Emergency and Urgent Care System Demand in Yorkshire and Humber: A retrospective analysis of routine data.
Addressing the long term rise in demand in urgent and emergency care (UEC) services is a key focus for the NHS. The Collaboration and Leadership in Applied Health and Care Yorkshire and Humber (CLAHRC YH) are undertaking a detailed population analysis to identify patients who present to the ED or who are admitted to hospital as an emergency who may be amenable to alternative management in the EUC system.
Avoiding Attendances and Admissions is a theme within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Yorkshire and Humber. It is the only CLAHRC theme in the country focused on addressing the challenges facing the emergency and urgent care system. The theme has collected, linked and analysed routine patient data from the ambulance service, NHS 111 and emergency departments to record the patient journey from ‘time of call to discharge from hospital’. Analyses of this data will identify key patients and parts of the system to target interventions at to improve system performance and patient care.
The ideal Urgent and Emergency Care system: Public and healthcare staff perspectives
Our urgent and emergency care services such as the ambulance service, minor injuries units, GP out-of-hours and emergency departments are under more pressure than ever to deliver fast, good quality care, in an environment with fewer resources (e.g. money and staff). How we use these services has changed over time but have the services changed to keep up with how we live today? This study aims to find out from the public and healthcare staff perspectives what their ideal urgent and emergency care system would look like.
TiLLI: Thromboprophylaxis in Lower Limb Immobilisation
People who have their leg immobilised in a plaster cast or brace are at risk of developing a blood clot in the leg. Anticoagulant drugs can reduce the risk of this happening but carry a small risk of serious bleeding complications. The TiLLI project will use systematic reviews, meta-analysis and elicitation of expert consensus methods to identify strategies for selecting people with leg immobilisation for anticoagulant treatment based on their risk of developing a blood clot and use health economic modelling to estimate the cost-effectiveness of these strategies.
Safety for Patients through Quality Review (SPQR)
This study aims to determine how medical examiner assessment of death certification and retrospective cases record review can best work together to identify potentially avoidable hospital deaths due to shortcomings in care. It involves comparing medical examiner assessments to retrospective case record review in 2500 hospital deaths, thematic analysis of discordant judgements and problems with care, and qualitative interviews with medical examiners to understand their role.
The ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) feasibility study
Continuous positive airway pressure (CPAP) may improve outcomes in patients with acute respiratory failure due to heart or lung disease. ACUTE is a pilot randomised controlled trial to determine whether paramedics in the UK can deliver CPAP before arrival at hospital, whether there are enough eligible patients to make this a potentially worthwhile part of paramedic practice and whether a definitive trial of clinical effectiveness and cost-effectiveness is feasible.
Evaluating the Diversion of Alcohol-Related Attendances (EDARA)
Alcohol Intoxication Management Services (AIMS) are designed to receive, treat and monitor intoxicated patients who would normally attend emergency departments and to lessen the burden that alcohol-misuse places on unscheduled care. They are usually located close to areas characterised by excessive intoxication and are open at times when levels of intoxication peak (Friday and Saturday evenings). EDARA will evaluate the effectiveness, cost-effectiveness, efficiency and acceptability of AIMS in managing alcohol-related Emergency Departments’ attendances.
Connected Health Cities: Data linkage of urgent care data
By linking together patient data from different hospitals and services across Yorkshire, researchers are able to build a more complete picture of how emergency and urgent care (UEC) services in the region function. The purpose of this study is to collate routine NHS data from a number of UEC service providers in Yorkshire and the Humber region from 2011-2017, and link records together. This picture will help researchers understand the flow of patients through EUC services, to understand what the most common health issues are and to better plan community services in the future.
The AHEAD Study: monitoring anticoagulated patients who suffer head injury
Existing practice in emergency departments in the UK for managing patients taking warfarin after a blunt head injury is variable with little research that supports the most appropriate way to manage these patients. The AHEAD Study aims to undertake research in order to understand the range and frequency of outcomes following head injury in this group of patients and to develop robust clinical guidance for how they should be optimally managed in the future.
Senior Doctor Triage in the emergency department
With the increasing problem of poor flow and crowding in emergency departments (ED), there is a growing interest in whether senior doctor triage (SDT) can improve flow and departmental performance. This improvement project aimed to develop and test a senior doctor led triage process for patients arriving by ambulance to the ED that would reduce the time from arrival to triage for patients and consequently reduce the time to treatment and overall time spent in the ED.
DiPEP: Diagnosis of Pulmonary Embolism in Pregnancy
Pregnant and postpartum women are at increased risk of pulmonary embolism (PE) but also commonly report symptoms suggesting PE as part of normal pregnancy. The DiPEP study aims to develop and evaluate clinical decision rules and biomarkers for diagnosing PE in pregnant and postpartum women using data from women presenting to hospital with suspected PE and women with diagnosed PE identified through the UK Obstetric Surveillance System (UKOSS).
The PAINTED Study (Pandemic Influenza Triage in the Emergency Department)
This study has been set up and is ready to be activated in the event of an influenza pandemic. PAINTED aims to identify the most accurate triage method for predicting severe illness among patients attending the emergency department with suspected pandemic influenza. It will involve collecting standardised information from people with suspected influenza and using this information to predict the risk of adverse outcome.
Pre hospital Outcomes for Evidence Based Evaluation (PhOEBE)
The PhOEBE project is a programme of research designed to develop new ways of measuring the impact of ambulance service care that can be used to monitor performance, measure quality improvement and evaluate service innovation.