Patient-level data linkage across ambulance services and acute trusts: assessing the potential for improving patient care

ABSTRACT Objectives The potential of linked healthcare data to support improvements to the care quality, efficiency and service planning is recognised by the Department of Health and NHS England. UK ambulance services however, have little information regarding the outcome of patients as there is no routine data sharing. An urban ambulance service has previously piloted linked data with one acute trust. The Pre-Hospital Emergency Department Data Linking Project (PHED Data) aims to assess the potential opportunities for and challenges to routinely linking data for several sites. It aims to define what indicator sets can be developed from these linked data, with a view to informing commissioning and improvement of healthcare delivery. Approach The project is a two-year mixed-methods observational study, funded by the Health Foundation, working with six acute trusts of various size and CQC-derived performance, to carry out six work packages. Work package one uses liaison activities with trust senior staff to negotiate information sharing agreements, and a learning log to enable an economic assessment of the set-up costs. Work packages two to five analyse ambulance response time, referrals from healthcare professionals, ED mortality, and frequent ED diagnoses, respectively, exploring relationships with ED outcomes, quantitatively. Qualitative analysis will explore, with staff groups, how the findings might influence commissioning and pre-hospital care. Work package six will examine commissioning decisions and patient care, through interviews with commissioners and performance managers. Results In work package one, we have successfully negotiated overall research ethics and governance approval, involving in-depth discussion about definitions of identifiable patient data, and protecting against potential re-identification. We have recruited six acute trusts, comprising 13 hospital sites, for whom equivalent data is available. We have been working for six months in liaison with these Trusts to deliver information sharing agreements (three are currently approved) and data transfer, working with research governance, information governance and clinical staff. The processes have varied, with intra-Trust co-dependencies introducing delays and non-linear processes being common. For work packages two to five, some data analysis will be available for presentation at the conference. Conclusion This project has the potential to shed light on the practicalities of data linkage for health service providers who face similar challenges with patient data held in multiple organisations. The study also anticipates being able to recommend quality improvement to support the development of new pathways in pre-hospital care

Adult nurse turnover and retention : South London project report

This project was commissioned by Health Education South London (HESL) in response to the workforce planning process for 2014/15 indicating an unprecedented increase in demand for adult nurses in NHS Trusts. The focus of the project was to identify issues and interventions to improve retention of adult nurses and reduce the rate of leaving jobs (turnover). During 2015 the work of the project has included: a systematic literature review to examine evidence of determinants, costs and interventions of adult nurse turnover; analysis of adult nurse workforce data to identify trends and rates in sub-groups of nurses and by characteristics of their employment context; interviews with senior nurse and human resource managers across South London for views and examples of initiatives to reduce turnover; interviews with adult nurses and nurse managers managers as to their views on the issues and initiatives that might help retain nurses. The evidence from each element is presented and then synthesised

Perceived impact on efficiency and safety of experienced American physician assistants / associates in acute hospital care in England : findings from a multi-site case organisational study

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required

The contribution of physician assistants/associates to secondary care : a systematic review

OBJECTIVE: To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN: Systematic review. SETTING: Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES: Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS: Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS: 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS: PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER: CRD42016032895

Physician associates working in secondary care teams in England: Interprofessional implications from a national survey

Physician associates (PAs) are a new type of healthcare professional to the United Kingdom; however, they are well established in the United States (where they are known as physician assistants). PAs are viewed as one potential solution to the current medical workforce doctor shortage. This study investigated the deployment of PAs within secondary care teams in England, through the use of a cross-sectional electronic, self-report survey. The findings from 14 questions are presented. Sixty-three PAs working in a range of specialties responded. A variety of work settings were reported, most frequently inpatient wards, with work generally taking place during weekdays. Both direct and non-direct patient care activities were reported, with the type of work undertaken varying at times, depending on the presence or absence of other healthcare professionals. PAs reported working within a variety of secondary care team staffing permutations, with the majority of these being interprofessional. Line management was largely provided by consultants; however day-to-day supervision varied, often relating to different work settings. A wide variation in ongoing supervision was also reported. Further research is required to understand the nature of PAs' contribution to collaborative care within secondary care teams in England

A patient survey of out-of-hours care provided by Emergency Care Practitioners

© 2007 Halter et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Use and impact of the prehospital 12-lead ECG in the primary PCI era (PHECG2) : protocol for a mixed-method study

Introduction Use of the prehospital 12-lead ECG (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found that although PHECG use was associated with improved 30-day survival, a third of patients (typically women, the elderly and those with comorbidities) under EMS care did not receive a PHECG. The overall aim of the PHECG2 study is to update evidence on care and outcomes for patients eligible for PHECG, specifically addressing the following research questions: (1) Is there a difference in 30-day mortality, and in reperfusion rate, between those who do and those who do not receive PHECG? (2) Has the proportion of eligible patients who receive PHECG changed since the introduction of primary percutaneous coronary intervention networks? (3) Are patients that receive PHECG different from those that do not in terms of social and demographic factors, or prehospital clinical presentation? (4) What factors influence EMS clinicians' decisions to perform PHECG? Methods and analysis This is an explanatory, mixed-method study comprising four work packages (WPs). WP1 is a population-based, linked-data analysis of a national ACS registry (Myocardial Ischaemia National Audit Project). WP2 is a retrospective chart review of patient records from three large regional EMS. WP3 comprises focus groups of EMS personnel. WP4 will synthesise findings from WP1-3 to inform the development of an intervention to increase PHECG uptake. Ethics and dissemination The study has been approved by the London-Hampstead Research Ethics Committee (ref: 18LO1679). Findings will be disseminated through feedback to participating EMS, conference presentations and publication in peer-reviewed journals