The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation

Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.

We observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.

Mechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.


Michelle Edwards, Cardiff University, Division of Population Medicine

Alison Cooper, Cardiff University, Division of Population Medicine

Thomas Hughes, John Radcliffe Hospital, Emergency Department

Freya Davies, Cardiff University, Division of Population Medicine

Delyth Price, Cardiff University, Division of Population Medicine

Pippa Anderson, Swansea University, Swansea Centre for Health Economics

Bridie Evans, Swansea University, Swansea University Medical School

Andrew Carson-Stevens, Cardiff University, Division of Population Medicine

Jeremy Dale, Warwick University, Academic Primary Care

Peter Hibbert, Macquarie University, Centre for Healthcare Resilience and Implementation Science

Barbara Harrington, Cardiff University, Division of Population Medicine

Julie Hepburn, Cardiff University, Division of Population Medicine

Aloysius Niroshan Siriwardena, University of Lincoln, Community and Health Research Unit

Helen Snooks, Swansea University, Swansea University Medical School

Adrian Edwards, Cardiff University, Division of Population Medicine


Probation and COVID-19: Lessons learned to improve health-related practice

Probation staff perform a health-related role involving identifying health-related drivers of offending behaviour; facilitating access to support for these, including continuity of care for people leaving prison; and advising the courts on appropriate sentencing. This study analyses data from probation staff surveys and interviews with people that were under probation supervision during the pandemic to investigate the impact of the response to the pandemic on a) this health-related role, b) the lived experience of accessing health support whilst engaging with probation, and c) partnership working and pathways into healthcare for people under probation supervision


University of Lincoln, College of Social Science

Coral Sirdifield, University of Lincoln, School of Health and Social Care

Helen Nichols, University of Lincoln, School of Health and Social Care

Phillip Mullen, Revolving Doors Agency


 

The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation

Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.

We observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.

Mechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.

We recommend service improvement strategies, operational management, monitoring, evaluation and training to ensure that ED nurses stream patients presenting at an ED seeking urgent care to the most appropriate clinicians for their needs in a safe and efficient manner.


University of Lincoln, College of Social Science Research

Michelle Edwards, Cardiff University, Division of Population Medicine

Alison Cooper, Cardiff University, Division of Population Medicine

Thomas Hughes, John Radcliffe Hospital, Emergency Department

Freya Davies, Cardiff University, Division of Population Medicine

Delyth Price, Cardiff University, Division of Population Medicine

Pippa Anderson, Swansea University, College of Human and Health Sciences, Swansea Centre for Health Economics

Bridie Evans, Swansea University, Swansea University Medical School

Andrew Carson-Stevens, Cardiff University, Division of Population Medicine

Jeremy Dale, Warwick University, Academic Primary Care

Peter Hibbert, Macquarie University, Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science

Barbara Harrington, Cardiff University, Division of Population Medicine

Julie Hepburn, Cardiff University, Division of Population Medicine

Niro Siriwardana, University of Lincoln, School of Health & Social Care, Community and Health Research Unit

Helen Snooks, Swansea University, Swansea University Medical School

Adrian Edwards, Cardiff University, Division of Population Medicine


 

The effect of slow-wave sleep and rapid eye-movement sleep interventions on glycaemic control: a systematic review and meta-analysis of randomised controlled trials

