bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying requisite learning health system competencies: a scoping review
Authors: McDonald Paige L , Phillips Jessica , Harwood Kenneth , Maring Joyce , van der Wees Philip J
Published: August 2022

Objectives

Learning health systems (LHS) integrate knowledge and practice through cycles of continuous quality improvement and learning to increase healthcare quality. LHS have been conceptualised through multiple frameworks and models. Our aim is to identify and describe the requisite individual competencies (knowledge, skills and attitudes) and system competencies (capacities, characteristics and capabilities) described in existing literature in relation to operationalising LHS.

Methods

A scoping review was conducted with descriptive and thematic analysis to identify and map competencies of LHS for individuals/patients, health system workers and systems. Articles until April 2020 were included based on a systematic literature search and selection process. Themes were developed using a consensus process until agreement was reached among team members.

Results

Eighty-nine articles were included with most studies conducted in the USA (68 articles). The largest number of publications represented competencies at the system level, followed by health system worker competencies. Themes identified at the individual/patient level were knowledge and skills to understand and share information with an established system and the ability to interact with the technology used to collect data. Themes at the health system worker level were skills in evidence-based practice, leadership and teamwork skills, analytical and technological skills required to use a ‘digital ecosystem’, data-science knowledge and skill and self-reflective capacity. Researchers embedded within LHS require a specific set of competencies. Themes identified at the system level were data, infrastructure and standardisation; integration of data and workflow; and culture and climate supporting ongoing learning.

Conclusion

The identified individual stakeholder competencies within LHS and the system capabilities of LHS provide a solid base for the further development and evaluation of LHS. International collaboration for stimulating LHS will assist in further establishing the knowledge base for LHS.
Sixteen-week multicentre randomised controlled trial to study the effect of the consumption of an oat beta-glucan-enriched bread versus a whole-grain wheat bread on glycaemic control among persons with pre-diabetes: a study protocol of the CarbHealth study
Authors: Hjorth Therese , Schadow Alena , Revheim Ingrid , Spielau Ulrike , Thomassen Lise M , Meyer Klara , Piotrowski Katja , Rosendahl-Riise Hanne , Rieder Anne , Varela Paula , Lysne Vegard , Ballance Simon , Koerner Antje , Landberg Rikard , Buyken Anette , Dierkes Jutta
Published: August 2022

Introduction

In 2012, the estimated global prevalence of pre-diabetes was 280 million, and the prevalence is expected to rise to 400 million by 2030. Oat-based foods are a good source of beta-glucans, which have been shown to lower postprandial blood glucose. Studies to evaluate the effectiveness of the long-term intake of beta-glucan-enriched bread as part of a habitual diet among individuals with pre-diabetes are needed. Therefore, we designed a multicentre intervention study in adults with pre-diabetes to investigate the effects of consumption of an oat-derived beta-glucan-enriched bread as part of a normal diet on glycated haemoglobin (HbA1c) in comparison to consumption of whole-grain wheat bread.

Methods and analysis

The CarbHealth trial is a multicentre double-blind randomised controlled 16-week dietary intervention trial in participants 40–70 years of age with a body mass index of ≥27 kg/m2 and HbA1c of 35–50 mmol/mol. The study is conducted at four universities located in Norway, Sweden and Germany and uses intervention breads specifically designed for the trial by Nofima AS. The aim is to recruit 250 participants. The primary outcome is the difference in HbA1c between the intervention and the control groups. The main analysis will include intervention group, study centre and baseline HbA1c as independent variables in an analysis of covariance model.

Ethics and dissemination

The study protocol was approved by respective ethical authorities in participating countries. The results of the study will be communicated through publication in international scientific journals and presentations at (inter)national conferences.

Trial registration number

NCT04994327.
Perioperative mental health intervention bundle for older surgical patients: protocol for an intervention development and feasibility study
Authors: Abraham Joanna , Holzer Katherine J , Lenard Emily M , Freedland Kenneth E , Tellor Pennington Bethany R , Wolfe Rachel C , Cordner Theresa A , Baumann Ana A , Politi Mary , Avidan Michael Simon , Lenze Eric
Published: August 2022

Introduction

The perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisation. These experiences can, in turn, exacerbate anxiety and depressive symptoms. Despite these risks, little is known about how to treat perioperative anxiety and depression among older adults.

Methods and analysis

We designed a feasibility study of a perioperative mental health intervention bundle to improve perioperative mental health, specifically depression and anxiety. The overarching goals of this study are twofold: first, to adapt and refine an intervention bundle comprised of behavioural activation and medication optimisation to meet the needs of older adults within three surgical patient populations (ie, orthopaedic, oncological and cardiac); and second, to test the feasibility of study procedures and intervention bundle implementation. Quantitative data on clinical outcomes such as depression, anxiety, quality of life, delirium, falls, length of stay, hospitalisation and pain will be collected and tabulated for descriptive purposes. A hybrid inductive–deductive thematic approach will be employed to analyse qualitative feedback from key stakeholders.

Ethics and dissemination

The study received approval from the Washington University Institutional Review Board. Results of this study will be presented in peer-reviewed journals, at professional conferences, and to our perioperative mental health advisory board.

Trial registration number

NCT05110690.
Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial
Authors: Zhu Song , Yang Chen , Chen Shihao , Kang Lu , Li Tong , Li Jina , Li Lezhi
Published: August 2022

Introduction

Family caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients’ health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer.

Methods and analysis

This study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects.

Ethics and dissemination

The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study’s findings by publishing them in international scientific journals.

Trial registration number

ChiCTR2200058280.
01 ‘Between a rock and a hard place’: Care home staff perceptions of balancing risks during resident transfer decisions
Authors: Harrad-Hyde Fawn , Williams Chris , Armstrong Natalie
Published: August 2022

Background

Care home residents are more likely to attend and be admitted to hospital in unplanned, emergency situations than age-matched people living in their own homes, yet some transfers and admissions can be burdensome, leading to declines in health and well-being. Existing research has acknowledged the importance of understanding the local context in which transfers occur, yet research conducted in England is lacking.

Methods

To develop an in-depth understanding of care home staff transfer decisions in England, data collection occurred in two phases. Firstly, semi-structured interviews were carried out with 30 care home staff across six care homes in the East and West Midlands. Secondly, 113 hours of ethnographic work (consisting of observations, documentary analysis and informal conversations) occurred across three of the six homes. Data gathered in both phases were analysed together using the Straussian approach to grounded theory.

Results

Staff preferred to care for residents in the care home where possible. Transfers often occurred following a series of escalations in which staff sought to balance a number of risks. Staff primarily understood risk by drawing on their experiential knowledge of what was usual for each resident, yet also drew upon advance care plans and observations of early warning signs. Staff sought to manage risks by involving others in decision-making (colleagues, residents, relatives, healthcare professionals), yet this required staff to anticipate and mitigate potential disagreements.

Conclusions

This study highlights a substantial amount of work care home staff undertake prior to calling external services and offers a novel approach to understanding hospital transfers from care homes, by foregrounding the different forms of risk staff feel responsible for balancing. Further research is needed to assess the ways new and existing interventions enable care home staff to manage risk during transfer decisions. The implications for emergency care services will be discussed.
EP10 Community first responders‘ contribution to rural emergency medical service provision in the UK
Authors: Botan Vanessa , Asghar Zahid , Rowan Elise , Smith Murray D , Patel Gupteswar , Phung Viet-Hai , Trueman Ian , Spaight Robert , Brewster Amanda , Mountain Pauline , Orner Roderick , Siriwardena Aloysius Niroshan
Published: August 2022

Background

Community First Responders (CFRs) are volunteers dispatched by Emergency Medical Services (EMS) to potentially life-threatening emergencies to provide care until the ambulance staff arrive. Previous qualitative research described CFRs’ role, perceptions, and motivations, but quantitative evidence on their contribution to rural healthcare provision is lacking. We aimed to investigate the number, types, and location of calls (rural or urban), and characteristics of patients attended.

Methods

We used a retrospective observational design analysing routine data from six of ten ambulance services in England during 2019. Descriptive statistics were used to directly compare incidents where CFRs attended first with attendances from ambulance staff. A multiple logistic regression model was used to identify the main predictors of CFR attendance.

Results

The data included 4.5 million incidents over one year. CFRs attended first a significantly higher proportion of calls in rural areas compared to urban areas (3.90% vs 1.48%, p<0.05). The main predictors of CFR presence were rurality (Odds Ratio [OR] 2.05, 95% Confidence Interval [CI] 1.99-2.11, p<0.001), conditions including cardiorespiratory (OR 9.20, 95%CI 5.08-16.64, p<0.001) or neurological/endocrine (OR 9.26, 95%CI 5.12-16.77, p<0.001) and the most urgent call category 1 (OR 5.19, 95%CI 3.86-6.99, p<0.001) and call category 2 (OR 4.44, 95%CI 3.31-5.96 p<0.001). CFRs were also less likely to attend patients from minority ethnic backgrounds, those younger than 39 years, and incidents in more deprived areas.

