Creating a decision support tool to help paramedics decide if their patients need to go to hospital
| ISRCTN | ISRCTN12121281 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN12121281 |
| IRAS number | 260505 |
| Secondary identifying numbers | IRAS 260505 |
- Submission date
- 02/03/2021
- Registration date
- 17/03/2021
- Last edited
- 19/05/2023
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
Paramedics have specialist knowledge and skills in helping people in emergencies. For example, if you are involved in a road traffic collision, house fire or if your heart stops. These events are quite rare, and the bulk of ambulance service patients who call have problems that are described as ‘urgent’. These cases are where you may need access to healthcare and medical help, but there is only a very small chance
your problem is life threatening.
The care of urgent patients is complex and trying to find the right place for their care can be hard. In 2014 in Yorkshire, up to 16.9% of patients could have avoided being taken by ambulance to the Emergency Department (ED). This group of patients had no special tests or treatments and were sent home. This means they had a minor problem that could have been managed elsewhere.
When the ED is busy, ambulances have to wait a long time to handover the care of their patients. In the winter of 2017 in England, 41,879 ambulance handovers took more than 1 hour. This delay stops ambulances being free to respond to the next emergency. These problems mean paramedics need to make sure the ED is the right place for their patient before they take them there.
This project aims to develop a tool to help with that decision. It is designed to show the paramedic the likelihood of ED being an avoidable experience if the patient was to be transported. They can apply this tool to all their patients.
Who can participate?
All patients who called an ambulance and received a face-to-face response between 1st July 2019 and 29th February 2020.
What does the study involve?
The first step will link data from the ambulance service with that from all Emergency Departments in Yorkshire between July 2019 and February 2020. This data will show the complete patient journey from their call for help through to leaving the ED. The data will be anonymised so the researchers will only be able to see what happened in a journey, not whose journey it was. This information will help create a tool that identifies patients who may not need to be taken to the ED. The next step will test the tool in different settings by subdividing the data. The tool will also be applied to a group of patients that were not transported to hospital.
What are the possible benefits and risks of participating?
The study will help to create a decision support tool so that future patients can get to the most appropriate healthcare setting, first time.
Where is the study run from?
Yorkshire Ambulance Service NHS Trust and the University of Sheffield (UK)
When is the study starting and how long is it expected to run for?
April 2019 to March 2022
Who is funding the study?
1. National Institute for Health Research (UK)
2. Health Education England (UK)
Who is the main contact?
Jamie Miles
j.miles@sheffield.ac.uk
Contact information
Scientific
Yorkshire Ambulance Service HQ
Springhill 1, Brindley way
Wakefield
WF2 0XQ
United Kingdom
 ORCID ID |
0000-0002-1080-768X |
|---|---|
| Phone | +44 (0)333 130 0550 |
| jamie.miles@nhs.net |
Study information
| Study design | Observational multi-centre cohort study using a retrospective linked dataset |
|---|---|
| Primary study design | Observational |
| Secondary study design | Cohort study |
| Study setting(s) | Other |
| Study type | Diagnostic |
| Participant information sheet | No participant information sheet available |
| Scientific title | The Safety INdEx of Prehospital On Scene Triage (SINEPOST): the derivation and internal validation of a risk prediction model to support ambulance transport decisions to the Emergency Department |
| Study acronym | SINEPOST |
| Study hypothesis | Primary research question: Can ambulance service clinical data predict an avoidable attendance at the ED in adults? Secondary research question: What is the simulated transportability of the model derived from the primary outcome? |
| Ethics approval(s) | Approved 11/11/2019, Yorkshire and the Humber - South Yorkshire Ethics Committee (Yorkshire & The Humber - South Yorkshire Research Ethics Committee, NHSBT Newcastle Blood Donor Centre, Holland Drive, Newcastle upon Tyne, NE2 4NQ, UK: +44 (0)207 104 8079; southyorks.rec@hra.nhs.uk), REC ref: 19/YH/0360 |
| Condition | Unselected (not selected by disease or demographic status) adult patients who called an ambulance and received a face-to-face response |
| Intervention | Transported ambulance patients will have the prehospital care record linked to the ED record and a new binary variable will be created as to whether the level of care they received in ED justified the transportation by ambulance. Models will then be built to predict the positive class (avoidable attendance). |
| Intervention type | Other |
| Primary outcome measure | An avoidable attendance at ED, defined as first attendance with some recorded treatments or investigations, all of which may have reasonably been provided in a non-emergency care setting, followed by discharge home or to GP care. Measured by combining elements of routinely collected ED clinical data once a patient is discharged from ED. |
