Electronic Patient Report Research Articles

Acceptance of Digital Health Technologies in Palliative Care Patients.

Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life.

Naloxone use by Aotearoa New Zealand emergency medical services, 2017-2021.

Emergency medical services (EMS) use of naloxone in the prehospital setting is indicated in patients who have significantly impaired breathing or level of consciousness when opioid intoxication is suspected. The present study characterised naloxone use in a nationwide sample of Aotearoa New Zealand road EMS patients to establish a baseline for surveillance of any changes in the future. A retrospective analysis of rates of patients with naloxone administrations was conducted using Hato Hone St John (2017-2021) and Wellington Free Ambulance (2018-2021) electronic patient report form datasets. Patient demographics, presenting complaints, naloxone dosing, and initial and last vital sign clinical observations were described. There were 2018 patients with an equal proportion of males and females, and patient median age was 47 years. There were between 8.0 (in 2018) and 9.0 (in 2020) naloxone administrations per 100 000 population-years, or approximately one administration per day for the whole country of 5 million people. Poisoning by unknown agent(s) was the most common presenting complaint (61%). The median dose of naloxone per patient was 0.4 mg; 85% was administered intravenously. The median observed change in Glasgow Coma Scale score was +1, and respiratory rate increased by +2 breaths/min. A national rate of EMS naloxone patients was established; measured clinical effects of naloxone were modest, suggesting many patients had reasons other than opioid toxicity contributing to their symptoms. Naloxone administration rates provide indirect surveillance information about suspected harmful opioid exposures but need to be interpreted with care.

Prevalence of psychological distress, quality of life, and satisfaction among patients and family members following comprehensive genomic profiling testing: Protocol of the Quality of life for Cancer genomics and Advanced Therapeutics (Q-CAT) study.

Precision medicine is rapidly changing the diagnostic and treatment spectrum of oncology. In May 2019, comprehensive genomic profiling (CGP) (somatic and/or germline) was approved for reimbursement in Japan. While the promise of novel and targeted therapies has elevated hopes for the benefits of CGP, the lack of relevant genomic findings and/or limited access to relevant therapies remain important themes in this field. These challenges may also negatively influence the psychology of both cancer patients and their family members. However, few studies have reported longitudinal data on quality of life (QOL) with CGP. Here, we report the protocol of a prospective study, Q-CAT (QOL for Cancer genomics and Advanced Therapeutics among patients and their family members), which aims to explore the mental burden on patients and families arising from the implementation of CGP testing by collecting real-world longitudinal data using outcomes obtained with an electronic patient report, known as ePRO. This study has been registered with the Japan Registry of Clinical Trials (jRCT1030200039).

A metamorphic cryptography approach towards securing medical data using chaotic sequences and Ramanujan conjecture

Medical Images has evolved from time to time and the need to protect sensitive information related to such images have also grown significantly. Nowadays data being the primary asset of an individual, protecting them has posed new challenges from time and again. With the advancement of the digital medium, the medical image has been at greater risk and there is an urgent need to protect the information and the raw pixel data of such images. This research focuses on ensuring the confidentiality of DICOM medical images and protecting the Electronic Patient Report (EPR) by applying both cryptographic and steganographic protection techniques. The encryption keys are generated using the Logistic Chaotic Map and Non-Linear Feedback Shift Register. the electronic patient report (EPR) is converted into a 9-space-format using Continued Fraction of Ramanujan conjecture and then using steganography techniques EPR is embedded into the Most Significant Bits of Medical Images. The final encrypted image contains the EPR as well as encrypted medical image. The key sequence used in order to encrypt the medical image is highly pseudo random and the Key Space Analysis depicted that the algorithm is very strong. This work has paved a better way of securely storing 16-bit DICOM medical images and EPR into the Picture Archive and Communication System repository. The proposed security model has shown promising results in comparison to other research and the various analysis did show significant improvements over past studies.