Conclusions

CFRs play an important role in EMS delivery, supporting the work of ambulance services, especially in rural areas. The work of CFRs has expanded from its original purpose to attend out-of-hospital cardiac arrest to more types of emergencies. Future development of CFR schemes should prioritise training for a range of conditions, and access to more deprived and ethnically diverse areas.
PP21 Factors affecting community first responders’ role in rural emergencies: a qualitative interview study
Authors: Patel Gupteswar , Phung Viet-Hai , Julie Pattinson J , Trueman Ian , Ørner Roderick , Botan Vanessa , Asghar Zahid , Smith Murray D , Ridyard Colin , Rowan Elise , Brewster Amanda , Mountain Pauline , Evans Jason , Spaight Robert , Niroshan Siriwardena Aloysius
Published: August 2022

Background

Community first responders (CFRs) are volunteers delivering emergency medical assistance and maintaining a patient’s condition until an ambulance arrives. Previous research has highlighted the CFR role and relationships, motivations, practice and perceptions, and need for mental health support. However, factors influencing CFR practise in the field are a relatively underexplored area. We aimed to explore the factors embedded in CFR implementation processes that either facilitated or hindered CFRs’ activities and practice in the UK.

Method

In a qualitative study, we conducted interviews with CFRs and CFR leads, paramedics and ambulance clinicians, commissioners, patients and relatives across six English ambulance service regions. Thematic analysis, supported by NVivo, enabled the identification codes and themes.

Result

Overall, 47 participants were interviewed including CFR leads (15), CFRs (21), ambulance staff (4), and commissioners (2) from six ambulance services with patients and relatives (5) from the same regions. The findings revealed multi-layered factors influencing effective CFR functioning at three levels, namely individual, institutional, and societal. CFRs’ local expertise helped them to navigate operational challenges. Use of a personal vehicle and navigation software aided CFRs’ ability to respond promptly. Continuing training improved CFRs’ skills. CFR functioning was facilitated by positive relationships with ambulance crews. Identification and recognition by patients were important and aided by wearing uniforms. Community support was a facilitator for CFR activities in rural areas. In contrast, limited communication in remote regions, long waits for an ambulance, and reliance on community donations impeded CFRs’ care function. Volunteer shortages and lack of access to a blue light while using trusts’ car hindered CFRs’ ability to respond quickly. Negative relationships with ambulance crews also hampered CFRs’ involvement.

Conclusion

This study highlights factors associated with effective CFR functioning and the requirement for supportive institutional and societal contexts for CFRs to assist patients in medical emergencies.
PP23 Improving CPR quality by the innovative use of a CPR quality officer: a simulation randomised control trial
Authors: Sumera Kacper , Ilczak Tomasz , Lane Jon Dearnley , Bakkerud Morten , Pallas Jeremy , Martorell Sandra Ortega , Quinn Tom , Sandars John , Siriwardena Aloysius Niroshan
Published: August 2022

Background

Ambulance services around the world play a pivotal role in the delivery of advanced life support (ALS) in an out of hospital setting. The European Resuscitation Council guidelines highlight the importance of high-quality cardiopulmonary resuscitation (CPR) and early defibrillation for out-of-hospital advanced life support, with the quality of CPR associated with patient outcomes. Despite this importance, research suggests that there is variable quality of ALS in out of hospital settings.

Methods

A multicentre simulation randomised controlled trial was conducted to measure the effectiveness of introducing a CPR quality officer role in supervising and maintaining the quality of CPR in ALS. The data was collected by a research team that undertook training from the principal researcher.

The participants were ALS trained paramedic students who had experience responding to out of hospital cardiac arrests. The participants were randomised into an intervention and control group and asked to undertake two simulated scenarios, one employing the CPR quality officer, the other without.

The primary outcome measure was the compression score calculated by Laerdal QCPR® software. The score was represented as an overall percentage, illustrating the quality of performed chest compressions, interruptions, and chest recoil.

Results

This is a work in progress, with full data collection now completed. The trial pilot results produced reported an increased overall QCPR score, reduced interruptions, improved chest recoil and an improved chest compression fraction.

Qualitative data from focus groups identified that participants were supportive of the inclusion of the CPR quality officer and did not feel the role interfered with their ALS efforts.

