• Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration?

      Shaw, Joanna; Fothergill, Rachael; Clark, Sophie; Moore, Fionna (2017-08)
      Introduction The National Early Warning Score (NEWS) aids the early recognition of those at risk of becoming critically ill. NEWS has been recommended for use by ambulance services, but very little work has been undertaken to date to determine its suitability. This paper examines whether a prehospital NEWS derived from ambulance service clinical observations is associated with the hospital ED disposition. Methods Prehospital NEWS was retrospectively calculated from the ambulance service clinical records of 287 patients who were treated by the ambulance service and transported to hospital. In this cohort study, derived NEWS scores were compared with ED disposition data and patients were categorised into the following groups depending on their outcome: discharged from ED, admitted to a ward, admitted to intensive therapy unit (ITU) or died. Results Prehospital NEWS-based ambulance service clinical observations were significantly associated with discharge disposition groups (p<0.001), with scores escalating in line with increasing severity of outcome. Patients who died or were admitted to ITU had higher scores than those admitted to a ward or discharged from ED (mean NEWS 7.2 and 7.5 vs 2.6 and 1.7, respectively), and in turn those who were admitted to a ward had higher pre-hospital NEWS than those who were discharged (2.6 vs 1.7). Conclusion Our findings suggest that the NEWS could successfully be used by ambulance services to identify patients most at risk from subsequent deterioration. The implementation of this early warning system has the potential to support ambulance clinician decision making, providing an additional tool to identify and appropriately escalate care for acutely unwell patients https://emj.bmj.com/content/emermed/34/8/533.full.pdf 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/emermed-2016-206115
    • A clinical audit of the pre-hospital paediatric respiratory assessment in London

      Clark, Sophie; Shaw, Joanna; Wrigley, Fenella (2014-02)
      Abstract published with permission. Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient’s age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the noncompliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.
    • Data linkage across ambulance services and acute trusts: assessing the potential for improving patient care

      Clark, Sophie; Porter, Alison; Halter, Mary; Damiani, Mike; Dorning, Holly; McTigue, Martin (2016-09)
      Background Currently, most callers to 999 ambulance services are transported to the hospital emergency department (ED). However, ambulance services receive no further information on those patients, and commissioners do not have the full picture of patient care. The London Ambulance Service have worked with one acute trust to establish the feasibility of data linkage, but questions remain about transferability of the model, and how learning from linked data can bring about changes in patient care and outcomes. Methods PHED Data is our two-year mixed-methods observational study which began in May 2015. We aim to establish the potential for routinely linking data from acute trusts and ambulance services, to allow diagnosis, health care intervention, and mortality outcomes to be tracked, with a range of potential benefits for patient care within ambulance services and across the healthcare economy. We will work with six acute trusts from across London, selected to give a range of performance. The study has six work packages: WP1 examines the technical aspects of the linkage process; WP2-5 each analyse the data to develop one themed indicator set, with qualitative work examining their perceived relevance and viability; WP6 examines how the indicator sets might influence commissioning decisions and service improvements. Results So far, we have engaged with six selected acute trusts; all have shown strong interest in collaborating. We are currently arranging the logistical aspects of data sharing. We aim to respond to trusts' particular interests in our analyses, in addition to developing our common indicator set. Conclusions The proposed work has the potential to bring about quality improvements to current systems and support the development of new pathways and protocols for pre-hospital interventions. Benefits will be felt across the healthcare system. Our findings will be relevant to health service providers across the UK, who all face similar challenges in pre-hospital care. https://emj.bmj.com/content/emermed/33/9/e12.2.full.pdf 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/emermed-2016-206139.39
    • Data linkage across ambulance services and acute trusts: challenges and opportunities

      Clark, Sophie; Porter, Alison; Halter, Mary; Dorning, Holly (2017-10)
      Background Most callers to 999 ambulance services are transported to hospital emergency departments (EDs), but ambulance services receive no information on patient outcomes. PHED Data is a two-year mixed-methods observational study of the process and potential benefits of linking data from EDs with ambulance service data to allow analysis of patient outcomes. We report on our first aim, to examine the potential opportunities and challenges to routinely linking these data. Methods We approached six acute trusts, selected to give a range of performance, location and size, from an English metropolitan area. We used a structured learning log to collect data on the process, time input and reflections. We analysed these data with descriptive statistics, and qualitatively for themes. Results All six trusts we approached agreed to participate. Data were linked using an algorithm based on date, time and patient demographics. We achieved a dataset of 7 75 018 records covering 2012–2016, and a linkage rate of 81%. We identified five stages of the process: senior approval; exploring data availability; information governance agreement; data transfer and linking. The most intensive phases were; negotiating senior approval (mean research team input per trust of 8 hours 5 min [SD 8 hours 3 min] plus additional time from acute trusts), and data linkage (mean research team input per trust 12 hours 40 min [SD 7 hours 4 min]). The stage which took the longest was information governance (mean 19 weeks). Key themes included the positive attitudes of trusts to participating, the range of decision-makers involved, and the need for sustained input from the research team. Conclusions We have found the process of data linkage to be feasible, but requires dedicated time from research and trust staff, over a prolonged period, in order to achieve initial set up. Linked data are now being analysed. https://emj.bmj.com/content/34/10/696.1 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/emermed-2017-207114.3
    • Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers?

      Clark, Sophie; Halter, Mary; Porter, Alison; Smith, Holly Christina; Brand, Martin; Fothergill, Rachael; Lindridge, Jaqualine; McTigue, Martin; Snooks, Helen (2019-08)