THU0313 DISEASE PATTERN AND TIME TO DIAGNOSIS IN A FAST-TRACK GIANT CELL ARTERITIS CLINIC USING ULTRASOUND AS PRIMARY DIAGNOSTIC TOOL

Background:Giant Cell Arteritis (GCA) is a vasculitis predominantly affecting the large vessels from aorta and its proximal branches and extra-cranial arteries. Precise and fast diagnosis is important in order to initiate proper treatment and avoid ischaemic events, e.g. irreversible visual loss. Unnecessary and prolonged glucocorticoid treatment is also unwanted due to its significant side effects. Therefore, immediate diagnosis of GCA is recommended, and the primary diagnostic tool, according to EULAR recommendation, is vascular ultrasound (US)1. In 2018, a GCA Fast-Track Clinic (FTC) was implemented in our department covering a population of approximately 900.000. Patients even with a low á-priori suspicion of GCA were accepted. It is the aim to have patients seen within one office day.Objectives:In this retrospective study, to describe clinical data from patients seen in the FTC in a 1-year period from September 1st, 2018 and to investigate the time required for making a diagnosis, and to which extent US as the primary diagnostic tool was adequate for making the final diagnosis.Methods:All patients, irrespective of clinical presentation, had US of bilateral temporal-, facial-, axillary and common carotid arteries done (exam time 30 min.). All US were done by ultrasonographers with experience and training in vascular US. Immediately after the initial US, patients were seen by a senior registrar in rheumatology at our out-patient clinic. The senior registrar was aware of the conclusion of the US. Decisions on further diagnostic procedures were solely up to this rheumatologist. From electronic patient report files, all patients’ clinical- and US-findings as well as results from other diagnostic procedures (temporal artery biopsy (TAB) and positron emission tomography computed tomography (PET-CT)) were evaluated. Furthermore, final diagnosis and fulfilment of ACR1990 classification criteria for temporal arteritis at three months was noted, as was the number of days required for diagnosis.Results:A total of 120 patients were seen in the FTC and had a vascular US done. Demographic and clinical data are seen in table 1. Of 120 patients, 42 (35%) had a clinical diagnosis of GCA at three months and 42% fulfilled ACR1990 criteria for temporal arteritis. Based on US alone, 36% of patients had GCA. A diagnosis or exclusion of GCA were done on median 1 day (in 55% of patients). However, in cases where further diagnostics (TAB and PET-CT) were necessary, the time for diagnosis increased substantially. See table 2 for data on waiting time from referral, diagnoses and time required for diagnosis.Table 1Demographic and clinical data (n=120)Females72%Age (years)74 (46-98)Symptom duration (days)16 (1-180)New onset headache72%Jaw claudication21%Temporal artery abnormality33%Visual symptoms42%Visual loss (permanent visual loss)18% (19%)Constitutional symptoms32%Fever11%Weight loss18%Polymyalgia symptoms33%Glucocorticoid therapy68%Duration of glucocorticoid (days)3 (1->365)Haemoglobin (mmol/L)8.0 (5.0-10.0)C-reactive protein (mg/L)22 (0-290)Sedimentation rate (mm/hr)38 (2-146)Values are percentage, median (range)Table 2Office days from referral to visit1 (0-20)Days for diagnosis/exclusion of GCA1 (1-46)GCA clinical diagnosis35%GCA ACR1990 criteria42%Nr. of US (% w. GCA)120 (36%)Nr. of PET-CT (% w. GCA)44 (23%)Nr. of TAB (% w. GCA)34 (21%)Polymyalgia diagnosis17%Arthritis diagnosis5%Other diagnosis17%Conclusion:In this newly established GCA FTC, fast and precise diagnosis of GCA or exclusion of this was possible in majority of patients referred, even though referral criteria were liberal. In 55% of patients, further diagnostic procedures were considered unnecessary, and a diagnosis on day 1 could be established based on US, clinical findings and existing paraclinical data.

Understanding how Eastern European migrants use and experience UK health services: a systematic scoping review

BackgroundThe UK has experienced significant immigration from Eastern Europe following European Union (EU) expansion in 2004, which raises the importance of equity and equality for the recent immigrants. Previous research on ethnic health inequalities focused on established minority ethnic groups, whereas Eastern European migrants are a growing, but relatively under-researched group. We aimed to conduct a systematic scoping review of published literature on Eastern European migrants’ use and experiences of UK health services.MethodsAn initial search of nine databases produced 5997 relevant publications. Removing duplicates reduced the figure to 2198. Title and abstract screening left 73 publications. Full-text screening narrowed this down further to 10 articles, with three more from these publications to leave 13 included publications. We assessed publications for quality, extracted data and undertook a narrative synthesis.ResultsThe included publications most commonly studied sexual health and family planning services. For Eastern European migrants in the UK, the most commonly cited barriers to accessing and using healthcare were limited understanding of how the system worked and language difficulties. It was also common for migrants to return to their home country to a healthcare system they were familiar with, free from language barriers. Familial and social networks were valuable for patients with a limited command of English in the absence of suitable and available interpreting and translating services.ConclusionsTo address limited understanding of the healthcare system and the English language, the NHS could produce information in all the Eastern European languages about how it operates. Adding nationality to the Electronic Patient Report Form (EPRF) may reveal the demand for interpretation and translation services. Eastern European migrants need to be encouraged to register with GPs to reduce A&E attendance for primary care conditions. Many of the issues raised will be relevant to other European countries since the long-term outcomes from Brexit are likely to influence the level of Eastern European and non-Eastern European migration across the continent, not just the UK.

Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme

BackgroundAmbulance service quality measures have focused on response times and a small number of emergency conditions, such as cardiac arrest. These quality measures do not reflect the care for the wide range of problems that ambulance services respond to and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme sought to address this.ObjectivesThe aim was to develop new ways of measuring the impact of ambulance service care by reviewing and synthesising literature on prehospital ambulance outcome measures and using consensus methods to identify measures for further development; creating a data set linking routinely collected ambulance service, hospital and mortality data; and using the linked data to explore the development of case-mix adjustment models to assess differences or changes in processes and outcomes resulting from ambulance service care.DesignA mixed-methods study using a systematic review and synthesis of performance and outcome measures reported in policy and research literature; qualitative interviews with ambulance service users; a three-stage consensus process to identify candidate indicators; the creation of a data set linking ambulance, hospital and mortality data; and statistical modelling of the linked data set to produce novel case-mix adjustment measures of ambulance service quality.SettingEast Midlands and Yorkshire, England.ParticipantsAmbulance services, patients, public, emergency care clinical academics, commissioners and policy-makers between 2011 and 2015.InterventionsNone.Main outcome measuresAmbulance performance and quality measures.Data sourcesAmbulance call-and-dispatch and electronic patient report forms, Hospital Episode Statistics, accident and emergency and inpatient data, and Office for National Statistics mortality data.ResultsSeventy-two candidate measures were generated from systematic reviews in four categories: (1) ambulance service operations (n = 14), (2) clinical management of patients (n = 20), (3) impact of care on patients (n = 9) and (4) time measures (n = 29). The most common operations measures were call triage accuracy; clinical management was adherence to care protocols, and for patient outcome it was survival measures. Excluding time measures, nine measures were highly prioritised by participants taking part in the consensus event, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to refine and prioritise measures and 20 measures scored ≥ 8/9 points, which indicated good consensus. Eighteen patient and public representatives attending a consensus workshop identified six measures as important: time to definitive care, response time, reduction in pain score, calls correctly prioritised to appropriate levels of response, proportion of patients with a specific condition who are treated in accordance with established guidelines, and survival to hospital discharge for treatable emergency conditions. From this we developed six new potential indicators using the linked data set, of which five were constructed using case-mix-adjusted predictive models: (1) mean change in pain score; (2) proportion of serious emergency conditions correctly identified at the time of the 999 call; (3) response time (unadjusted); (4) proportion of decisions to leave a patient at scene that were potentially inappropriate; (5) proportion of patients transported to the emergency department by 999 emergency ambulance who did not require treatment or investigation(s); and (6) proportion of ambulance patients with a serious emergency condition who survive to admission, and to 7 days post admission. Two indicators (pain score and response times) did not need case-mix adjustment. Among the four adjusted indicators, we found that accuracy of call triage was 61%, rate of potentially inappropriate decisions to leave at home was 5–10%, unnecessary transport to hospital was 1.7–19.2% and survival to hospital admission was 89.5–96.4% depending on Clinical Commissioning Group area. We were unable to complete a fourth objective to test the indicators in use because of delays in obtaining data. An economic analysis using indicators (4) and (5) showed that incorrect decisions resulted in higher costs.LimitationsCreation of a linked data set was complex and time-consuming and data quality was variable. Construction of the indicators was also complex and revealed the effects of other services on outcome, which limits comparisons between services.ConclusionsWe identified and prioritised, through consensus processes, a set of potential ambulance service quality measures that reflected preferences of services and users. Together, these encompass a broad range of domains relevant to the population using the emergency ambulance service. The quality measures can be used to compare ambulance services or regions or measure performance over time if there are improvements in mechanisms for linking data across services.Future workThe new measures can be used to assess different dimensions of ambulance service delivery but current data challenges prohibit routine use. There are opportunities to improve data linkage processes and to further develop, validate and simplify these measures.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Factors impeding the effective utilisation of an electronic patient report form during handover from an ambulance to an emergency department.