Poor glycaemic control is found in diabetes, one of the most common, serious, non-communicable diseases worldwide. Trials suggest a relationship between glycaemic control and measures of sleep including duration and quality of sleep. Currently, the relationship between specific sleep stages (including slow-wave sleep (SWS), a sleep stage mainly found early in the night and linked to restorative functioning) and glycaemic control remains unclear. This systematic review aimed to synthesise the evidence of the effectiveness of specific sleep stage manipulation on measures of glycaemic control (insulin resistance, fasting and post-prandial glucose and insulin). Public databases (eg psychINFO, MEDLINE, Academic Search Complete, psychARTICLES, OpenDissertations, Scopus and Cochrane library) were searched for randomised controlled trials. Trials were included if they involved direct manipulation of SWS and/or rapid eye-movement sleep to explore the impact on measures of glycaemic control (insulin resistance, fasting and post-prandial glucose and insulin). Eight trials met the eligibility criteria, with four providing data for inclusion in one of the three meta-analyses. Insulin resistance was significantly higher in the SWS disruption when compared to the normal sleep condition, (p = 0.02). No significant differences were found for measures of fasting or post-prandial glucose or insulin. Risk of bias was considered low for performance bias, detection bias and incomplete outcome data, with unclear selection bias. This is an emerging area of research and this review provides preliminary findings and recommendations for future research around optimising sleep stage disruption (to further explore mechanisms) and sleep stage enhancement techniques (to explore potential interventions).


University of Lincoln, College of Social Science

Jennifer Johnson, University of Lincoln, Lincoln Sleep Research Centre and School of Health and Social Care

Simon Durrant, University of Lincoln, Lincoln Sleep Research Centre and School of Psychology

Graham Law, University of Lincoln, Lincoln Sleep Research Centre and School of Health and Social Care

Joao Santiago, University of Tübingen, Institute of Medical Psychology and Behavioural Neurobiology; German Center for Diabetes Research and University of Tübingen, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich

Eleanor Scott, University of Leeds, School of Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine

Ffion Curtis, University of Lincoln, Lincoln Sleep Research Centre and Leicester General Hospital, Biological Sciences and Psychology, Diabetes Research Centre, College of Medicine


 

Prehospital Research Methods and Practice

Bringing together a team of leading international experts in the field of research, this book provides an up-to-date and accessible overview of applied research methods in the prehospital environment.

Written to support the needs of the paramedicine, emergency medicine and wider healthcare communities in this rapidly advancing research setting, the authors introduce the key areas of research design and methods, evidence-based practice, ethics and quality improvement for both the novice and the more advanced researcher. Relevant examples of prehospital research are also included to fully explain and illustrate the key approaches.

High-quality, robust evidence is of the utmost importance to inform prehospital clinical practice and ensure better patient care. This book is essential reading for anyone interested in undertaking research within the prehospital or emergency care setting, including undergraduate and postgraduate students in paramedic science, medicine, nursing and allied health.


University of Lincoln, College of Social Science Research

Gregory Whitley, University of Lincoln, School of Health and Social Care

Niro Siriwardena, University of Lincoln, School of Health and Social Care


A systematic review of practitioner enquiry into adverse childhood experiences in primary care

This article presents the findings of a systematic review undertaken to assess adverse childhood experiences (ACE) enquiry among practitioners of primary care for children’s services. Literature was eligible for inclusion if it included the primary care practitioner experience of ACE enquiry, was published from 1998–2021 and was in English. The most frequently cited themes across all included studies were time and training, with time the most commonly cited barrier. The findings indicate that aspects of the health visitor service model include facilitators to integrate ACE enquiry into routine health visitor practice, although the research highlights barriers of time and resources. Further research is required to expand the limited evidence base for incorporating ACE enquiry into health visitor practice in the UK and to similar models of care internationally.


University of Lincoln, College of Social Science Research

Louise Ashe, Derbyshire Community Health Service NHS Trust

David Nelson, University of Lincoln, Lincoln International Institute for Rural Health

Aneesa Lindau, Chesterfield Royal Hospital NHS Foundation Trust

Ian McGonagle, University of Lincoln, School of Health and Social Care

Ros Kane, University of Lincoln, School of Health and Social Care


 

Evidence-based Practice for Nurses and Allied Health Professionals

This book guides nursing and healthcare students through the central concepts of evidence-based practice to help them gain a critical understanding of what evidence is, why it is important and how it should be applied in healthcare.

The new edition reflects contemporary approaches to practice, drawing from lessons learned during the Covid-19 pandemic, and includes a new chapter on the difference between evaluation, audit and research.