Conclusions

The addition of a designated CPR quality officer addresses a fundamental component within the chain of survival. High-quality sustained CPR positively correlates with patient outcomes. Furthermore, assigning a designated CPR officer affords other team members to focus on their tasks. This inclusion is simple, cost-effective and can be utilised in an array of healthcare settings.
PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study
Authors: Sampson Fiona C , Bell Fiona , Webster Peter , Coster Joanne , O’Hara Rachael , Goodacre Steve , Foster Alexis , Miles Jamie , Millins Mark , Pountney Andrew , Rosser Andy , Spaight Robert , Turner Janette , Boyd Aimee , Pilbery Richard , Long Jaqui
Published: August 2022

Background

Ambulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how a decision to pre-alert is made and how this is communicated and acted upon in the receiving ED. Whilst appropriate use of pre-alerts benefits patient care, their overuse carries a risk of harm or opportunity costs. The impact of pre-alerts on ambulance clinicians, ED staff and patients is not currently well understood.

Methods

We are conducting a mixed methods study with five inter-related work packages. We will analyse 12 months of routine data from ambulance pre-alerts in three regions to identify factors in the variation of pre-alert use, including pre-hospital decision-making. We will undertake a national online Qualtrics survey of ambulance clinician perspectives and experience of pre-alerts. We will explore the impacts of a pre-alert on staff, ED facilities and the patient using semi-structured interviews with ambulance clinicians, ED staff, patients and carers and undertake non-participant observation of ED pre-alert response.

Expected Results

We will describe current pre-alert practice using 12 months’ data for 3 Ambulance Services, including volume and types of pre-alerts. We will identify specific conditions or patient groups for whom pre-alerts are most likely to lead to change in clinical practice, or for whom action is unlikely to provide benefit. We will hold a feedback workshop in which we will share and discuss our findings with key stakeholders.

Conclusions

Current variation in pre-alert processes, both pre-hospital and in-hospital and the impact on patient care is not understood. The outputs of this study will establish an evidence base to update national guidance for pre-alert practice and identify areas of good pre-alert practice for both ambulance service and Emergency Department staff.
PP27 NHS 111 staff and user views of online NHS 111: a useful adjunct to the NHS 111 telephone service
Authors: Sampson Fiona C , Turner Janette , Knowles Emma , Long Jaqui , Coster Joanne
Published: August 2022

Introduction

In 2018 the online NHS111 service was introduced in response to increasing and unsustainable demand for NHS111 telephone service. We explored user and staff perspectives of the online service to understand awareness and acceptability of the online service, how the online service is used and how it may affect demand for the NHS111 telephone service.

Methods

We used data from the national online NHS111 user survey and telephone user survey for two NHS111 areas. We also undertook semi-structured interviews with 32 recent users of online NHS111 and 16 staff and stakeholders from NHS111 sites. We analysed data for 3728 online users and 795 telephone users in SPSS. Qualitative data was analysed using thematic analysis.

Results

Online NHS111 was perceived as a useful low-risk, low-cost anonymous alternative to the telephone service that could be used instead of, or prior to calling NHS111, particularly for lower-acuity conditions. Staff and stakeholders characterised online and telephone 111 as separate services, with different audiences and purposes. User satisfaction and compliance with advice was lower for online than telephone NHS111 for all measures. Participants appeared to value advice from telephone NHS111 more highly, due to health adviser skills in probing and obtaining ‘soft information’. This was perceived to lead to more appropriate and trusted advice than online interactions, whose questions were considered over-simplified or inappropriate. However, the anonymity, lower pressure and low resource implications of the online service appeared to increase access to NHS111 services for a subset of users who would not otherwise access the telephone service.

Conclusions

Online NHS111 has a useful role in the emergency and urgent care system, but as an adjunct to, rather than replacement of, telephone NHS111. Human interactions associated with the telephone service were seen as key to users obtaining appropriate and trusted advice in many instances.
PP28 Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow test and direct admissions pathway: exploring why well received ideas have low uptake
Authors: Sampson Fiona C , Coster Joanne , Bell Fiona , Miller Elisha , Easom Nicholas
Published: August 2022

Background

In January 2021 Yorkshire Ambulance Service and Hull University Teaching Hospitals implemented a pilot COVID-19 lateral flow testing (LFT) and direct admissions pathway to assess the feasibility of using pre-hospital LFTs to bypass the Emergency Department. Due to lower than anticipated uptake of the pilot amongst paramedics, we undertook a service evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot.

Methods

We undertook semi-structured telephone interviews with 12 paramedics and hospital staff. We aimed to interview paramedics who had taken part in the pilot, those who had received the project information but not taken part and ward staff receiving patients from the pilot. We transcribed interviews verbatim and analysed data using thematic analysis according to the principles of Braun & Clarke (Ref).

