Ambulance Response Programme (ARP)
In 2015 NHS England implemented the Ambulance Response Programme (ARP) to review, re-design and test ambulance clinical response processes. Cure provided evaluation and oversight of this programme. We analysed over 14 million 999 calls and found changing triage and dispatch resulted in substantial efficiencies by freeing up resources, a quicker response for the most critical calls and enabled trial services to provide a more consistent response to all 999 calls. On the basis of this robust evidence the Secretary of State for Health approved the adoption of these changes across the country and in July 2017 NHS England announced the national rollout of ARP and new response performance standards – the biggest change in ambulance service operation for 40 years.
Improving treatment for heart attack patients
Our evaluation of the National Infarct Angioplasty Pilot showed that primary angioplasty for ST-elevation myocardial infarction (heart attack) is feasible, cost-effective and acceptable to patients and carers. As a direct result, a new national strategy using primary angioplasty was published in the National Service Framework for Coronary Heart Disease. National audit data has since shown the proportion of patients receiving primary angioplasty increasing from 42% to 73% and mortality falling from 10.6% to 8.7%. An impact assessment based on our economic analysis estimated a £294 million net benefit to the NHS.
Changed clinical guidelines to improve the diagnosis of deep vein thrombosis (DVT)
Our research has led to the development of guidelines on the diagnosis of deep vein thrombosis (DVT), reducing the risk of death and saving resources by reducing unnecessary tests and treatments. Our meta-analysis and decision-analysis modelling studies formed the basis of the National Institute for Health and Clinical Excellence (NICE) and the American College of Chest Physicians (ACCP) guidelines for diagnosing DVT. These guidelines determine the management of over 140,000 patients each year in the United Kingdom with suspected DVT, and many more in other countries.
Reducing hospital admissions for suspected heart attack
Our systematic review and meta-analysis showed that recently developed high sensitivity troponin blood tests can effectively rule out myocardial infarction (heart attack) within a few hours of hospital attendance. Decision analysis modelling of cost-effectiveness showed that the standard NHS practice of using delayed troponin blood testing to rule out a heart attack was not cost-effective compared to the new alternative of early testing using high sensitivity troponin testing. In 2014 NICE issued new guidance based on our research that recommended using high sensitivity troponin assays to rule out a heart attack within 3 hours of hospital attendance. NICE anticipated that this guidance would allow a heart attack to be ruled out without the need for hospital admission, thus reducing avoidable admissions and saving NHS costs.
Identifying poor trauma care: A new measure implemented by NHS England
The 2014 Trauma Probability of Survival Model “PS14” was developed as a direct result of research led by CURE researchers. Trauma probability of survival models are used to predict outcomes after serious injury and provide a comparison against which actual outcomes can be compared for research and quality assurance purposes. PS14 is now the sole survival prediction model used for quality assurance in trauma care in NHS England, Wales, the Irish Republic and some hospitals in continental Europe. It is used to evaluate changes to the trauma system and improve the quality of trauma care.
Treating older people with acute minor conditions at home
Our research showed that paramedics with extended skills can provide a clinically effective alternative to standard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions. As a result many ambulance services have implemented paramedic practitioner and emergency care practitioner roles allowing older people with acute minor conditions to be treated at home rather than being transferred to hospital.