| Secondary outcome measures | There are no secondary outcome measures |
| Overall study start date | 01/04/2019 |
| Overall study end date | 31/03/2022 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | Both |
| Target number of participants | 409937 |
| Total final enrolment | 409937 |
| Participant inclusion criteria | Cohort 1: 1. Age 18 years old or older 2. Transported to ED by Yorkshire Ambulance Service between 01/07/2019 and 29/02/2020 3. Have an ED Care record of the event 4. Assessed by a qualified ambulance clinician ((either paramedic (of any level) or technician grade II)) 5. Had an electronic patient care record completed 6. Transported to an ED between 01/07/2019 and 29/02/2020 7. Were handed over and booked in as a patient to the ED Cohort 2 1. Age 18 years or older 2. Assessed by a qualified ambulance clinician (either paramedic or technician grade II) 3. Had an electronic patient care record completed 4. Discharged on scene and not transported between 01/07/2019 and 29/02/2020 |
| Participant exclusion criteria | Cohort 1: 1. Patient cases where they were less than 18 years old at time of episode 2. Patient cases where they had five or more patient contacts within the data collection period Cohort 2: 1. Patient cases where they were less than 18 years old at time of episode 2. Patient cases where they had five or more patient contacts within the data collection period 3. Patient cases that were transported by the ambulance crew on scene |
| Recruitment start date | 01/07/2019 |
| Recruitment end date | 29/02/2020 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Springhill 1
Brindley Way
Wakefield
WF2 0XQ
United Kingdom
Barnsley
S75 2EP
United Kingdom
Wakefield
WF1 4DG
United Kingdom
Leeds
LS9 7TF
United Kingdom
Leeds
LS1 3EX
United Kingdom
Harrogate
HG2 7SX
United Kingdom
Lindley
Huddersfield
HD3 3EA
United Kingdom
Halifax
HX3 0PW
United Kingdom
Hull
HU3 2JZ
United Kingdom
Rotherham
S60 2UD
United Kingdom
York
YO31 8HE
United Kingdom
Steeton
Keighley
BD20 6TD
United Kingdom
Doncaster
DN2 5LT
United Kingdom
Sheffield
S5 7AU
United Kingdom
Bradford
BD9 6DA
United Kingdom
Dewsbury
WF13 4HS
United Kingdom
Scarborough
YO12 6QL
United Kingdom
Sponsor information
Hospital/treatment centre
Yorkshire Ambulance Service HQ
Springhill 1, Brindley Way
Wakefield
WF2 0XQ
England
United Kingdom
| Phone | +44 (0)7557955748 |
|---|---|
| jamie.miles@nhs.net | |
| Website | http://www.yas.nhs.uk/ |
"ROR" |
https://ror.org/01sawky49 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
No information available
Results and Publications
| Intention to publish date | 31/03/2022 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| Publication and dissemination plan | 1. Planned publication of the protocol in BMJ Open 2. Planned publication of the study results in a high-impact, peer-reviewed, open-access journal Strategy for disseminating to the public and patients: Public members will be invited to co-produce a video that will be created for the public. This will introduce the concept of not transporting all patients and using a tool to help clinicians with making the decision to transport or not. They will also be invited to co-author conference abstracts and present findings with the researcher. As the research progresses, a PI group formed out of the Sheffield Emergency Care Forum (SECF) and interested members of the RDS PI event will steer and develop further dissemination strategies. Strategy for disseminating to NHS: The research will be presented to the Association of Ambulance Chief Executives. This will be to highlight the findings and scope feasibility to implement nationwide. Contacts made at this level will be followed up at regional and local level. Contact with the National Leads for Urgent and Emergency Care will be maintained throughout the project and feedback will be invited from them at various stages. In addition, workshops will be put on for NHS staff and the work will be presented to the UECRT and the National Ambulance Commissioners Network (NEWS). A Lay executive summary will be produced in digital format to disseminate widely on stakeholders web pages. Strategy for disseminating to the wider population: The linked data used in the research uses the Systemized Nomenclature of Medical Clinical Terms (SNOMED-CT), which is an international recognised clinical terminology. This would allow the possibility of international integration. Contacts will be made at the PAIC conference for future studies. Reproducibility of the tool outside of the NHS would require a validation step including calibration and discrimination. Strategy for implementation: Areas for further research will be identified and grant applications will be made to secure funding. Once the model has been developed, there will be collaboration with NHSD. They will be the main route to implementation. There will also be an opportunity to work with industry partners who own patient care software. The clinical terminology that the variables are captured (SNOMED CT) is advantageous in implementing the tool as the National Information Board (NIB) has mandated all NHS organisations capture clinical information in this language. |
| IPD sharing plan | The data sharing plans for the current study are unknown and will be made available at a later date |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | 08/11/2021 | 19/05/2023 | Yes | No | |
| HRA research summary | 28/06/2023 | No | No |
Editorial Notes
19/05/2023: Publication reference added.
03/03/2021: Trial's existence confirmed by the NIHR.
