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 2022; 38:e14612.

Laparidou D, Botan V, Law G, Rowan E, Smith M, Brewster A, Spaight R, Mountain P, Dunmore S, James J, Roberts L, Khunti K, Siriwardena AN. People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, “Hypos can strike twice”: A mixed methods process evaluation. BMC Emergency Medicine 2022; 22:1.

Smith MD, Ridyard C, Botan V, Brewster A, Dunmore S, James J Khunti K, Laparidou D,  Law G,  Mountain P, Roberts L, Rowan E Spaight R, Spurr K, Siriwardena AN. Model-based economic evaluation of the effectiveness of “‘Hypos’ can strike twice”, a leaflet-based ambulance clinician referral intervention to prevent recurrent hypoglycaemia. PLoS One 2023; 18(3): e0282987.

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.

Dr Vanessa Botan was winner of the Highest Quality Research prize at the 999 EMS Research Forum conference in 2021 and was invited and presented as prizewinner at the Australasian College of Paramedicine International Conference (ACPIC) 2021.

Laparidou D, Botan V, Law GR, Rowan E, Smith MD, Brewster A, Spaight R, Spurr K, Mountain P, Dunmore S, James J, Roberts L, Khunti K, Siriwardena AN. People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, ‘hypos can strike twice’: a mixed methods process evaluation. Emergency Medicine Journal 2022;39:e5.

Despina Laparidou won the award for the most innovative use of routine data for her poster presenting the process evaluation of the study, ‘The effects of a booklet-based intervention, “Hypos can strike twice”, on recurrent ambulance attendances for hypoglycaemic episodes and the ambulance staff and patients’ perceptions of it’ at the 999 EMS Research Forum conference in 2022.
Impact This study showed that a simple booklet, given along with advice from ambulance crews, reduced the need for further emergency callouts for low blood sugar (hypoglycaemia) in people with diabetes. It helped people recognise early warning signs and manage their own condition. It shows the importance of helping people with diabetes to understand their condition and how to manage hypoglycaemia and the role of the ambulance crew in helping them to do this.

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 has been implemented by East Midlands and other ambulance services through NIHR ARC East Midlands.

The team has shared the booklet, which is freely available for services to print and use, with all ambulance services in the UK. More work is being considered to refine the intervention based on the feedback received in this trial. The team are exploring translating the booklet into other languages to make it accessible for community groups and developing an app based on it. The Ambu-HS2 intervention and study has been publicised through an NIHR alert at NHS Evidence and a YouTube animation.

 

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