Hypos can strike twice

HypoStrikeTwice

Effect of implementing an ambulance clinician delivered hypoglycaemia intervention on repeat ambulance calls, attendances and transportation to hospital

Funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, awarded £200,000.

Key contact: Professor Niro Siriwardena

This is a non-randomised stepped wedge study with a mixed-methods process evaluation study which aims to evaluate the effect of implementing the ‘Hypo’s can strike twice’ intervention to patients with diabetes and hypoglycaemia attended by East Midlands Ambulance Service NHS Trust in the East Midlands region.

TeamProf Niro Siriwardena, CaHRU, University of Lincoln
Mrs Amanda Brewster, Public and Patient Involvement representative from Healthier Ageing PPI (HAPPI) group
Mr Keith Spurr, Public and Patient Involvement
Mrs Pauline Mountain, Public and Patient Involvement representative, HAPPI group
Mrs Sally Dunmore, East Midlands Ambulance Service NHS Trust (EMAS)
Mrs June James, Diabetes Nurse Specialist
Rob Spaight, EMAS
Dr Leon Roberts, EMAS
Dr Murray D. Smith, CaHRU, University of Lincoln
Ms Despina Laparidou CaHRU, University of Lincoln
Dr Elise Rowan, CaHRU, University of Lincoln
Prof Kamlesh Khunti, Leicester Diabetes Centre, University of Leicester
Prof Graham Law, CaHRU, University of Lincoln
Team/ConsortiumUniversity of Lincoln
Healthier Ageing PPI group
University of Leicester
East Midlands Ambulance Service NHS Trust
Overarching aimTo evaluate the effect of implementing the ‘Hypo’s can strike twice’ intervention to patients with diabetes and hypoglycaemia attended by East Midlands Ambulance Service NHS Trust in the rural East Midlands region.
ObjectivesTo investigate the effect of implementing the ‘Hypo’s can strike twice’ on:

1. Repeat ambulance calls and attendances for hypoglycaemia;

2. Recorded referrals to an appropriate healthcare professional (e.g. GP, nurse);

3. Completed care bundle for hypoglycaemia (proportion of patients with all of blood glucose recorded before treatment, blood glucose recorded after treatment and treatment given for hypoglycaemia;

4. Costs of implementation ‘Hypo’s can strike twice’ intervention vs costs of health service resource use;

5. To conduct a process evaluation to explore how ‘Hypo’s can strike twice’ exerts its effects and can be scaled up if effective by understanding implementation, mechanisms of impact, and contextual factors using interviews and surveys
MethodsNon-randomised stepped wedge design with mixed-methods process evaluation.
Outcomes
If the new process of care is found to work, this will help prevent recurrence of “hypo”, improve patients’ future health, reduce unnecessary calls to ambulance services or transport of patients to the Emergency Department, and thus reduce pressures and costs for ambulance services and hospitals nationally by over £1 million.
OutputsPeer reviewed research and conference presentations.

Publications
ImpactImproved ambulance to community hypoglycaemia care pathways for diabetes have been approved nationally by the Association of Ambulance Chief Executives and National Ambulance Services Medical Directors (NASMed), and, if shown to be effective, could reduce repeat hypoglycaemia, ambulance attendances, hospitalisations and costs.