Key features:

  • Includes interesting activities and case studies which help consolidate learning
  • Provides a collection of critiquing tools and templates to use when reading research and evidence

Unpacks the terminology that comes with this subject in a detailed glossary

 

 

Mapping the Characteristics of Residents Using Temporary Housing on Lincolnshire’s East Coast and their Exposure to Risk Factors for Type 2 Diabetes

In the UK, approximately 17% of the population reside in coastal areas. Coastal communities are increasingly being identified as areas of growing risk for poor health and social outcomes. A recent report by the Chief Medical Officer highlights the unique health challenges faced by people who reside in coastal areas and Lincolnshire’s coastal communities, particularly the towns of Mablethorpe and Skegness in the district of East Lindsey, are amongst the most deprived in the country.

An important subgroup of Lincolnshire’s coastal communities are residents using ‘temporary’ housing (RUTH). Historically the coastal community has hosted a large number of caravans, chalets and other forms of temporary housing to accommodate large numbers of holiday makers. Over time the quantity and quality of this accommodation has changed and there has been an increase in the number of people choosing to use this housing option as a long-term residence. This has resulted in the emergence of what we might call long term RUTH.

Little is known about RUTH in the UK. Anecdotal evidence suggests that a significant proportion of long-term RUTH do not connect with local health and social care services (including registration with general medical practices) but have high health and care needs; they are older, present with multiple chronic health conditions and high levels of limiting long-term illness and disability. These characteristics increase their risk for developing type 2 diabetes or for poor control and management of existing diabetes. Undetected or uncontrolled type 2 diabetes generates significant cost pressure for health services and causes premature death, healthy life expectancy and long-term disability.

This project was funded by the National Institute for Health Research (NIHR) Clinical Research Network (CRN) East Midlands to conduct scoping work with Lincolnshire’s East Coast RUTH community who are potentially at risk of type 2 diabetes but experience inequity of access to diabetes prevention and management services. The work supports engagement with RUTH through three connected work packages. The first work package, which is the focus of this report1 involves mapping the numbers, demographics and geographical distribution of RUTH as well as their likely health needs related to diabetes prevention and management.

This first part of the research was to quantify and document the extent of the RUTH population on the East Coast of Lincolnshire and their exposure to type 2 diabetes.

To meet this aim we asked the following question(s):
Research Question 1: What is the geographical distribution of RUTH?
Research Question 2: What are the general characteristics and demographics of RUTH?
Research Question 3: What are the area-based indicators for type 2 diabetes risk where RUTH populations live?


University of Lincoln, College of Social Science Research

Dr David Nelson, Dr Maxime Inghels and Prof. Mark Gussy, Lincoln International Institute for Rural Health


Patient-maintained versus anaesthetist-controlled propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia: a randomised controlled trial

Patient-maintained propofol TCI sedation (PMPS) allows patients to titrate their own target-controlled infusion (TCI) delivery of propofol sedation using a handheld button. The aim of this RCT was to compare PMPS with anaesthetist-controlled propofol TCI sedation (ACPS) in patients undergoing elective primary lower-limb arthroplasty surgery under spinal anaesthesia.


David W. Hewson, Nottingham University Hospitals, Queen’s Medical Centre, Department of Anaesthesia and Critical Care Medicine
Frank Worcester, Nottingham Trent University, Medical Engineering Design Research Group
James Sprinks, Nottingham Trent University, Medical Engineering Design Research Group
Murray D. Smith, University of Lincoln, Community and Health Research Unit
Heather Buchanan, University of Nottingham, Division of Rehabilitation and Ageing
Philip Breedon, Nottingham Trent University, Medical Engineering Design Research Group
Jonathan G. Hardman, Nottingham University Hospitals, Queen’s Medical Centre, Department of Anaesthesia and Critical Care Medicine
Nigel M. Bedforth, Nottingham University Hospitals, Queen’s Medical Centre, Department of Anaesthesia and Critical Care Medicine