Summary of the impact

Professor Dawson's and Dr Scott's research is focused on the area of `patient safety and quality in health care delivery'. It includes the first prospective trial of falls risk in cognitively impaired patients and has led to: safer and better quality patient care transfers; guidance on the prevention of falls; and improved quality of care for frequent callers to ambulance services. Impact is achieved through patient care partnerships in the delivery of: safe interventions and care packages; local and national guidance for safe interventions; adherence to a falls prevention programme; and a unique engagement with Yorkshire Ambulance Service.

Underpinning research

Dawson was a founder member of this research area which began in 1996 with a successful competitive bid of £70k from NHS Executive (NHSE) Regional R&D fund over the period 1996-1998. The primary aim, to develop an effective multidisciplinary approach for risk management of falls in cognitively impaired elderly patients, was achieved through a randomised controlled trial (RCT). This project, in partnership with Newcastle University, was the first of its kind to systematically evaluate the impact of multi-disciplinary falls prevention strategies in older people with dementia [1].

A further successful competitive bid (1999-2001) for £124K from the NHSE Regional R&D enabled a second RCT — `SAFER 2: Syncope and falls in the emergency room' — to be undertaken. This research investigated falls risk in people with a history of falls attending accident and emergency departments [2].

Dawson's research extended its remit to investigate environmental and community dimensions of healthcare on falls risk. In order to facilitate the application of research into practice Dawson worked with a local action group (2008 to 2010) to transfer existing evidence, from previous RCTs, into realistic interventions. The outcome, the `Staying Steady' project, was a targeted community based primary and secondary prevention initiative [3] that has benefitted hundreds of people in the community.

Building on the success of the `Staying Steady' project, and in response to an increasing number of older people at risk of falls, the research focused on older people diagnosed with Non-Alcoholic Fatty Liver Disease. This research identified barriers to service delivery and investigated ways to improve adherence and compliance for patients undergoing a gold standard, evidence-based, exercise intervention to manage fatigue and falls risk. This project was enhanced through the use of a qualitative approach to explore the views and experiences of older people and physiotherapists on self-management and adherence with exercise-based falls prevention [4].

Professor Dawson managed to secure a full-time PhD studentship which facilitated Scott's inclusion in the team. The study investigated the combination of public involvement and patient safety in exploring patient perceptions during care transfers [5] and the development of a tool for patients to report on their own safety. In 2013 Dr Scott and Professor Dawson were awarded a Health Foundation grant of approximately £186,000 to further develop this research, with a study entitled `Patient reporting of safety in organisational care transfers (PRoSOCT)'. This research will test the feasibility of a patient reporting tool in identifying latent conditions within healthcare systems and pilot the tool with NHS patients discharged from care of the elderly, stroke, cardiovascular and orthopaedic wards. Other service providers, including ambulance services, will also participate in the study.

This research builds on existing partnerships with ambulance services, including Yorkshire Ambulance Service and North East Ambulance Service, where Dawson and Scott are leading on innovations to improve quality of care provided to patients who frequently call 999 [6]. A systematic review of evidence has been published and Dr Scott co-convened and chairs the Frequent Caller National Network (FreCaNN) for all ambulance services in England.

References to the research

Details of the impact

Professor Dawson's and Dr Scott's research has impacted on a wide range of services through: patient involvement and partnerships; development and delivery of safe interventions; and a quality improvement tool, led by patients.

Professor Dawson's `Staying Steady' research still exists as a community intervention providing a community-based exercise initiative for falls prevention [5.1 and 5.2], for which 298 people have downloaded the Staying Steady Falls Prevention Leaflet up to 25/11/2013.

The Department of Health Partnerships in Older People Programme (£200k, 2006-8 Action Research Evaluation of Northumberland `Fit, Involved, Safe', Healthy Networks for Falls Prevention) was a successful bid to evaluate a large scale community based programme of falls prevention [5.3].

Professor Dawson was a key member of the Patient Safety Education Study Group in 2009 which developed guidance on patient safety in pre-registration health care curricula. This was a multi-site national research project funded by a competitive bid to the Department of Health National Patient Safety Agency Patient Safety Research Programme. The study was based on the belief that what is taught to students in formal education is not necessarily what is then seen or done in practice. The study explored the formal and informal ways pre-qualification students from four health care professions (Medicine, Nursing, Pharmacy and Physiotherapy) learn about keeping patients safe from errors, mishaps and other adverse events [5.4].