We investigated the reasons why the transition from paper to electronically formatted records during patient handover between ambulance crews and emergency department staff in a North East England Emergency Department has not always been viewed positively. Interviews with seven paramedics and three emergency department staff were conducted in addition to observations of 74 ambulance staff during 37 handovers in the emergency department. In just over half of the handovers (20), paramedics found it necessary to provide written information to aid emergency department staff, in addition to that recorded electronically. There were a number of issues that impeded the ready utilisation of electronic records in this context. The major factors identified as contributing to this were the choice of system architecture, the design of user interfaces, and the procurement process used by the National Health Service. We have made some suggestions about how the system could evolve from one focused on providing management information to one that also supports operational needs.

EPR data hiding in MRI head volumes for telemedicine using rectangular box embedding method

Mapping of electronic patient report (EPR) text file to magnetic resonance imaging (MRI) volumes increases burden to diagnosis over telemedicine. In this paper, we propose a high capacity, robust technique to select slices of interest (SOI) from a MRI volume that to embed EPR and transfer on a network. Embedding EPR along with selected slices is used to removal of mapping procedure at the receiver end. Initially brain extraction algorithm (BEA) is used to focus the region and ease of pathology detection in the slices. Then the embedding scheme uses the technique of rectangular box mapping (RBM) where it takes care of sensitive part of medical image. EPR data is encrypted and embedded for security purpose. Experimental results on security and robustness have been tested against various images. The proposed method can store longer EPR string along with better authenticity and confidentiality properties while satisfying all the requirements of medical data transfer and has achieved 51% reduction in bit rate than the traditional methods.

Increased Rates of Documented Alcohol Counseling in Primary Care: More Counseling or Just More Documentation?

Clinical performance measures often require documentation of patient counseling by healthcare providers. Little is known about whether such measures encourage delivery of counseling or merely its documentation. To assess changes in provider documentation of alcohol counseling and patient report of receiving alcohol counseling in the Veterans Administration (VA) from 2009 to 2012. Retrospective time-series analysis. A total of 5413 men who screened positive for unhealthy alcohol use at an outpatient visit and responded to a confidential mailed survey regarding alcohol counseling from a VA provider in the prior year. Rates of provider documentation of alcohol counseling in the electronic health record and patient report of such counseling on the survey were assessed over 4 fiscal years. Annual rates were calculated overall and with patients categorized into four mutually exclusive groups based on their own reports of alcohol counseling (yes/no) and whether alcohol counseling was documented by a provider (yes/no). Provider documentation of alcohol counseling increased 23.6% (95% CI: 17.0, 30.2), from 59.4% to 83.0%, while patient report of alcohol counseling showed no significant change (4.0%, 95% CI: -2.3, 10.3), increasing from 66.1% to 70.1%. An 18.7% (95% CI: 11.7, 25.7) increase in the proportion of patients who reported counseling that was documented by a provider largely reflected a 14.7% decline (95% CI: 8.5, 20.8) in the proportion of patients who reported alcohol counseling that was not documented by a provider. The proportion of patients who did not report counseling but whose providers documented it did not show a significant change (4.9%, 95%CI: 0.0, 9.9). If patient report is accurate, increased rates of documented alcohol counseling in the VA from 2009 to 2012 predominantly reflected improved documentation of previously undocumented counseling rather than delivery of additional counseling or increased documentation of counseling that did not meaningfully occur.

PP16 Creating a linked dataset to explore patient outcomes after leaving ambulance care

BackgroundMost English ambulance services have implemented electronic patient report forms (ePRF), enabling electronic capture of patient information; previously all information was collected using paper forms. This development brings new opportunities,...

PP08 Does current pre-hospital analgesia effectively reduce paediatric pain within a uk ambulance service: a service evaluation

IntroductionPain is one of the most common symptoms presented by patients of all ages to ambulance services, however very few children receive analgesia. Analgesic treatment of pre-hospital injured children is...

