Miles, Jamie

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Biography
Since qualifying as a paramedic I have enjoyed a diverse range of clinical settings, including frontline ambulance work, minor injury units, medical repatriation and specialist cardiac arrest response cars. I joined the University of Sheffield in 2017 and have been mainly investigating ambulance conveyances to the Emergency Department - this has been part of the CLAHRC Y+H Avoiding Attendance and Admission in Long Term Conditions theme. I am the co-module director of Prehospital Emergency Care alongside Dr. Justin Squires. This is part of the MSc Advanced Emergency Care provided by ScHARR. I am currently undertaking an NIHR/HEE Clinical Doctoral Research Fellowship into risk prediction modelling of ambulance service conveyances to the Emergency Department.
Institutional profile
YAS (Yorkshire Ambulance Service): YAS has a longstanding commitment to the development of research and innovation, believing it is the driver for improving the quality of care and patient experience. The research team has a strong history of developing and achieving research grants in-house, delivering large trials and disseminating evidence through knowledge mobilisation. They are also strong advocates of developing staff wishing to develop a career in research. This includes successfully supporting staff to achieve NIHR Internships, Masters degrees in research and Clinical Doctoral Research Fellowships. CURE (The University of Sheffield): Sheffield is a leading national and international centre for urgent and emergency care research. CURE is a research group based in the School of Health and Related Research (ScHARR). CURE undertakes health service research into the organisation and delivery of urgent and emergency care, and works with the Clinical Trials Unit and Section of Health Economics and Decision Science to undertake health technology assessments relevant to urgent and emergency care.

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Now showing 1 - 9 of 9
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    Ambulance over-conveyance to the emergency department: a large data analysis of ambulance journeys
    (2018-04-16) Miles, Jamie; O'Keefe, Colin; Jacques, Richard; Stone, Tony; Mason, Suzanne
    Over-conveyance by the ambulance service is a compounding factor of emergency department (ED) crowding. Previous solutions have focused on specific patient groups which have a limited impact when compared to the whole urgent and emergency care system. This study aims to analyse non-urgent conveyances by the ambulance service that could be suitable for discharge on-scene. https://bmjopen.bmj.com/content/8/Suppl_1/A22.3. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI 10.1136/bmjopen-2018-EMS.59
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    Emergency Medicine Journal COVID-19 monthly top five
    (2021-02-12) Tonkins, Michael; Miles, Jamie; O'Keeffe, Colin; Jiminez Forero, Sonia; Goodacre, Steve
    Following from the successful ‘RCEM weekly top five’ series starting in April 2020, this is the third of a monthly format for EMJ readers. We have undertaken a focused search of the PubMed literature using a standardised COVID-19 search string. Our search between 1 December and 31 December 2020 returned 1183 papers limited to human subjects and English language. We also searched high impact journals for papers of interest. https://emj.bmj.com/content/early/2021/02/11/emermed-2021-211203 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2021-211203
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    The SINEPOST study
    (2023-06-23) Miles, Jamie; Jacques, Richard; Campbell, Richard; Turner, Janette; Mason, Suzanne
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    A service evaluation of paediatric pain management in an English ambulance service
    (2019-09-01) Pilbery, Richard; Miles, Jamie; Bell, Fiona
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    Using machine-learning risk prediction models to triage the acuity of undifferentiated patients entering the emergency care system: a systematic review
    (2020-10-02) Miles, Jamie; Turner, Janette; Jacques, Richard; Williams, Julia; Mason, Suzanne
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    Thinking on scene: using vignettes to assess the accuracy and rationale of paramedic decision making
    (2018-04) Miles, Jamie; Coster, Joanne; Jacques, Richard
    Aim Paramedics make important decisions on-scene as to whether a patient requires transport to hospital, referred, or discharged on scene. Research shows that nearly 20% of patients brought to ED by ambulance, could be treated elsewhere. This study aims to investigate the accuracy of conveyance decisions made by on-scene paramedics. Method Individual real-patient vignettes were created using linked ambulance, ED and GP data and used in an online survey to paramedics in Yorkshire. Half the vignettes were categorised as clinically necessary attendances at the ED and the other half were categorised as clinically unnecessary. Vignettes were validated by a small expert panel. Participants were asked to determine the appropriate conveyance decision and to explain the rationale behind their decisions using a free text box. Abstracts BMJ Open 2018;8(Suppl 1):A1–A34 A23 Trust (NHS). Protected by copyright. on 13 August 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.62 on 16 April 2018. Downloaded from Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (k=0.63) and for admission prediction (k=0.86). Overall accuracy was 0.69 (95% CI: 0.66 to 0.73). Paramedics were better at ‘ruling in’ the ED with sensitivity of 0.89 (95% CI: 0.86 to 0.92). The specificity of ‘ruling out’ the ED was 0.51 (95% CI: 0.46 to 0.56). Text comments were focused on patient safety and risk aversion. Conclusion Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that whilst decisions are safe they are not always appropriate. Some risk-averse decisions were made due to patient and professional safety reasons. It is important that paramedics feel supported by the service to make non-conveyance decisions. Reducing over-conveyance is a potential method of reducing ED demand. https://bmjopen.bmj.com/content/8/Suppl_1/A23.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.62
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    Using vignettes to assess the accuracy and rationale of paramedic decisions on conveyance to the emergency department
    (2019-06-01) Miles, Jamie; Coster, Joanne; Jacques, Richard
    Introduction: Paramedics make important decisions about whether a patient needs transport to hospital, or can be discharged on scene. These decisions require a degree of accuracy, as taking low acuity patients to the emergency department (ED) can support ambulance ramping. In contrast, leaving mid‐high acuity patients on scene can lead to incidents and recontact. This study aims to investigate the accuracy of conveyance decisions made by paramedics when looking at real life patient scenarios with known outcomes. It also aims to explore how the paramedic made the decision. Methods: We undertook a prospective mixed method triangulation design. Six individual patient vignettes were created using linked ambulance and ED data. These were then presented in an online survey to paramedics in Yorkshire. Half the vignettes related to mid‐high acuity attendances at the ED and the other half were low acuity. Vignettes were validated by a small expert panel. Participants were asked to determine the appropriate conveyance decision and to explain the rationale behind their decisions using a free-text box. Results: A total of 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions ( = 0.63). Overall accuracy was 0.69 (95% CI 0.66‐0.73). Paramedics were better at ‘ruling in’ the ED, with sensitivity of 0.89 (95% CI 0.86‐0.92). The specificity of ‘ruling out’ the ED was 0.51 (95% CI 0.46‐0.56). Text comments were focused on patient safety and risk aversion. Discussion: Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that while decisions are safe they are not always appropriate. It is important that paramedics feel supported by the service to make safe and confident non-conveyance decisions. Reducing over-conveyance is a potential method of reducing demand in the urgent and emergency care system. Abstract published with permission.
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    Exploring ambulance conveyances to the emergency department: a descriptive analysis of non-urgent transports
    (2017-12) Miles, Jamie; O'Keeffe, Colin; Jacques, Richard; Stone, Tony; Mason, Suzanne
    An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. https://emj.bmj.com/content/34/12/A872. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2017-207308.17