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!
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.
Members of Community and Health Research Unit (CaHRU), Jo Middlemass (research nurse) and Prof Niro Siriwardena travelled north to Tromsø, Norway, in the Arctic Circle, to discuss progress and the next phase of the European Commission Framework 7 funded study, Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED).
CHROMED is an international multicentre randomised control trial in five European countries: United Kingdom, Sweden, Estonia, Spain and Slovenia, representing different social and organisational contexts in Europe. The study is seeking to investigate the effectiveness of health and lifestyle status management using telehealth to support elderly patients with multiple conditions including chronic obstructive lung disease and chronic heart disease or sleep apnoea. The Lincoln arm of the study, which involves a partnership between Lincoln Community Health Services NHS Trust and CaHRU at the University of Lincoln comprises a feasibility study of five patients followed by a full study involving 32 patients.
Tromsø in the summer has permanent daylight, which means that after a hard day’s work many local residents and visiting researchers can be seen climbing the local mountains to enjoy the view!
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.
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:
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