Results

Participants who were involved in the pilot were overwhelmingly positive about the intervention, which they perceived as having limited risks and high potential benefits to the health service, patients and themselves and supported future roll-out. Participation in the pilot appeared to be positively influenced by high personal capacity for undertaking research (being ‘research-keen) and negatively influenced by ‘COVID-19 exhaustion’, electronic information overload and lack of time for training. Barriers to use of the pathway related to ‘poor timing’ of the pilot, restrictive patient eligibility and inclusion criteria. The rapid rollout meant that paramedics had limited knowledge or awareness of the pilot, and pilot participants reported poor understanding of the pilot criteria or the rationale for the criteria.

Conclusions

Ambulance clinician involvement in rapid research pilots may be improved by using multiple recruitment methods (electronic and other), providing protected time for training and increased direct support for paramedics with lower personal capacity for research. Improved communication (including face-to-face approaches) may help understanding of eligibility criteria and increase appropriate recruitment.
PP29 Aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major in Pakistan: a qualitative study
Authors: Hammad Muhammad
Published: August 2022

Background

Chronic patients with thalassemia major were mainly recognized as more prone to bad mental health during COVID-19 pandemic. However, why this populace has confronted these detrimental effects, how they have skilled them and the way they have coped, stays under-explored.

Aim

The aim was to evaluate the aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major and to identify the coping strategies to overcome the effects.

Methods

The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 21 patients with thalassemia major selected through probability consecutive sampling. All interviews were recorded, transcribed, and analysed with reflexive thematic analysis.

Results

The most commonly described mental health condition was depression and concern of overall health status.

Seven associated pandemic elements contributed in deterioration of mental health: i) Isolation at home, ii) Disrupt transfusion services, iii) Change in appetite and interests, iv) Uncertainty and lack of control, v) Intensive media coverage, vi) Worsening of chronic health problems, vii) Difficulty in sleeping.

Four coping strategies were identified for maintaining mental health: i) Practicing gratitude ii) Engaging in hobbies and activities, iii) Stay connected with others, iv) Discern social support.

Conclusions

Thalassemia major patients had been negatively affected during the pandemic. However, it seems a temporary respite for few, drew upon reserves of resilience and tailored their coping techniques to hold high quality wellbeing.
03 Home truths and long lies? Ambulance calls to fallen patients in residential care facilities within an English clinical commissioning group
Authors: Miller Josh , Barlow Andrew , Khashu Vivek
Published: August 2022

Background

Fallen patients who remain immobile for prolonged periods are at risk of rhabdomyolysis and pressure ulcers. Local factors such as training, equipment, and policies may impact whether residential care staff call emergency services for the fallen patient, rather than residential staff managing their care.

Methods

We used routine computer-aided dispatch data within one urban Clinical Commissioning Group (CCG), during the period 1st April 2021 to 31st October 2021, identifying all falls attended by ambulance at nursing, care or residential facilities. We used the percentage of fallen patients not conveyed to hospital as a proxy measure suggesting that homes were calling ambulance services for patients who may only have needed assistance from the floor, while recognising that there are other reasons why patients may have ambulance attendance and not be transported.

Results

Within the CCG, there were 763 ambulance attendances for falls in nursing, care or residential facilities within the seven-month period, with a median response time of 87 minutes (IQR 28-207). 315 (41%) of these calls were non-conveyances. The calls came from 126 homes across the CCG, which demonstrated marked variation from 35 (28%) having no non-conveyed falls, through to 11 (9%) having only non-conveyed falls – no patients taken to hospital. We identified 17 homes who had both high rates of non-conveyed falls and high overall rates of fallers (top quintile for each), and shared this with the relevant CCG, who found that local factors such as ‘no-lift’ policies and lack of equipment do exist at some of these sites.

Conclusions

Fallen patients in residential homes experience long waits for ambulance care, but two-fifths of these patients receive no onward hospital transport. A low-burden query of routine data identified a group of care homes where initiatives around training, equipment and policies might improve the care of these patients.
PP30 Comparing on-scene times and conveyance rates in medical, traumatic and psychiatric presentations to the ambulance service
Authors: Corrall Richard , Marks Dougie
Published: August 2022

Background

Whilst psychiatric presentations represent 10-12% of ambulance service demand, research into such presentations is disproportionately sparce. This study builds on literature which explores psychiatric dispositions by comparing conveyance rate and on-scene times with other common ambulance service presentations.

Methods

This study was a single centre retrospective observational study investigating on scene time and conveyance rate variances between medical, traumatic and psychiatric presentations to the ambulance service. Call timings and disposition were recorded from computer aided dispatch data and clinical impressions from associated electronic patient records were used to categorise cases. 720 records were sampled between January and December 2019, consisting of 20 randomised cases per month per case type.

