• Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study

      Halter, Mary; Vernon, Susan; Snooks, Helen; Porter, Alison; Close, Jacqueline; Moore, Fionna; Porsz, Simon (2011-01)
      BACKGROUND: Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. METHODS: During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. RESULTS: The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. CONCLUSIONS: An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance. https://emj.bmj.com/content/emermed/28/1/44.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/emj.2009.079566
    • 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
    • Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model.

      Koniotou, Marina; Evans, Bridie A.; Chatters, Robin; Fothergill, Rachael; Garnsworthy, Christopher; Gaze, Sarah; Halter, Mary; Mason, Suzanne; Peconi, Julie; Porter, Alison; et al. (2015-07)
    • Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial

      Snooks, Helen; Anthony, Rebecca; Chatters, Robin; Dale, Jeremy; Fothergill, Rachael; Gaze, Sarah; Halter, Mary; Humphreys, Ioan; Koniotou, Marina; Logan, Phillipa; et al. (2017-10)
    • 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)
    • What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

      Snooks, Helen; Khanom, Ashrafunnesa; Cole, Robert; Edwards, Adrian; Edwards, Bethan Mair; Evans, Bridie A.; Foster, Theresa; Fothergill, Rachael; Gripper, Carol P.; Hampton, Chelsey; et al. (2019-12-28)