PP12 New indicators for measuring patient survival following ambulance service care

BackgroundDeveloping better measures of quality and performance are key priorities for ambulance services. Using multi-stage, multi-stakeholder consensus studies, we developed eight new indicators of ambulance service quality and performance. We...

Does current pre-hospital analgesia effectively reduce pain in children caused by trauma, within a UK ambulance service? A service evaluation

Introduction – Pain is one of the most common symptoms presented by patients of all ages to ambulance services, however very few children receive analgesia. Analgesic treatment of pre-hospital injured children is viewed as ‘suboptimal’. The aim of this study was to explore current analgesia given to traumatically injured children in the pre-hospital setting and examine whether a clinically meaningful reduction in pain was achieved. Methods – We evaluated electronic patient report forms over a two-year period (2013–2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range 1–17 with a clinical impression of a fracture, dislocation, wound or burn were included. Patients with a Glasgow Coma Scale of < 15 were excluded. The outcome measure was a reduction in numeric pain rating scale or Wong and Baker faces of 2 or more out of 10. Results – Of the evaluable patients (N = 11,317), 90.8% had a documented pain score, or a reason why a pain score could not be documented. For patients reporting pain (N = 7483), 51.6% (n = 3861) received analgesia, 9.6% (n = 717) received no analgesia but did receive alternative treatment and 38.8% (n = 2905) received no analgesia and no alternative treatment. Morphine sulphate IV, oral morphine, Entonox, paracetamol suspension and poly-analgesia all achieved a clinically meaningful median reduction in pain score; –3.0 (IQR, –5.0 to –2.0), –2.0 (–5.0 to –2.0), –2.0 (–4.0 to –1.0), –2.0 (–4.0 to 0.0) and –3.0 (–4.0 to –1.0), respectively. Conclusions – Analgesia administered to traumatically injured children in the pre-hospital setting within this UK ambulance service NHS trust produces clinically meaningful reductions in pain for these patients. The concern is that a large number of patients received neither analgesia nor alternative treatment. There is a real need to identify barriers to analgesia administration in this patient group.

EPR Data Hiding in MRI Head Volumes for Telemedicine Using Rectangular Box Embedding Method

Mapping of electronic patient report (EPR) text file to magnetic resonance imaging (MRI) volumes increases burden to diagnosis over telemedicine. In this paper, we propose a high capacity, robust technique to select slices of interest (SOI) from a MRI volume that to embed EPR and transfer on a network. Embedding EPR along with selected slices is used to removal of mapping procedure at the receiver end. Initially brain extraction algorithm (BEA) is used to focus the region and ease of pathology detection in the slices. Then the embedding scheme uses the technique of rectangular box mapping (RBM) where it takes care of sensitive part of medical image. EPR data is encrypted and embedded for security purpose. Experimental results on security and robustness have been tested against various images. The proposed method can store longer EPR string along with better authenticity and confidentiality properties while satisfying all the requirements of medical data transfer and has achieved 51% reduction in bit rate than the traditional methods.

387 - Pharmacist-Led Transition of Care Interventions Identify and Reduce Medication Errors in Heart Failure Patients Post-Discharge

Background: Heart failure hospitalization typically results in new, complex medication regimens. Maintenance of guideline-directed medical therapy represents an evidence-based intervention to reduce rehospitalization and improve outcomes. However, patients must overcome significant affordability, access, and acceptance to remain on therapy. Objective: To quantify adherence to the discharge medication regimen, and qualitatively assess barriers to adherence to identify interventions for improvement. Methods: As part of a multidisciplinary transitional care initiative to reduce heart failure readmissions, we implemented pharmacist-led post-discharge transitional care interventions for patients identified as having potential barriers to medication adherence (one or more medication change to their heart failure regimen). The clinic pharmacist called the patient within 2 business days of hospital discharge, and followed up with the patient within 7 days at a heart failure discharge office visit. As part of this intervention, the pharmacist assessed for adherence and reviewed all medications, dosages, indications, and side effects. Medication errors were defined as any discrepancy between discharge instructions in the electronic medical record and patient report of medication administration. Discrepancies were corrected by the clinic pharmacist after consultation with the prescribing clinician. Reasons for medication errors were annotated and grouped using grounded theory approaches, to identify potential interventions for improvement. Results: During the study period, 86 patients were identified as having potential barriers to medication adherence and received a pharmacist-led transitional care call. Of the identified patients, 69/86 (80%) were reached and assessed for medication errors. Of those reached, 38/69 (55%) had at least one medication error. All identified medication errors were reconciled. Four major themes emerged as reasons for medication errors: 1. the patient did not understand the medication instructions (24/69), 2. the patient did not receive a prescription at discharge (11/69), 3. the patient chose not to adhere to instructions (8/69), and 4. the patient could not afford the prescribed medication(s) (4/69). Conclusions: Pharmacist-led transitional care interventions reveal a remarkable number of medication errors post-discharge, which group into 4 major themes. These medication errors create inaccuracies in the plan of care, introduce inefficiencies in the post-hospital follow-up visit, and place patients at avoidable risk for rehospitalization. Qualitative approaches allow for root cause analysis, and identification of targets for process improvement. Ongoing process of care work will reveal whether improvements in root causes of medication error rate will ameliorate heart failure rehospitalizations.

