Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)-protocol for the mixed-methods observational RADOSS project.

INTRODUCTION: Ambulances services are asked to further reduce avoidable conveyances to emergency departments (EDs). Risk of Adverse Outcomes after a Suspected Seizure seeks to support this by: (1) clarifying the risks of conveyance and non-conveyance, and (2) developing a risk prediction tool for clinicians to use 'on scene' to estimate the benefits an individual would receive if conveyed to ED and risks if not. METHODS AND ANALYSIS: Mixed-methods, multi-work package (WP) project. For WP1 and WP2 we shall use an existing linked data set that tracks urgent and emergency care (UEC) use of persons served by one English regional ambulance service. Risk tools are specific to clinical scenarios. We shall use suspected seizures in adults as an exemplar.WP1: Form a cohort of patients cared for a seizure by the service during 2019/2020. It, and nested Knowledge Exchange workshops with clinicians and service users, will allow us to: determine the proportions following conveyance and non-conveyance that die and/or recontact UEC system within 3 (/30) days; quantify the proportion of conveyed incidents resulting in 'avoidable ED attendances' (AA); optimise risk tool development; and develop statistical models that, using information available 'on scene', predict the risk of death/recontact with the UEC system within 3 (/30) days and the likelihood of an attendance at ED resulting in an AA.WP2: Form a cohort of patients cared for a seizure during 2021/2022 to 'temporally' validate the WP1 predictive models.WP3: Complete the 'next steps' workshops with stakeholders. Using nominal group techniques, finalise plans to develop the risk tool for clinical use and its evaluation. ETHICS AND DISSEMINATION: WP1a and WP2 will be conducted under database ethical approval (IRAS 307353) and Confidentiality Advisory Group (22/CAG/0019) approval. WP1b and WP3 have approval from the University of Liverpool Central Research Ethics Committee (11450). We shall engage in proactive dissemination and knowledge mobilisation to share findings with stakeholders and maximise evidence usage.

Optimising impact and sustainability: a qualitative process evaluation of a complex intervention targeted at compassionate care.

BACKGROUND: Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery. OBJECTIVES: To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings. METHODS: Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4). RESULTS: Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning. CONCLUSIONS: Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability.

Creating learning environments for compassionate care: a programme to promote compassionate care by health and social care teams.

BACKGROUND: The consistent delivery of compassionate health and social care to older people is a matter of global concern to the nursing profession and the public it serves. The development and evaluation of effective interventions to address this concern is of prime importance. AIMS AND OBJECTIVES: This paper draws on findings from previous research to propose the use of a novel implementation programme designed to improve and support the delivery of compassionate care by health and social care teams. INTERVENTION: Creating Learning Environments for Compassionate Care (CLECC) is a 4-month implementation programme designed for hospital ward nursing teams caring for older people, but relevant to other teams working with other client groups. The programme focuses on using workplace learning to promote change at unit/ward/team level by enabling the development of leadership and team relational practices which are also designed to enhance the capacity of individual team members to relate to older people. Existing research evidence suggests that optimising relational capacity in this way will support the delivery of compassionate care. CONCLUSIONS: This evidence-based intervention is designed to develop and sustain the relational work required by managers and team members to support care delivery and has the potential to address widely documented variations in care quality. IMPLICATIONS FOR PRACTICE: Attention should now be paid to establishing the feasibility of the intervention in practice.

Speech and language therapy in Sure Start Local Programmes: a survey-based analysis of practice and innovation.

BACKGROUND: Sure Start has been a flagship policy for the UK Labour Government since 1998. Its aim was to improve the life chances of children under five years of age who live in areas of socio-economic disadvantage by means of multi-agency, multidisciplinary Sure Start Local Programmes (SSLPs). Speech and language therapists have played a key part in many SSLPs, and have had the opportunity to extend their roles. Despite the scrutiny paid to Sure Start, there has been no comprehensive analysis of speech and language therapists' contribution to date. Studies have focused on individual programmes or small samples: there has been no attempt to collate the full range of practice. As Sure Start evolved and Children's Centres emerged, it became vital to learn from the Sure Start experience and inform the mainstreaming of practice, before the window of opportunity closed. AIMS: The survey aims were, firstly, to identify the range of practice amongst speech and language therapists working in SSLPs, highlighting new practice, and, secondly, to categorize the practices according to the tiered model of UK health and social services of the Royal College of Speech and Language Therapists (RCSLT 2006). METHODS & PROCEDURES: An online mixed-method, semi-structured survey was designed to elicit primarily quantitative and categorical data. A total of 501 Sure Start Local Programmes were invited to take part. A total of 128 speech and language therapists responded, giving a response rate of 26%. A descriptive analysis of the response data was undertaken. OUTCOMES & RESULTS: A total of 103 respondents (80%) reported maintaining a clinical role as well as extending their roles to include preventative services. Of those 103 respondents, 69% were able to see referred children at a younger average age and 80% saw them more quickly than before Sure Start. A wide variety of preventative practice was identified. A widening of access to speech and language therapist was reported in terms of venues used and hours offered. Respondents reported on their use of evaluation or outcome measures, which was at a higher rate for new practice than for established practice. A total of 121 respondents (95%) reported at least one example of new practice; 103 (80%) reported at least one use of evaluation or outcome measures. The tiered model of UK health and social services provided an effective way of categorizing practice. CONCLUSIONS & IMPLICATIONS: A categorized record of Sure Start speech and language therapist is presented that may contribute to establishing a broad curriculum of practice for speech and language therapist in the early years. The effectiveness of the practices is not investigated: suggestions are made for further research to develop the evidence base.

Development and preliminary validation of a measure for assessing staff perspectives on the quality of clinical group supervision.

BACKGROUND: In the UK clinical supervision is regarded as an essential process supporting quality improvement within the clinical governance framework, and the Royal College of Speech and Language Therapists regards it as a tool for promoting critical reflective practice. There is limited evidence of the impact on practice or improvements in healthcare quality, and the need for an evaluation instrument specifically tailored to group supervision. AIMS: To develop a measure for assessing staff perspectives on the quality of clinical group supervision and its impact on the quality of care. METHODS & PROCEDURES: A self-completion questionnaire was devised to measure staff perceptions of purpose, process and impact of clinical group supervision. Items were developed through an inductive process of consultation, peer and literature review. The questionnaire's content validity was assessed. The questionnaire was then administered to 57 subjects who had received approximately 1 year of clinical supervision to evaluate acceptability, factor structure and convergent validity. OUTCOMES & RESULTS: Response rates were 91% (52/57). Principal component factor analysis suggested a three-factor structure, the first three factors accounting for 72.4% of the total variance. Items loaded appropriately onto purpose, process and impact. These three dimensions were positively and moderately correlated. Internal consistency reliability (Cronbach's alpha = 0.86) indicated that the 14 items could be regarded as a scale. The overall CSEQ score was positively correlated with a single question assessing 'general opinion' about the CS program (Spearman's rho = 0.79, p < 0.001) giving evidence for convergent validity. CONCLUSIONS: The questionnaire is concise, easy to complete and simple to analyse, and appears to be a reliable and valid measure of staff perceptions of quality of clinical group supervision. Further studies with larger sample sizes and including other groups of health professionals are needed to confirm the validity and reliability of the CSEQ.