• The A2Z of Immediate Care

      Walker, Alison (2011-08)
    • “At the sharp end”: does ambulance dispatch data from south Yorkshire support the picture of increased weapon-related violence in the UK?

      Gray, J.T.; Walker, A. (2009-09-22)
      Objective: To assess whether ambulance responses in South Yorkshire to stabbing, gunshot, penetrating trauma cases have increased over the past few years, supporting the observed increase in media reporting. Methods: A review was undertaken of the frequency with which the ambulance medical priority dispatch system card 27 (stab/gunshot/penetrating trauma) was used, grouped by financial year, and comparison made over time and by patient age group. Results: There is a steady increase in the number of occurrences of these cases and also an increase in the percentage made up by the 10–29 year age group. Conclusions: Ambulance data from South Yorkshire support the media conclusion that there is an increase in stabbing, gunshot and penetrating trauma as well as an increase in the proportion of younger victims. This has wider implications for ambulance staff and the UK as a whole; however, these calls remain a low percentage of overall ambulance service activity. https://emj.bmj.com/content/26/10/741. 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/ DOI http://dx.doi.org/10.1136/emj.2008.067298
    • Evaluate the improved value that NHS 111 can provide to palliative care patients and their families by utilising specialist palliative care nurses within urgent and emergency care

      Bradley, Alison; Littlewood-Prince, Michela; Kaushal, Usha; Mitchell, Kathryn; Leyland, Claire; Wanstall, Judith; Cooper, Nicholas; NHS 111 (2016-09)
      Introduction NHS111 Yorkshire and Humber, using the 4C’s framework to review Concerns, Complaints, Compliments and Comments became aware of issues regarding ‘delays’ to care for palliative care patients. We conducted a systematic review of palliative care services to identify areas for improvement. Aims To improve the value that NHS111 could provide to palliative care patients by understanding pathways for palliative care, testing the use of specialist palliative resources, developing ideas for technology developments, enhancing access to medicines through the use of pharmacists and to understand how NHS111 can work to enhance out-of-hours palliative care services in the region. Methods Intelligence was gathered to identify the current position to support palliative patients. Interventions were designed to provide new and improved ways of working. Palliative Nurses were employed for 5-weeks during out-of-hours and training provided to the wider healthcare team. Results Analysis of the results allowed further improvements to the provision of 24-hour care and out-of-hours provision. Higher levels of demand were experienced during weekend hours and at the start of a Bank Holiday periods. Palliative Care Nurses were also able to provide high levels of self-care’ advice without requiring onward referral. Conclusions We directly identified empirical evidence and delivered a range of benefits which support the ‘Dying without Dignity’ report and provided recommendations to directly address the issues of poor symptom control, inadequate out of hour’s service and poor care planning. Furthermore Training and Development for NHS 111 staff in palliative care matters was further enhanced with the development of a palliative care e-learning package. https://spcare.bmj.com/content/6/3/406.1 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/bmjspcare-2016-001204.57
    • Is referral to emergency care practitioners by general practitioners in-hours effective?

      Gray, J.T.; Walker, A. (2009-07-22)
      Objective: To evaluate the cost effectiveness to primary care trusts (PCT) in commissioning general practitioner (GP) referrals in-hours to emergency care practitioners (ECP). Methods: A retrospective case note review for patients referred by GPs in-hours to ECP over a 4-month period to ascertain any added value over a GP visit. Results: In a 4-month period 105 patients were referred. In most cases (90.5%) the ECP was utilised as a substitute for a GP rather than providing any additional skills. Defining an avoided attendance as the ECP undertaking an intervention outside a GP skill set this equated to a 9.5% avoided attendance rate compared with the ECP service standard rate of 60%. This has implications both in terms of financial benefit and ongoing ECP service sustainability. Conclusions: There is little value in a PCT commissioning this service as they will pay twice and care must be taken in accepting new referral streams into existing services. https://emj.bmj.com/content/26/8/611. 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/ DOI http://dx.doi.org/10.1136/emj.2008.059956
    • Prehospital emergency anaesthesia: time taken to care for and respond to a critically injured patient

      Blinkhorn, Anthony (2019-07-10)
      The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Trauma: Who Cares? report recommended that people trained to administer anaesthesia and intubate severely injured patients should be available in prehospital environments. Published articles, reference documents and guidance reports were reviewed to compare the management plans and standard operating procedures produced by an ambulance trust in England that provides prehospital emergency anaesthesia (PHEA). Documents reviewed all provide a common un-referenced patient injury list showing indications to perform PHEA but do not state a time frame within which it should be performed. No minimum time before PHEA is started and how long is acceptable to wait for a specialist resource to arrive before an ambulance can transport to a hospital were found. Further work is required to establish and formalise this time frame. Abstract published with permission.
    • Severe hypoglycaemia is a frequent reason for 999 calls in Yorkshire

      James, Cathryn; Scott, A. R.; Walker, Alison; Clapham, Linda (2010-03)