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Care provided to patients by emergency ambulance services is changing nationally and internationally. For example the proportion of 999 calls in England resulting in conveyance to hospital fell from 68% in 2007-8 to 55% in 2012-3. Professor Snooks of Swansea University and colleagues have collaborated with clinicians, policy makers and academics to identify approaches more cost-effective than routine conveyance to Emergency Departments (EDs) for many patients. International application of Snooks's evidence that telephone advice, decision support and referral pathways are safe and effective has reduced unnecessary attendance at EDs and costs without compromising patient experience, safety or quality of care.
The emergency care team at Warwick Medical School has a strong track record of high-quality health sciences research encompassing evidence synthesis, health-services research and clinical trials. Our trials of a 03b2-agonist (salbutamol) in acute respiratory distress syndrome (ARDS) have influenced therapeutic recommendations in the International Sepsis Guidelines (2013), reducing the use of this potentially detrimental therapy. Our cardiac arrest research informed the 2010 international guidelines on cardiopulmonary resuscitation (CPR) led to the generation of new intellectual property, and prompted industrial collaborations to build new technologies, such as TrueCPRTM (2013). These have led to improved CPR practice and improved patient survival. Furthermore, our research has led to major policy changes and to a redesign of UK emergency healthcare, improving cost efficiency, the patient experience and clinical outcomes (e.g. 95% of patients were treated within 4 hours - up from 65%; and people leaving without been seen reduced to less than 5%).
Improving patient experience of health services is a policy priority worldwide. The University of Manchester (UoM) has conducted research on patient experience since 1995, leading to the development of a series of validated measures for assessing patient experience of quality of care in primary care, including access to care and the degree to which services are patient-centred. Our measures have been in routine use in the NHS since 2004, sent to samples of several million patients. The data have been used to provide incentives for the highest quality practices, and to inform policy makers about current care throughout the UK.
Research conducted at the University of Manchester (UoM) has shaped the design of national systems of accreditation for general practice in the UK, Europe and beyond. Accreditation systems set standards that reflect key aspects of the organisational systems and processes in general practice that are needed to ensure delivery of good quality care. Accreditation systems also provide a kite mark of quality assurance and act as a platform for supporting continuous quality improvement. UoM developed indicators of quality in general practice structure and organisation and demonstrated how they could be used effectively to improve quality. Working in partnership with health professional organisations, governmental organisations and other universities, UoM used knowledge from the research to develop systems for general practice accreditation now used in the UK and across Europe.
Beneficiaries of this research are patients in intensive care and healthcare staff. This research has had impacts in two distinct but related areas:
These advances are informed by our synthesis and application of rigorous, innovative methodologies relating to questionnaire development and real-time data collection.
The research has led to the design of a new clinical pharmacy service model, centred on community pharmacies, to improve the care of patients with palliative care needs living in the community. This resulted in better provision of information for patients (and their carers) and new training resources and staff development opportunities for the multi-disciplinary palliative care team. Funding has been secured to rollout the new service across NHS Greater Glasgow and Clyde Health Board (NHS GGC - 1.2M population) in 2013. The research has also supported a successful bid to explore the service model in a remote and rural Health Board (NHS Highland) and has informed specific programmes of Macmillan Cancer Support UK, pharmacy workforce planning, and the Boots Macmillan Information Pharmacists initiative.
Accurate recording of adult SPC activity using the revised MDS has resulted in the transformation of SPC services. The MDS provides economic benefits by informing the planning and funding of local services by capturing full service costs and is being used to develop a new NHS funding system for SPC. Informing accurate audit and national benchmarking of services, it shows how revised service composition, enhanced day care, and seven day services, are contributing to reduced hospital admissions. This has both policy and economic benefits. It demonstrates how services are addressing SPC provision for non-malignant disease, a key policy driver.
The ability of healthcare professionals to empathise with patients has been shown to enhance patient satisfaction, improve symptoms and promote well-being. Research at University of Glasgow has developed the Consultation and Relational Empathy (CARE) Measure — the first validated, patient-rated questionnaire developed in a primary care setting that measures patient perceptions of healthcare professionals' empathy and quality of care. The CARE Measure is formally embedded into healthcare professional training standards through its inclusion in Scottish General Practitioner (GP) appraisals and the Royal College of General Practitioners Membership (MRCGP) and Interim Membership by Assessment of Performance (iMAP) processes; through these means more than 8,000 GPs are using the CARE Measure. It has also been incorporated into the Scottish Government's policy on Healthcare Quality and adopted by the General Medical Council and the Chartered Society of Physiotherapy.
We have developed the first ever physiotherapy guidelines (2008-) for contracted (frozen) shoulder (CFS). CFS is painful and disabling, affects c.9% of the UK working-age population,1 and costs the NHS > £13.5 million annually.2 Appropriate physiotherapy could improve outcomes and reduce costs by up to £2,000 per case.b
Endorsed by the Chartered Society of Physiotherapy (CSP), the guidelines have generated great interest and already influenced practice and will improve the quality and cost-effectiveness of clinical management, as well as patients' experiences. They will also provide a better framework for research into the condition and, as a `live', electronic document, will evolve with future research.
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.