Results

Analysis of variance identified a statistically significant effect of case type on on-scene time (F(2,717) = 7.14), p = 0.001, η2= 0.02) and conveyance rate (F(2,717) = 8.59, p < 0.001, η2= 0.02). Across all dispositions patients medical cases required 8.18 fewer minutes (p < 0.001, 95% CI[3.65,12.7]) on-scene than psychiatric cases and 6.67 fewer minutes (p = 0.004, 95% CI[2.14,11.19]) than trauma cases. Psychiatric on-scene times were 9.9 (p = <0.001, 95% CI [3.53, 16.29]) and 10 (p = 0.001, 95% CI [4.37, 15.70]) minutes longer than medical and trauma cases where patients were not conveyed to hospital. Conveyance rates were 15% (p = 0.001, 95% CI[-0.23, -0.06]) lower and 17% (p < 0.001, 95% CI[-0.26, -0.08]) lower in psychiatric and trauma cases respectively than medical cases.

Conclusion

Psychiatric on-scene times were longer than medical presentations irrespective of conveyance and longer than both medical and traumatic presentations where patients were not conveyed. Conveyance rates in psychiatric presentations were lower than medical cases. Further research is required to understand factors which may contribute to this variation and how this may impact on service and care delivery.
PP32 Airway management of cardiac and respiratory arrest patients in the pre-hospital environment
Authors: Clarke Liam , Shaw Joanna , Fothergill Rachael
Published: August 2022

Background

Successful airway management is a fundamental part of cardiac and respiratory arrest care. Since our last airway management record review in 2010, the supraglottic airway (SGA) has replaced endotracheal intubation (ETI) as the primary advanced airway intervention, and the i-Gel has become the SGA device of choice. This re-audit aimed to assess for improvements since 2010 and ensure all aspects of essential and advanced airway management are being carried out effectively.

Methods

A retrospective review of 384 cardiac and respiratory arrest clinical records were assessed against standards of care derived from national and local ambulance service guidance.

Results

Improvement was evidenced in the following areas: clearance of the patient’s airway (+14%; 100%, n=237/237); use of simple manoeuvres (+11%; 99%, n=377/382), and documentation of high flow oxygen (+12%; 88%, n=336/381). There was a reduction in the documented use of simple adjuncts (-2%; 86%, n=320/373). An advanced airway was attempted for 100% (n=325/325) of patients clinically indicated to receive one and was successful for 98% (n=317/325). An SGA was attempted for 100% (n=290/290) of clinically indicated patients, and an ETI for 98% (n=116/118). EtCO2 values were recorded for 98% (n=309/317) of patients, and 79% (n=249/317) had a capnograph printout submitted showing a box wave-form.

Conclusions

Findings indicate improvements since 2010 in many areas of essential airway management, and that advanced airways were frequently successfully placed, with the SGA the most commonly used method. However, further improvement is required in the documentation of the administration of high flow oxygen, the use of simple adjuncts, and the submission of capnography printouts. To ensure a focus on these areas, amendments have been proposed to the Trust’s continual audit process which allows for individualised feedback tailored to each clinician.
PP33 Use of point of care ultrasound in prehospital care: an interview study
Authors: Akanuwe Joseph , Niroshan Siriwardena Aloysius , Bidaut Luc , Mitchell Pauline , Bird Paul , Lasserson Dan , Lilford Richard
Published: August 2022

Background

Point of Care Ultrasound (PoCUS) is a currently available and rapidly developing technology but still not widely used in the UK. Prehospital PoCUS could help to prioritise initial treatment, procedures and appropriate patient conveyance.

A recent literature review suggests that the image quality, portability and cost of ultrasound devices are improving with widening indications for prehospital PoCUS but evidence of prehospital use and impact is needed in the UK. We aimed to explore the views of practitioners (who use ultrasound in practice) on the potential role of PoCUS and the facilitators associated with its use in prehospital care.

Methods

We conducted a qualitative interview study using purposive sampling through social media and a snowballing technique to recruit eligible participants. Individual interviews were conducted online via Microsoft Teams. The interviews were recorded, transcribed and analysed using a Thematic Framework approach assisted by NVivo 12 software until data saturation.

Results

In total, 16 practitioners aged between 36 and 62 years, with a range of professional backgrounds including paramedics and prehospital emergency physicians, participated in interviews. Participants identified several facilitators to support a widespread implementation of PoCUS in prehospital care: resource requirements for purchase and deployment of devices, sufficient time and a skilled workforce; paying special attention to training, education and support needs; ensuring there is proper organisational governance, guidelines and quality assurance; and including supportive staff, champions and leadership in workforce considerations. Enabling ease of use in aiding decision making and taking unintended consequences or incidental findings into consideration; and more robust evidence to support perceptions of improved patient outcomes and experience, were also identified as facilitators.

