Comparing Triage and Direct Transfer to Specialist Care Centres with Delivery to the Nearest Hospital

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Project title A Systematic Review of Clinical Outcome and Cost Effectiveness Comparing a Policy of Triage and Direct Transfer to Specialist Care Centres with Delivery to the Nearest Local Hospital.
Funding body National Institute for Health Research Service Delivery and Organisation (NIHR SDO)
Total funding £135,928
Team 
  • Dr Alastair Pickering, School of Health & Related Research (ScHARR), University of Sheffield (Chief Investigator)
  • Professor Jon Nicholl, School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Suzanne Mason, School of Health & Related Research (ScHARR), University of Sheffield
  • Fiona Campbell, School of Health & Related Research (ScHARR), University of Sheffield
  • Rosemary Harper, School of Health & Related Research (ScHARR), University of Sheffield
  • Mike Holmes, School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Niroshan Siriwardena, School of Health & Social Care, University of Lincoln
  • Professor Matt Stevenson, School of Health & Related Research (ScHARR), University of Sheffield.
Overarching aim To enable evidence-based policy decisions about the reconfiguration of hospital and pre-hospital services; specifically on the clinical and cost effectiveness of bypassing local hospitals to transfer emergency patients directly to specialist care centres.
Objectives 
  • Perform a systematic review of the evidence for a policy of triage and direct transfer to specialist care centres in three clinical conditions. These are: Multi-system trauma (classed as major/severe), Stroke and Head injury
  • Identify previous relevant reviews that compare directly the clinical effectiveness of different transfer strategies
  • Identify current recommendations for best practice for acute management of the three clinical presentations specified
  • Develop evidence-based models for each decision-making strategy with assessment of both clinical and cost-effectiveness, including potential secondary effects of service reconfiguration
  • Provide recommendations for areas of primary research.
Methods
  • Systematic Review including randomised and non-randomised controlled studies, published and unpublished grey literature to identify relevant studies
  • Decision Analysis Modelling to identify strategies that are both clinically and cost effective for each of the conditions under review..
Outcomes explored in the systematic review 
  • Mortality measured at pre-hospital; seven days; and 30 days post-event
  • Morbidity measured using validated outcome measures including: Barthel Index; Glasgow Outcome Scale; Medical Outcomes Study Short Form (SF36); and Nottingham Health Profile
  • Length of stay
  • Time on intensive care
  • Patient satisfaction, using tools such as the Picker Patient Experience Questionnaire or Patient Satisfaction Questionnaire
  • Impact on existing service provision, using previous health impact assessments and identification of any quantifiable data, secondary effects on local catchment area patients
  • Costs and utilities data specific to identify incremental costs per Quality Adjusted Life Year (QALY).
Outputs
  • Publication of the systematic review in peer-reviewed journals
  • Oral and poster presentations at national and international conferences. A priority would be for a published report being demonstrated to local policy makers within the Strategic Health Authority for feedback and comments.
Impact  Significant findings would be highlighted to the Department of Health as potential suggestions for changes in policy and practice.

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