Specialist Paramedic Rotations And Their Impact on Non-conveyancE Decisions (SPRAINED)

December 11, 2019 updated by: Yorkshire Ambulance Service NHS Trust

The Effect of a Specialist Paramedic Primary Care Rotation on Appropriate Non-conveyance Decision: a Controlled Interrupted Time Series Analysis

The National Health Service (NHS) in the United Kingdom is facing a 5% increase in demand every year for urgent and emergency care services, and there is evidence that patients are being taken to hospitals by ambulance services when they do not need to go. This is a problem because emergency departments are becoming more crowded, which can lead to poorer quality care. Also, less ambulances are available to respond to emergencies, because they are queueing at hospital for a long time.

To improve the care Yorkshire Ambulance Service provide to their patients, some paramedics have received additional training. These advanced paramedics have been very successful at treating patients in their own home safely. However, their training is long and expensive, so another role, the specialist paramedic role has been introduced. Their training does not take as long and is cheaper to provide. However, the specialist paramedics do not appear to keep patients safely at home more often than regular paramedics. Recently, the specialist paramedics have taken part in a national paramedic programme, where they are given the chance to work in GP surgeries and emergency call centres.

This study aims to see if specialist paramedics who have worked in a GP surgery for 10 weeks, can keep patients at home safely, and without costing too much, more often than regular paramedics.

Study Overview

Status

Unknown

Detailed Description

The National Health Service (NHS) in the United Kingdom is facing a 5% year-on-year increase in demand for urgent and emergency care services. In 2018/19, ambulance services in England provided a face-to-face assessment to nearly 7.9 million incidents, of which 7.6 million were conveyed to hospital. This conveyance rate of around 69% is occurring despite an increase in urgent cases and is placing increasing demands on already crowded emergency departments (EDs), leading to decreased availability of ambulances as turnaround times at hospitals increase. ED overcrowding is a significant issue for patients, resulting in poorer quality of care, increased healthcare costs and potentially, increased mortality.

Yorkshire Ambulance Service have been early adopters of initiatives to address inappropriate conveyance, and have had paramedics working in the role of Emergency Care Practitioners (ECP), since 2004. ECPs consistently have non-conveyance rates double that of other paramedics in the Trust. More recently, the specialist paramedic (SP) role has been introduced, although the educational programme is less substantial than that of the ECPs, and non-conveyance rates have been no different to other paramedics within the Trust.

In 2018, Health Education England funded a pilot scheme to rotate paramedics into a range of healthcare settings, with the aim of improving patient care and relieving pressures on primary care, ambulance services and other parts of the NHS in a sustainable way. This pilot also presents an opportunity to develop SPs and potentially, improve their rates of appropriate non-conveyance which may deliver patient and cost-benefits of the role as originally anticipated.

This study aims to evaluate whether the paramedics who have rotated into primary care, are appropriately and cost-effectively increasing the level and trend of non-conveyance decisions compared to a matched control population of YAS paramedics.

This study will use a dataset comprised of non-identifiable, routinely collected, ambulance service data to undertake a controlled interrupted time series analysis. This is one of the strongest quasi-experimental designs to detect change in the level and trend of paramedic appropriate non-conveyance decisions. The cost-effectiveness analysis will examine the cost per appropriate non-conveyance achieved for patients receiving care from paramedics who have completed a 10-week rotation in a GP surgery compared with those receiving care from paramedics who did not take part in the primary care rotational pilot.

Study Type

Observational

Enrollment (Anticipated)

33600

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • West Yorkshire
      • Wakefield, West Yorkshire, United Kingdom, WF2 0XQ
        • Yorkshire Ambulance Service NHS Trust

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

N/A

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

All face-to-face patient care episodes that were attended by one of the 10 rotational paramedics between the 1st June, 2017 to 31st December, 2019 and an additional cohort of patients who have receive a face-to-face assessment by paramedics who have not taken part in the GP rotation.

Description

Inclusion Criteria:

  • Incident date 12 months before or after the 10 week rotational pilot period
  • Adult patient receiving a face-to-face assessment by a paramedic taking part in the primary care rotation pilot, or
  • Matched adult patient who receive a face-to-face assessment by a paramedic not taking part in the rotation pilot
  • Has a completed paper or electronic patient care record.

Exclusion Criteria:

  • Patient under the age of 18 years of age

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Rotational paramedic pilot group
Ten paramedics underwent a 10 week rotation into a GP practice in the Leeds area of South Yorkshire, England.
Paramedic control group

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in proportion and trend of safe non-conveyance
Time Frame: 12 months
Change in proportion of appropriate non-conveyance decision by paramedics immediately following a 10-week rotation in a GP surgery, and the trend in non-conveyance decision in the 12-month period following the rotation
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Anticipated)

January 1, 2020

Primary Completion (Anticipated)

January 2, 2020

Study Completion (Anticipated)

April 1, 2020

Study Registration Dates

First Submitted

December 6, 2019

First Submitted That Met QC Criteria

December 6, 2019

First Posted (Actual)

December 10, 2019

Study Record Updates

Last Update Posted (Actual)

December 16, 2019

Last Update Submitted That Met QC Criteria

December 11, 2019

Last Verified

December 1, 2019

More Information

Terms related to this study

Other Study ID Numbers

  • YASRD128

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

No plans to make this dataset available to other researchers.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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