Service [EMAS]) and David Francis (East of England Ambulance Service) to attend the 17th International Forum on Quality and Safety in Healthcare.

The team presented work undertaken as part of the Ambulance Service Cardiovascular Quality Initiative (ASCQI) a two year nationwide project involving all 12 ambulance trusts in England and the University of Lincoln funded by the Health Foundation.

From the 2,000 poster submissions that were originally received, around 900 were selected for display following a two stage peer review process. Fiona, Nadya and Debbie were all invited to present their work during the poster presentation session held. This provided a brilliant opportunity to talk to interested delegates from around the world about the quality improvement work and research that is being undertaken at the University and East Midlands Ambulance Service.

Fiona Togher

Fiona represented the IS-PROVE team, which also includes Professor Siriwardena and Dr Zowie Davy. Their poster entitled “The importance of qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital and emergency care of stroke and heart attack” attracted attention from French, Swedish and American delegates that were keen to find out more. Nadya Presented on ergonomic redesign to improve care for heart attack and Debbie presented on ‘Joining the dots’ and the use of annotated control charts for quality improvement in ASCQI.

Debbie Shaw

With a tough act to follow from last years’ excellent event in Amsterdam, Paris was just as enjoyable,  thought provoking and inspiring. The key note speakers were again outstanding and captivated the audiences with their motivational reflections on working in health care and how to improve the quality of care provided to patients.

The opening keynote by Maureen Bisagnano from the Institute for Healthcare Improvement focused on goal oriented patient care, ‘what matters to patients’ and the redesign of services for patients. We heard about leadership from Dr David Williams, a Canadian professor of surgery who has been an astronaut and now leads a regional health organisation in Toronto.

Another highlight of the conference was the session entitled “Delivering better care to rural communities inAfrica” which focused on the application of quality improvement methods including Plan, Do, Study, Act cycles, to reducing asphyxia in newborn babies and mortality rates in children under the age of five. The success of the initiatives was amazing, more so because of the limited resources of equipment and manpower available.

Nadya Essam

One of the most inspiring speeches was given by Dr. Nancy Snyderman, who is not only a paediatrician and an ENT surgeon but also chief medical editor for NBC news in America – and an award winning journalist! Her speech focused on the importance of listening to patients and hearing what they are actually saying as opposed to what health care professionals presume they are saying. This central message resonated with what we are aiming to achieve through the patient experience studies that we are conducting in prehospital care in Lincoln and EMAS.

The take home message from this conference was that the application of quality improvement methodologies makes a real difference to the standard of care that is provided to patients; there were hundreds of examples of fantastic successes from around the world and in some instances the evidence translated to a significant contribution of quality improvement projects to saving lives.

Fiona Togher and Niro Siriwardena

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New study published on how acute pain management could be improved in urgent care

Mohammad Iqbal, research fellow and PhD student at the University of Lincoln and research associate at East Midlands Ambulance Service (EMAS), together with Anne Spaight (senior research fellow at the University of Lincoln and Head of Clinical Governance, Audit and Research at EMAS) and Niro Siriwardena (professor of primary and prehospital health care) have a new study published online in the Emergency Medical Journal. The study entitled: ‘Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study’  follows on from an earlier study investigating prehospital pain management which showed that under two-fifths of patients with a painful condition (heart attack or fracture) were provided with pain relief.

Although patients and staff expected pain to be relieved in the ambulance, refusal of or inadequate analgesia were common. Pain was often assessed using a verbal pain score, but practitioners’ views of severity were sometimes different from patients’ views. Morphine and Entonox were commonly used to treat pain, but reassurance, positioning and immobilisation were used as alternatives to drugs.

The authors concluded that pre-hospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multi-organisational pain management protocols supported by training for staff. These findings may be used to inform guidance, education and policy to improve the pre-hospital pain management pathway.

Niro Siriwardena co-leads the NIHR Programme Grant for Applied Research: Prehospital Outcomes for Evidence based Evaluation (PhOEBE).