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The management of acute paediatric episodes of care within the urgent and emergency care system.


School of Health and Related Research

About the Project

Supervisor(s): Professor Chris Burton (Professor of Primary Care and Centre for Urgent and Emergency Care (CURE) Research, ScHARR, University of Sheffield) and Dr Kerryn Husk (The NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Plymouth). CURE has an excellent track record of successful PhD supervision, and developing early career researchers to become the next generation of leading academics in emergency medicine research.

Paediatric ED Attendances and unplanned admissions in England are at an all-time high. In 2015/16 there were 425 A&E attendances for every 1,000 children and young people compared with 345 A&E attendances for every 1,000 adults aged 25 and over (NHS Digital, 2017). The largest number of attendances were in 1-4 year olds and 20-24 year olds, with the highest number of attendances per population size in the 1-4 year olds. Unsurprisingly, this increase in paediatric attendances at EDs has seen an increase in the number of emergency admissions in this patient group, rising by 14% to 133,960 admissions between 2005/6 and 2015/16, with the largest increase in 1-4 year olds. Short stays (of less than a day) have been demonstrated to be most common type of emergency admission for children and young people. There is therefore a pressing need to both better understand the flow of paediatric patients through the UEC system to acute hospital care and to identify the potential for solutions to reduce inappropriate use and provide a better quality of care.

Objectives
1) To review the international literature on urgent and emergency care management of children and young people, to understand trends in their management in UEC settings, implications of this management on patient and service outcomes and solutions for better care.
2) To use an established dataset with linked routine paediatric patient data from NHS organisations across Yorkshire & Humber to study how care is provided for urgent and emergency paediatric episodes and identify, where potential causes of concern are in the system and therefore where interventional approaches should be targeted.

The PhD opportunity is part of the ARC YH Urgent and Emergency Care (UEC) Theme, led by Professor Suzanne Mason, which is aimed to deliver improvements to demand and flow through the UEC system using a learning health systems approach, prioritising outcomes important to patients and providers and building on a track record of delivery and impact in this area of national NHS priority. https://www.arc-yh.nihr.ac.uk/what-we-do/urgent-care

The research theme has developed particular expertise in curating and analysing a large regional routine linked UEC dataset (CUREd) which has health and social care data from a number of providers (including 999, NHS111, acute hospital and health and social care). This dataset provides a unique resource to utilise with our key stakeholders to build collaborations with NHS providers and answer key research UEC priorities in the region and nationally.

The UEC Theme is part of the Centre for Urgent and Emergency Care within the School of Health and Related Research (ScHARR). One of the nine departments in the Faculty of Medicine, Dentistry and Health at the University of Sheffield, ScHARR comprises 4 academic sections (Design Trials and Statistics, Health Economics and Decision Science, Health Services Research and Public Health), and a professional services section (Central Resources Group).

The successful candidate will be expected to utilise this resource as part of their research. Research training can be provided to develop the necessary analytic and computational skills. To find out more visit:
https://www.sheffield.ac.uk/scharr/sections/hsr/cure/projects/chc/accessing_data

PenARC is a partnership of NHS Trusts and Local Authorities across Cornwall, Devon and Somerset, plus the Universities of Exeter and Plymouth. PenARC have a programme of work, the Paediatric Acute Care Project, which developed and evaluates interventions introduced within paediatric acute care settings in the South West to try and improve service delivery and reduce both unnecessary unplanned admissions and the number of children and young people presenting to hospital in need of urgent care

Funding Notes

Funding:
This opportunity is funded by the NIHR ARC and University of Sheffield, and includes fees and stipend of £14,776 per annum.

Entry Requirements:
Candidates must have a first or upper second class honors degree, a master’s degree and/ or significant research experience and have an interest in analysing large datasets using statistical and/or computational methods. The studentship may be of particular interest to those with a background in health informatics / data analytics.

References

Proposed start date: January 2021

This exciting studentship opportunity is provided by the National Institute for Health Research (NIHR) Applied Research Collaboration for Yorkshire and Humber (ARC), in collaboration with South West Peninsula ARC (PenARC) on a project aimed at understanding how paediatric patients are managed within the urgent and emergency care (UEC) system, towards developing strategies to improve current care. The NIHR ARC is an important programme of applied research delivered through a partnership of organisations, including NHS organisations, local authorities, universities, third sector organisations and industry.

Chris Burton is an academic GP with a wide range of interests in health services delivery research. He has experience of using routine healthcare data for studies of healthcare use, diagnosis and prescribing. This has included new approaches derived from complex systems science which are currently being used within CURE to look at ED attendance in adults. Chris currently supervises 4 PhD students (2 as first supervisor). The PhD will be co-supervised by Kerryn Husk, an experienced health services researcher with an interest in developing and evaluating complex interventions, paediatric acute care, and methods of evidence synthesis. Recent work in this field has examined the effectiveness of PAUs and telephone guidance between GPs and paediatricians, as well as the recording and impact of mental health problems on paediatric wards. He is currently supervising two PhD students.

Co-supervision meetings will be on a monthly basis (face-to-face or videoconference), and will include a focus on PhD progress, provide an opportunity for the student to present findings and address any problems encountered. Each meeting will also include dedicated time to discuss how the student might best maximise the added value offered by the collaboration between the ARC programmes, to ensure that they are well positioned for post-doctoral research applications and future career progression.

Enquiries:
Interested candidates should in the first instance contact (Colin O’Keeffe, [email protected], 0114 222 0780)

How to apply:
Please complete a University Postgraduate Research Application form available here: www.shef.ac.uk/postgraduate/research/apply

Please clearly state the prospective main supervisor in the respective box and select 'School of Health & Related Research' as the department.

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