Reducing inappropriate admissions to hospital: Understanding and enhancing tolerance of uncertainty amongst staff and patients

This is an exciting opportunity to undertake a PhD within the Yorkshire and Humber Patient Safety Translational Research Centre (Yorkshire and Humber PSTRC), a partnership between the University of Leeds and Bradford Teaching Hospitals Foundation funded by the National Institute for Health Research (NIHR)

Project Aim: To understand how patients and staff deal with uncertainty and how this affects patient management decisions and safety in Emergency Departments.

Admission to, and stays in, hospital are associated with adverse events, with UK estimates being that 1 in 10 patients experience some harm during a hospital stay. The period following discharge from hospital is also associated with increased risks, particularly within a population of older adults (Forster et al., 2003). The evidence for a post-hospital syndrome and its association with an increased allostatic load is also growing. Lack of mobility, poor sleep, nutrition and hydration as well as experience of pain and other stresses associated with being in an unfamiliar environment are all suggested to be related to poorer health after a hospital admission (Goldwater et al., 2018). This means that admission to hospital is associated with risks.

Emergency departments (ED) are commonly the route into a hospital admission. Patients come to ED via a number of different pathways – self-referral, GP referral and the ambulance service being the most common. Within ED, patients are reviewed by a doctor, diagnostic tests are ordered and reviewed, patients are diagnosed and managed and decisions are made to admit. In our own and previous work it has been identified that sometimes tests are ordered and patients are admitted unnecessarily and that this may, in part, be associated with the anxiety associated with uncertainty.

There is growing interest in the concept of ‘tolerance of uncertainty’ and in 2017 an integrative model was published (Hillen et al., 2017), describing the sources and outcomes of uncertainty in a healthcare context. This PhD will apply this framework to understanding tolerance of uncertainty amongst staff and patients and how this might impact on decisions to 1) attend and present the case for attendance in ED, 2) manage the patient in ED and beyond. We will also assess the relationship between decisions and subsequent outcomes for patients.

This prestigious award is available to an exceptional candidate who can demonstrate excellent academic ability, an enthusiasm for healthcare safety, the drive and determination to undertake a PhD and an ambition to work in a multi-disciplinary team to deliver research that makes healthcare safer.

Environment:

Working with Professor Rebecca Lawton and Drs Beth Fylan and Gemma Louch in School of Psychology, University of Leeds the successful applicant will also be supported by Clinical Leaders in Emergency Medicine. The holder of this prestigious PhD Fellowship will also be embedded within the NIHR Yorkshire and Humber Patient Safety Translational Research Centre (www.yhpstrc.org). The University of Leeds, a member of the Russell Group of research-intensive universities, is one of the top 10 Universities in the UK and is ranked in the top 100 universities in the QS World University Rankings 2019.

Eligibility:

You should hold a first degree equivalent to at least a UK upper second class honours degree, or suitable postgraduate degree in psychology, social science or a health-related subject. You will be enthusiastic, organised and motivated with experience in, or knowledge of healthcare services

The Faculty minimum requirements for candidates whose first language is not English are:
• British Council IELTS – score of 6.5 overall, with no element less than 6.0
• TOEFL iBT – overall score of 92 with the listening and reading element no less than 21, writing element no less than 22 and the speaking element no less than 23.

How to apply:

To apply for this project applicants should complete a Faculty Scholarship Application form using the link below https://medicinehealth.leeds.ac.uk/downloads/download/78/fmh_scholarship_application_form_2018_2019 and send this alongside a 300 word research proposal based on the project brief, a full academic CV, degree certificates and transcripts (or marks so far if still studying) to the Faculty Graduate School at [Email Address Removed]

We also require 2 academic references to support your application. Please ask your referees to send these references on your behalf, directly to [Email Address Removed] by no later than Friday 26 April.

Any queries regarding the application process should be directed to [Email Address Removed].

If you would like to know more about this scholarship, please contact: Professor Rebecca Lawton ([Email Address Removed]).