What are the highest priorities for research in pre-hospital care? : Results of a review and Delphi consultation exercise

Abstract

Background: A recent national review of English ambulance services, Taking Healthcare to the Patient: Transforming NHS Ambulance Services,1 published by the Department of Health, recommended that pre-hospital care research topics should be prioritised to ensure that service provision and development are evidence based wherever possible and that limited available funds are targeted to the most pressing needs. Study objectives: To identify gaps in research evidence related to delivery of pre-hospital care; and to rank topics in order of priority for research. Methods: Research priorities were initially identified by delegates at the UK Ambulance Service Association’s annual conference, AMBEX 2006. An examination of research reviews in pre-hospital care identified other research evidence gaps. Relevant websites, databases and review bibliographies were also searched. Management, service delivery and treatment recommendations in UK policy/guidance documents published since 2000 were matched to research evidence. A list of evidence gaps was circulated in a Delphi-style three-round consultation to experts in pre-hospital care, including clinicians, managers and researchers. Round 1 confirmed/identified research gaps; Round 2 focussed on ranking topics; and Round 3 reviewed the scores and provided an option to rescore. Scores were analysed using SPSS. Results: Ninety-six research issues were identified for circulation and prioritisation from 52 reviews and expert consultation and these were matched against 30 policy and guidance documents. Forty people participated in the Delphi exercise. The subject receiving highest priority for research was the development of new performance measures other than emergency ambulance response times. Other highly ranked priorities included treatment of stroke, cardiac conditions, children and people who self-harm; alternatives to Accident and Emergency (A&E) treatment; patient information sharing across care providers; access issues; decision support systems; and demand management systems for pre-hospital care. These priorities reflect three key issues: measuring activity to benefit patients; development of safe non-A&E care; and providing appropriate evidence-based clinical care in the pre-hospital environment. Implications: There are many evidence gaps related to current pre-hospital policy and practice including management, clinical and service delivery issues. This Delphi consultation combines expertise of clinicians, managers and researchers to generate consensus on future research priorities in pre-hospital care. The need to develop meaningful performance measures plus alternative methods of patient management illustrates the synergistic relationship between service delivery and performance measurement. It suggests an opportunity to identify alternatives to response times as indicators of quality of pre-hospital care. The final results from this study will be useful to commissioners when developing their strategic approach to decision making about which research should be funded to facilitate continued development of quality patient care in the pre-hospital setting.