The patient reporting of safety research, originally conducted as part of Dr Scott's PhD, was conducted in collaboration with Safer Care North East (SCNE), a programme of safety work conducted by the North East Strategic Health Authority (SHA). At the request of the SHA, the research was conducted in the clinical theme of care transfers, discharges and handovers; one of nine clinical themes identified under the SCNE programme. The research was used as a case study to inform safe transfers throughout the region by the Patient Safety Action Team at the SHA, and was used in the SCNE final report [5.5]. In addition, the research has been used to inform the 2013 Health Foundation evidence scan `Involving patients in improving safety' under the `Service Improvement' heading, which provides information to help those involved in improving the quality of healthcare to understand what research is available [5.6].

In 2010 Professor Dawson's research paper `Professionals and the public' was cited, on the NIHR web page, in: Patient and Public Involvement in Health and Social Care Research: A Bibliography [5.7].

As part of the research with Yorkshire Ambulance Service (YAS) and North East Ambulance Service (NEAS), Dr Scott has been seconded to YAS to work alongside the frequent caller case manager, which has enabled research to inform practice within YAS and NEAS [5.8]. In particular, YAS developed a new database for frequent callers based on this research, which has allowed YAS proactively to monitor frequent callers and case manage those who are most frequent users [5.8].

In addition to his secondment, Dr Scott co-convened the Frequent Caller National Network (FreCaNN) for all ambulance services in England in April 2013, and now chairs the group which received the backing of the National Ambulance Service Medical Directors (NASMeD) group and reports into the Quality, Governance and Risk Directors group (QGARD). By collaborating with frequent caller case managers from every ambulance service in England, this is a role that reinforces the impact of the research in this area by ensuring direct applicability to practice, and informs both practice and policy on a national level [5.9].

The current Ambulance Quality Indicator (AQI) focuses upon locally agreed definitions of a frequent caller, which range from specific definitions (such as 15 or more calls in a 6 month period) to clinical judgment (identified based on a paramedic or call handler recognizing the same patient consistently). These approaches result in varying levels of practice, and Dr Scott has led the development of a proposal for a new AQI with all English ambulance services via FreCaNN. This has received the support of QGARD and has been submitted to the Association of Ambulance Chief Executives, to come into practice in April 2014.

Professor Dawson's and Dr Scott's research expertise in the area of safety facilitated their involvement in `An Independent Review of Care Home Closure and the Involuntary Relocation of Elderly Residents by the City of York Council.' This evaluation is part of the Moving Homes Safely programme which has informed the next stage of the City of York Council's relocation programme [5.10].

Sources to corroborate the impact

5.1 Staying steady programme 2008 to 2012
http://www.healthworksnewcastle.org.uk/our-projects/staying-steady/

5.2 Advanced Falls Practitioner, Freeman Hospital
Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN

5.3 Department of Health Partnerships in Older People Programme (£200k, 2006-8 Action Research Evaluation of Northumberland `Fit, Involved, Safe, Healthy Networks for Falls Prevention').

5.4 Patient Safety Education Study Group (2009) Patient Safety in Health Care Professional Education: Examining the Learning Experience. End of Project Report, HMSO.
http://www.haps.bham.ac.uk/publichealth/psrp/documents/PS030_PSRP_Report_FINAL_0609.pdf

5.5 Former Programme Manager, Safer Care North East.

5.6 Health foundation research scan: Involving patients in improving safety
http://www.health.org.uk/publications/involving-patients-in-improving-safety/

5.7 Professionals and the public: power or partnership in health research. Journal of Evaluation in Clinical practice, 2010.
http://www.rds-yh.nihr.ac.uk/_file.ashx%3Fthematic%2BPPI%2Bbibliography%2Blatest%2Bversion%2B5.doc

5.8 Director of Standards and Compliance at Yorkshire Ambulance Service and co-commissioner of the care transfer research.

5.9 Frequent Caller Case Manager, Yorkshire Ambulance Service.

5.10 Read, A., Scott, J. & Dawson, P. (2013). Moving homes safely. York: York St John University. ISBN: 978-1-906604-41-7.
http://www.york.gov.uk/downloads/download/2341/moving_homes_safely