Coordinate My Care from the perspective of the London Ambulance Service.

Often, an emergency ambulance is called by a palliative care patient or their family when a crisis occurs, but on most occasions the attending crew will have never met the patient before. They may, therefore, have difficulty finding patient notes and medications in the house. Without information to guide management, or knowing the patient's preferred wishes, or contact details to obtain specialist help, the patient may be inappropriately conveyed to the emergency department. This lack of information has also, from our experience, led to inappropriate resuscitation attempts. In an effort to reduce such occurrences, the London Ambulance Service NHS Trust (LAS) have held paper-based records for end-of-life care patients since 2005, with more than 5000 records stored by 2012. There are several problems with paper-based records in this context; across London, the provision of care plans to the LAS has been sporadic and frequently the forms provide only limited information, which in turn limits their assistance with patient management. Coordinate My Care (CMC) now enables the LAS to access over 7250 patient records at the point of the 999 call. This ensures that crucial information can be provided to an ambulance crew before they arrive on scene, which is of particular importance when regarding those who do not want to be resuscitated (DNAR). This is achieved by the LAS placing a ‘flag’ on a patient's address once they are entered on to CMC. Should an emergency call be made at any point from this address, the ‘flag’ is activated, indicating to control room staff and the ambulance crew that a CMC record is held for a palliative care patient. Work is currently underway to develop a web interface that will enable address ‘flags’ for new patients, in addition to certain alterations to existing patients, to be automatically updated within LAS command and control systems every 12 hours. The LAS clinical support desk staff in the control room access CMC records and send a message about the patient to the ambulance crew via mobile data terminals in vehicles or personal radios. Once the crew is on scene, and have assessed the patient, they are able to telephone the paramedics who staff the clinical support desk to obtain further details, discuss the situation and use the information held on CMC to make decisions regarding treatment, referral or conveyance. Early feedback from staff about the CMC system is positive. CMC is now accessed daily by the clinical support desk. In April 2013, 67 records were shared with crews on scene – a number that is expected to grow as CMC expansion continues. Ambulance crews, who are not experts in end-of-life care, report satisfaction concerning the amount of information now available to them, assisting with complex decision-making. The introduction of CMC represents a significant advance towards greater integration between the LAS and other services that provide definitive end-of-life care, and is expected to reduce the frequency of unnecessary conveyance to emergency departments. Combined with the implementation of end-of-life care education for LAS clinicians, this will improve patient experience, quality of care provision and help to ensure that an individual's needs and wishes are met at the initial point of contact. We welcome the support of the clinical commissioning groups in encouraging the early identification of palliative patients by general practitioners (GPs) and their subsequent registration on CMC, allowing for shared communication and coordination of care. Although CMC at this time is primarily a tool used for palliative care patients, the LAS are keen to work with CMC, and other sectors of the healthcare community, to develop communication tools such as this. Further progress would include enhanced communication for the shared care of vulnerable patients or those with complex and/or chronic conditions that currently have paper-based plans, such as patient-specific protocols, held by the LAS and the special patient notes held by out-of-hours GP services. It is also hoped that as technology develops, an ambulance crew will be able to access CMC directly from the patient's side using an electronic patient report system. This will have the added benefit that ambulance crews can more efficiently communicate between electronic systems and share the care they have undertaken with the wider healthcare community.

Retention of information by emergency department staff at ambulance handover: do standardised approaches work?

Background: Ambulance crews usually have just one opportunity to convey information about their patients to emergency department (ED) personnel. ED staff receiving patients from ambulance crews will naturally be focussed...