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.
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.
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.