Publications by authors named "Maxine Kuczawski"
Background: Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot.
Methods: We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot.
Background: Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care.
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- This article outlines the creation of CUREd, a comprehensive research data platform aimed at analyzing the Urgent and Emergency Care system in a specific UK region, involving nearly 30 million patient contacts.
- The platform integrates data from various sources, including 14 NHS Hospital Trusts and the NHS 111 service, and includes analyses on triage misclassifications, avoidable pediatric emergency visits, and patterns of frequent attendance.
- It emphasizes the importance of collaboration between data collectors, guardians, and researchers to effectively utilize routine healthcare data for ongoing research and improvements in the system.
Background: Patients taking direct oral anticoagulants (DOACs) commonly undergo CT head imaging after minor head injury, regardless of symptoms or signs. However, the risk of intracranial haemorrhage (ICH) in such patients is unclear, and further research has been recommended by the UK National Institute for Health and Care Excellence head injury guideline group.
Methods: An observational cohort study was performed in the UK South Yorkshire major trauma centre between 26 June and 3 September 2018.
Background: Policies aimed at diverting care from EDs to alternative services have not been successful in reducing ED attendances and have contributed to confusion for service users when making care-seeking decisions. It is important that service users are at the heart of decision making to ensure new services meet the needs of those who will be accessing them. In this study, service users were encouraged to think freely about the desirable qualities of an ideal urgent and emergency care (UEC) system.
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- - Anticoagulated patients, particularly those on warfarin, make up a growing percentage of head trauma cases in emergency departments, but there's a lack of international consensus on how to properly evaluate and treat them.
- - Existing guidelines are based on limited and low-quality studies, which fail to provide clear direction for managing these patients effectively.
- - The article advocates for a more selective approach to CT scanning, suggesting that patients with a GCS score of 15 and no head injury symptoms may not need a scan, promoting individualized decision-making based on risk assessment.
Objectives: Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.
Design: Multicentre, observational study using routine patient records.
Objectives: It is not currently clear whether all anticoagulated patients with a head injury should receive CT scanning or only those with evidence of traumatic brain injury (eg, loss of consciousness or amnesia). We aimed to determine the cost-effectiveness of CT for all compared with selective CT use for anticoagulated patients with a head injury.
Design: Decision-analysis modelling of data from a multicentre observational study.
Article Synopsis
- The study aims to evaluate whether having a senior doctor triage patients in emergency departments (ED) results in better performance compared to a standard triage by a single nurse, using various quality indicators.
- The researchers conducted a systematic review of studies published between 1994 and 2014, focusing on those that assessed the impact of senior doctor triage on factors like waiting times, length of stay, and patient treatment completion.
- Out of 4506 articles reviewed, they found 25 relevant studies, with most indicating improvements in ED performance, although the quality of the studies varied with some being stronger than others.
Article Synopsis
- In February 2014, a study highlighted that all 23 National Institute for Health Research medical research specialties in the UK, especially 'Injuries and Emergencies', were not meeting patient recruitment targets, prompting an investigation into recruitment issues in emergency departments.
- The AHEAD study focused on over 3,000 anticoagulated patients with head injuries and surveyed 33 emergency departments, discovering significant variability in recruitment rates and identifying obstacles such as site resources and recruitment methods.
- The findings suggest that many barriers to effective patient recruitment have been previously documented, yet persistent issues remain, risking future research efficiency and quality in emergency medicine.