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Background

Emergency department (ED) crowding is a significant challenge, often leading to delays in time-critical treatment and, tragically, avoidable patient harm. Timely and accurate initial assessment of patients upon arrival at the ED or by ambulance clinicians is crucial for prioritising those in need of immediate intervention. Various initial assessment tools, such as early warning scores and triage systems, have been developed to aid clinicians in this process. However, the evidence supporting their effectiveness in accurately identifying patients requiring time-critical treatment remains limited.

Studies have not followed methodological guidance for developing complex interventions, input from clinicians and patients has been limited, and external validation has often been omitted. Furthermore, predictive accuracy has focussed on mortality and other measures that may not reflect need for time-critical treatment. 

Our team has developed an outcome measure designed to evaluate predictive accuracy specifically for time-critical treatment. This measure has demonstrated strong reliability (kappa=0.89) and usability within its initial setting, suggesting its potential to enhance the development and evaluation of initial assessment tools.

Aims and Objectives

This Programme Development Grant aims to lay the groundwork for a comprehensive research programme focused on developing and evaluating an improved initial assessment tool or toolkit for identifying adults in need of time-critical treatment within the ED. The objectives of this grant are to:

• Review existing initial assessment tools: Conduct an umbrella review of current ED and prehospital initial assessment tools to assess the available evidence and a scoping review of primary studies focusing on predictive accuracy for time-critical interventions.
• Establish an intervention co-production group: Create a collaborative group comprising 10-20 ED and ambulance service clinicians, alongside a patient and public involvement (PPI) group of 10-20 representatives (including those from under-researched populations). This group will actively participate in reviewing existing tools, shaping the research programme, and co-producing the intervention.
• Test and refine our outcome measure and characterise patient need: Conduct a retrospective observational study of 4000 adult patient records from four diverse EDs. This will assess the reliability of our developed outcome measure for identifying need for time-critical treatment and characterise the patient profiles associated with this need.

Funding and Sponsor

This research has been funded by NIHR Programme Development Grants (NIHR208906).

The research governance sponsor is the University of Sheffield.

Co-applicants