Improving pre-hospital emergency care

A low blood sugar level, or “hypoglycaemia”, is when the level of glucose in a patient’s blood drops too low – and it primarily affects those living with diabetes. Unless treated quickly, hypoglycaemia can be very dangerous. That’s why hypoglycaemia events account for between 48,000 and 98,376 UK emergency ambulance calls every single year.

In order to help emergency services better attend those calls and secure improved outcomes for patients, the University of Stirling launched a long-standing collaboration with the Scottish Ambulance Service (SAS) to further research in two key areas: hypoglycaemia emergencies and clinical handover.

As a result, our research has not only changed pre-hospital hypoglycaemia and handover practice across the UK but is even being adopted in the USA.

Emergency ambulance

Our research

The University of Stirling's study, entitled “Improving pre-hospital emergency care” was designed to develop and evaluate a behavioural change intervention to improve the rates of individuals’ attendance at diabetes care providers after a hypoglycaemic event.

The University’s team consisted of:

  • Edward Duncan, Associate Professor
  • David FitzPatrick, Senior Lecturer

While the team’s intervention form was popular with staff and patients, further research found it wasn’t making a significant difference to patients in terms of their follow-up care. Population-based data was then studied to figure out whether there’d been a change in the incidence rates of people with types 1 and 2 diabetes needing emergency treatment for hypoglycaemia events.

The team discovered incidents were on the rise – and so researchers undertook Scotland’s first-ever national survey of hypoglycaemia awareness among people who use the ambulance service, including interviews comparing the experiences of patients both attended and not attended by an ambulance. It turned out there was impaired awareness of hypoglycaemia amongst those who required an ambulance.

Next, researchers conducted the first-ever published study investigating perceptions of the handovers that take place between ambulance clinicians and prehospital care teams.

The team conducted a national cross-sectional survey, which led to the development of a shared mental health model through system standardisation across Scotland, a simple aid-memoire to support information recording and delivery, and the clear identification at incidents of a handover lead using simple handover cards.

Creating new guidance to improve pre-hospital emergency care

Stirling’s hypoglycaemia emergency research improved UK Joint Royal College Ambulance Service Clinical Guidelines for paramedics attending hypoglycaemic emergencies – which involves up to 95,000 patients per year.

The new guidelines enable paramedics with the skills they need to address hypoglycaemia unawareness, and patients are now advised to follow-up their diabetes care to treat that unawareness. This reduces the number of ambulance attendances those individuals need in the future.

The University’s emergency research also helped to improve third sector policy and service delivery because it has influenced how national third sector agencies develop their policies — including Diabetes Scotland and Chest Heart and Stroke, Scotland. As a result of our research, those policies have evolved to become more evidence-based and have enhanced the ability of agencies to deliver their care services.

As a result of our research, those policies have evolved to become more evidence-based and have enhanced the ability of agencies to deliver their care services.

Improving patient safety through better communication

Handover of patient information is an extremely vital task when it comes to patient safety. The University of Stirling’s research has subsequently helped to improve the quality and quantity of pre-alerts to emergency departments and reduced clinical information loss.

The Scottish Ambulance Service practice has accordingly adopted the research team’s handover cards and embedded this into their systems. Those cards have since had a positive effect on patient care by enhancing communication levels between different roles across the emergency services.

That being said, the impact of Stirling’s emergency handover research has since extended beyond the borders of Scotland — with US states now having used the study to identify communication barriers within their own handover to develop processes and adopt more effective tools.

As a result, this research has not only led to positive patient outcomes for those living with types 1 and 2 diabetes here in the UK. It’s made a global impact towards improving lives.

This research has not only led to positive patient outcomes for those living with types 1 and 2 diabetes here in the UK. It’s made a global impact towards improving lives.

Diabetes test being done on a finger

Related publications

Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis

Article: Duncan E & Fitzpatrick D (2016) Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis. BMC Emergency Medicine, 16, Art. No.: 13.

Role and prevalence of impaired awareness of hypoglycaemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study

Article: Duncan EAS, Fitzpatrick D, Ikegwuonu T, Evans J & Maxwell M (2018) Role and prevalence of impaired awareness of hypoglycaemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study.

Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study

Article: Wang H, Donnan PT, Leese C, Duncan E, Fitzpatrick D, Frier BM & Leese G (2017) Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study