Brian Power
Doctorate
Doctorate Title: An evaluation of the safety of, and criteria for, the implementation of pre-hospital ‘treat and referral’ strategies for hypoglycaemia and seizure in Ireland.
Doctorate Description: Prior to the establishment of the Pre-Hospital Emergency Care Council (PHECC) in 2000 the emphasis on pre-hospital emergency care practice in Ireland was on rapid assessment and ‘load and go’ with treatment en-route to an emergency department (ED). This modality can have significant benefits for time-critical emergencies and should not be discarded. The increase in the scope of practice has however resulted in pre-hospital practitioners now managing some complex medical emergencies on-scene. The culture of rapid transport, however, continues to militate against alternative disposition decisions.
Unscheduled care is associated with disease processes such as diabetes and epilepsy. When an acute event is abated by pre-hospital practitioners a decision should then be made on an appropriate clinical care pathway that is most appropriate for the patient’s clinical needs. Routinely transferring all patients to an ED, regardless of clinical needs, adds to the over already stretched ED system. International research has identified a lack of evidence in relation to the safety, costs, and benefits of ‘treat and referral’ as one of those potential clinical care pathways.
In Ireland inappropriate lodging of patients, admitted to hospital, on ED trollies overnight has risen three-fold in the three years to January 2018. Previous research has indicated that treat and referral could reduce ED visits by up to 7%.
Objective:
To evaluate the safety of, and proposed criteria for, the implementation of pre-hospital ‘treat and referral’ strategies for two common medical emergencies (hypoglycaemia and seizure) in Ireland.
Conclusion:
High levels of support exist among PHECC practitioners for alternative care pathways for patients who have recovered from seizure or hypoglycaemia.
Approximately 40% of patients attending ED following a seizure or hypoglycaemia episodes met the research safety criteria for potential suitability for treat and referral.
Approximately 5% of seizure patients and 10% of hypoglycaemia patients who receive an ambulance response refuse to travel to ED. Of these patients, almost 90% met the research safety criteria for treat and referral.
Of the currently available hospital/ ED triage tools REMS is most promising for pre-hospital emergency care use with a sensitivity of 89% when identifying patients suitable for treat and referral.
Patient safety is always a concern with new initiatives therefore appropriate training of PHECC practitioners is required prior to being privileged for this scope of practice.
Implementation of interventional research in the Irish EMS system may be compromised by the complex operational and professional environment in which it is rolled out.
Efficiencies in both ambulance service and ED resources would be achieved following the introduction of treat and referral.
Details:
Type: PhD
University: University College Dublin
Primary Supervisor: Prof Gerard Bury
Category: Other
Funding:
Start Date: 2012
End Date: 2020
Status: Complete
Thesis
Awaiting
Research Interests
Publications
Power B, Bury G, Ryan J. Stakeholder opinion on the proposal to introduce 'treat and referral' into the Irish emergency medical service. BMC Emerg Med. 2019;19(1):81
Power B, Bury G. A survey of general practitioner's opinion on the proposal to introduce 'treat and referral' into the Irish emergency medical service. Ir J Med Sci. 2020;189(4):1457-63.
Power B, Bury, G, Ryan, J. Clinical presentations and practitioner levels appropriate for the introduction of ‘treat and referral pathway(s)’ into the Irish Emergency Medical Service: A survey of Consultants in emergency medicine. Irish Journal of Paramedicine. 2020.
Paramedic PhD is endorsed by:
