Effect of implementing an ambulance clinician delivered hypoglycaemia intervention (‘Hypos can strike twice’) on repeat ambulance calls, attendances and transportation to hospital: non-randomised stepped wedge and process evaluation (Ambu-HS2)

PROJECT TITLE EFFECT OF IMPLEMENTING AN AMBULANCE CLINICIAN DELIVERED HYPOGLYCAEMIA INTERVENTION (‘HYPOS CAN STRIKE TWICE’) ON REPEAT AMBULANCE CALLS, ATTENDANCES AND TRANSPORTATION TO HOSPITAL: NON-RANDOMISED STEPPED WEDGE AND PROCESS EVALUATION (AMBU-HS2)
Funding body National Institute for Health Research Applied Research Collaboration East Midlands
Total funding  £65,618
Team
  • Prof Niro Siriwardena, CaHRU, University of Lincoln
  • Mrs Amanda Brewster, Public and Patient Involvement representative from Healthier Ageing PPI (HAPPI) group
  • Mr Keith Spurr, Public and Patient Involvement
  • Mrs Pauline Mountain, Public and Patient Involvement representative, HAPPI group
  • Mrs Sally Dunmore, East Midlands Ambulance Service NHS Trust (EMAS)
  • Mrs June James, Diabetes Nurse Specialist
  • Rob Spaight, EMAS
  • Dr Leon Roberts, EMAS
  • Dr Murray D. Smith, CaHRU, University of Lincoln
  • Ms Despina Laparidou CaHRU, University of Lincoln
  • Dr Elise Rowan, CaHRU, University of Lincoln
  • Prof Kamlesh Khunti, Leicester Diabetes Centre, University of Leicester
  • Prof Graham Law, CaHRU, University of Lincoln
  • University of Lincoln
  • Healthier Ageing PPI group
  • University of Leicester
  • East Midlands Ambulance Service NHS Trust
Overarching aim To evaluate the effect of implementing the ‘Hypo’s can strike twice’ intervention to patients with diabetes and hypoglycaemia attended by East Midlands Ambulance Service NHS Trust in the rural East Midlands region.
Objectives To investigate the effect of implementing the ‘Hypo’s can strike twice’ on:

  1. Repeat ambulance calls and attendances for hypoglycaemia;
  2. Recorded referrals to an appropriate healthcare professional (e.g. GP, nurse);
  3. Completed care bundle for hypoglycaemia (proportion of patients with all of blood glucose recorded before treatment, blood glucose recorded after treatment and treatment given for hypoglycaemia;
  4. Costs of implementation ‘Hypo’s can strike twice’ intervention vs costs of health service resource use;
  5. To conduct a process evaluation to explore how ‘Hypo’s can strike twice’ exerts its effects and can be scaled up if effective by understanding implementation, mechanisms of impact, and contextual factors using interviews and surveys
Methods Non-randomised stepped wedge design with mixed-methods process evaluation.
Outcomes If the new process of care is found to work, this will help prevent recurrence of “hypo”, improve patients’ future health, reduce unnecessary calls to ambulance services or transport of patients to the Emergency Department, and thus reduce pressures and costs for ambulance services and hospitals nationally by over £1 million.
Outputs Peer reviewed research and conference presentations.

Publications

Botan V, Law G, Laparidou D, Rowan E, Smith M, Ridyard C, Brewster A, Spaight R, Spurr K, Mountain P, Dunmore S, James J, Roberts L, Khunti K, Siriwardena AN (). The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study. Diabetic Medicine 38:e14612.

Presentations

Botan V, Law GR, Laparidou D, Rowan E, Smith MD, Ridyard C, Brewster A, Spaight R, Spurr K, Mountain P, Dunmore S, James J, Roberts L, Khunti K, Siriwardena AN. The effects of a leaflet-based intervention, ‘hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study. EMJ 2021;38: A1. Oral presentation awarded prize for highest quality research (Sponsor – Health and Care Research Wales) at 999EMS research Forum Conference online 23 March 2021.

Impact Improved ambulance to community hypoglycaemia care pathways for diabetes have been approved nationally by the Association of Ambulance Chief Executives and National Ambulance Services Medical Directors (NASMed), and this intervention has been shown to be effective, reducing repeat ambulance attendances for hypoglycaemia. It is being implemented by East Midlands and other ambulance services through NIHR ARC East Midlands.

 

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