Conclusions

Prehospital PoCUS could be a useful intervention for improving care processes and patient health outcomes. However, the facilitators identified should be considered for a widespread implementation of prehospital PoCUS.
PP35 Predictors and effects of prehospital feedback: protocol for a mixed-methods diary study
Authors: Wilson Caitlin , Budworth Luke , Janes Gillian , Lawton Rebecca , Benn Jonathan
Published: August 2022

Background

Emergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.

Methods

This will be an observational mixed-methods study involving a baseline survey, diary entries and a follow-up survey. The emphasis of data collection is quantitative survey data, which is supported by qualitative open-ended survey items that will be integrated using triangulation. Data analysis will involve logistic regression (baseline survey), multilevel modelling (diary entries) and content analysis (qualitative data). The baseline survey includes questions on demographics, feedback frequency and the Feedback Environment Scale (Steelman et al., 2004). Participants will be asked to complete 10 diary entries for an event where feedback is received and 5 diary entries where feedback is desired but not received. Eligible participants will be NHS ambulance staff delivering face-to-face patient care. Power calculations suggest a sample size of n=325 participants.

Results and Conclusion

The findings from this study will demonstrate how feedback characteristics, person and environment variables influence reported feedback effects in the prehospital setting and highlight missed opportunities for feedback.
PP37 Examining the potential for uncontrolled organ donation after out-of-hospital cardiac arrest in Canada – a sub analysis of the canROC registry
Authors: Lanos Chelsea , Drennan Ian , Batt Alan , Solimon Karim , Lin Steve , Vaillancourt Christian , Dhanani Sonny , Cook Dominique , Jenkins Sue
Published: August 2022

Background

In 2020, there were 4,352 people waiting for organ transplantation in Canada. A rise in demand has led to national exploration of non-traditional pathways for organ donation to increase the potential pool of donors and subsequent transplant recipients. Donation after Cardiac Death (DCD) has become a promising option across Canada and in other jurisdictions worldwide. One unexplored aspect to uncontrolled DCD (uDCD) in Canada is the inclusion of patients who suffer an out-of-hospital cardiac arrest (OHCA) into the pool of potential donors, of which there are an estimated 40,000 each year in Canada. The primary objective of this study is to quantify the potential pool of donors that would be eligible for uDCD subsequent to OHCA. This will allow us to understand how many potential donors are being missed when treated, but not transported after an OHCA.

Methods

A retrospective observational cohort study will be undertaken, using pre-existing data from the Canadian Resuscitation Outcomes Consortium (CanROC) registry, a pan- Canadian registry that collects prospective OHCA data. Consecutive OHCA cases from January 1, 2016 - December 31, 2018 meeting inclusion criteria will be included.

Results

Descriptive analysis will be used to examine patient and event characteristics, and determine the proportion of patients who meet the indication for uDCD. Results will be reported as mean (standard deviation [SD]) or median (interquartile range [IQR]) for continuous variables and frequency (%) for categorical variables.

Conclusions

Preliminary literature review suggests uDCD subsequent to OHCA is a viable opportunity to increase the donor pool in Canada. Presently, there is a lack of understanding of this pool of potential donors, and no programs exist in Canada to recruit from this population. In order to determine if pursuing uDCD subsequent to OHCA to improve organ donation rates is worthwhile, we must first quantify its potential.
PP39 Emergency service provider perspectives of feasibility and acceptability of emergency services distribution of take home naloxone
Authors: Sampson Fiona C , Hughes Jane , Long Jaqui , Buykx Penny , Snooks Helen
Published: August 2022

Introduction

Naloxone is an effective emergency antidote to opioid overdose. Increasing availability of take-home naloxone (THN) may reduce overdose deaths from heroin and other opiate drugs. We explored stakeholder perspectives of the processes, feasibility and acceptability of THN distributed in emergency settings as part of a feasibility study for a randomised controlled trial (RCT).

Methods

We conducted qualitative semi-structured interviews (12 participants) and a focus group (8 participants) with Emergency Department staff and paramedics. We transcribed interviews verbatim and used Normalisation Process Theory to guide data collection and analysis.

Results

Participants perceived emergency service provision of THN as a low cost, low risk intervention and demonstrated coherence in understanding the aims of the trial and how it related to their work practices. Paramedics in particular recognised benefits of THN as distinct from naloxone alone and valued the additional provision of training and education, compatible with ‘making every contact count’. Participants reported limited opportunities for THN provision to this cohort due to low engagement from eligible patients, but perceived there to be high potential benefit for a subset of emergency service users who would not otherwise access THN. Provision of THN to patients during the trial was low due to limited numbers of eligible patients, high turnover of trained staff and recruitment pauses due to protocol changes and Covid-19. Determination of effectiveness was perceived to be challenging within a trial due to high levels of community provision of THN. There was overall support from ED and paramedic staff for the roll out of emergency setting provision of THN as standard practice, outside the confines of a trial.

Conclusions

Distribution of THN in emergency settings appears to be feasible and acceptable for stakeholders and may widen access to THN for users not engaging with wider community drug services. Further RCTs of THN in emergency settings may be limited by difficulties in recruitment and limited opportunity to recruit new patients, where THN provision from other settings is widespread.
04 People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, ‘hypos can strike twice’: a mixed methods process evaluation
Authors: Laparidou Despina , Botan Vanessa , Law Graham R , Rowan Elise , Smith Murray D , Brewster Amanda , Spaight Robert , Spurr Keith , Mountain Pauline , Dunmore Sally , James June , Roberts Leon , Khunti Kamlesh , Niroshan Siriwardena Aloysius
Published: August 2022

Background

Hypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and self-managed if expert support (e.g., education on lifestyle and treatment) is provided. Our aim was to conduct a process evaluation to investigate how ambulance staff and PWD perceived the ‘Hypos can strike twice’ booklet-based ambulance clinician intervention.

Methods

We used an explanatory sequential design with a self-administered questionnaire study followed by interviews of PWD and ambulance staff. We followed the Medical Research Council framework for process evaluations of complex interventions to guide data collection and analysis. Following descriptive analysis and exploratory factor analysis, multiple regression models were fitted to identify demographic predictors of overall and subscale scores.

Results

113 ambulance staff members and 46 PWD completed the survey. We conducted interviews with four ambulance staff members and five PWD who had been attended by an ambulance for a hypoglycaemic event. Overall, there were positive attitudes to the intervention from both ambulance staff and PWD. Although the intervention was not always implemented, most staff members and PWD found the booklet informative, easy to read and to use/explain. PWD who completed the survey reported that receiving the booklet reminded and/or encouraged them to test their blood glucose more often, adjust their diet, and have a chat/check up with their diabetes consultant. Interviewed PWD felt that the booklet intervention would be more valuable to less experienced patients or those who cannot manage their diabetes well. Participants felt that the intervention could be beneficial but were uncertain about whether it can prevent a second hypoglycaemic event and/or reduce the number of repeat ambulance attendances.

Conclusions

The ‘Hypos may strike twice’ intervention was found to be feasible, acceptable to PWD and staff, prompting reported behaviour change and help-seeking from primary care.
PP45 ‘Every day was a learning curve’: the experience of implementing COVID-19 triage protocols in UK ambulance services – a qualitative study
Authors: Porter Alison , Bell Fiona , Brady Mike , Brown Shona , Carson-Stevens Andy , Duncan Edward , England Louise , Evans Bridie , Foster Theresa , Gallanders John , Gunson Imogen , Harrington Barbara , Harris-Mayes Robert , Kingston Mark , Lyons Ronan , Miller Elisha , Newton Andy , Quinn Tom , Rosser Andy , Siriwardena Niro , Snooks Helen , Spaight Robert , Watkins Alan , Williams Victoria
Published: August 2022

Background

TRIM is an evaluation of the models used to triage and manage emergency ambulance service care for patients with suspected Covid-19 during the first wave of the pandemic in 2020. We aimed to understand experiences and concerns of clinical and managerial staff about implementation of triage protocols in call centre and on-scene.

Methods

Research paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and ED clinical staff from one hospital per site. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from the implicit and explicit ideas within participants’ accounts, following the six stages of analysis described by Braun and Clarke, conducted by a group of researchers and PPI partners working together.

Results

We identified the following themes:

Constantly changing guidelines– at some points, updates several times a day

The ambulance service as part of the wider healthcare system- changes in other parts of the healthcare system left ambulance services as the default option

Peaks and troughs of demand- demand fluctuated greatly over time, with workload varying across the ambulance service, including an increased role for clinical advisors

A stretched system -resources to respond to patient demand were stretched thinner by staff sickness and isolation, longer job times, and increased handover delays at ED

Emotional load of responding to the pandemic -particularly for call centre staff

Doing the best they can in the face of uncertainty -in the face of a rapidly evolving situation unlike any which ambulance services had faced before

Discussion

Implementing triage protocols in response to the Covid-19 pandemic was a complex and process which had to be actively managed by a range of front line staff, dealing with external pressures and a heavy emotional load.