Primary and Emergency Care Research

Studying effectiveness, organisation and delivery of care

Over 90% of patient contacts in the NHS are in primary, urgent or emergency care, and demand is increasing. We use quantitative and qualitative approaches to research how this part of the healthcare system can be most effective, efficient and sustainable. We collaborate with NHS partners to deliver research responding to real-world challenges – research which is policy- relevant, patient-centred, and has impact. PRIME Centre has received more than £4.8m infrastructure funding.

3 ambulances with mountains in background

Areas of Research Focus

All of our research has a strong patient focus, and we work with patients and the public, from developing ideas into proposals, through delivering research and then disseminating findings to maximise impact in the real world.

Running across all these themes are commitments to new methods in research, particularly the use of anonymised linked data, and to working with patients and service users in planning and delivering research.

New treatments in emergency ambulance service care

Emergency ambulance services are increasingly delivering clinical care directly to patients, and aiming to keep patients out of hospital wherever possible. Our current research studies include TIME, a feasibility trial of take home naloxone for opioid overdoses in pre-hospital care (NIHR HTA); PHECG2, a mixed method study of the use and impact of the Pre-Hospital 12-lead electrocardiogram (British Heart Foundation); and RAPID2, a trial of pre-hospital analgesia for patients with hip fracture (NIHR HTA).

Responding to high intensity users of pre-hospital care

A small proportion of callers to emergency ambulance services make particularly high use of the service, often because of long term needs which have not otherwise been resolved. Our STRETCHED study is evaluating case management approaches to providing care for this patient group (NIHR HS&DR). The INFORM study aims to understand more about who these patients are and what motivates them to call (HCRW).

Risk prediction in primary care

Risk prediction software has been developed to help primary care clinicians to identify patients at highest risk of emergency admission. Our PRISMATIC trial found that the software had the opposite effect to that intended, and was associated with higher use of healthcare. Our EARPS study is examining the uptake and implementation of risk prediction tools across the UK.

Access to healthcare by disadvantaged groups

Asylum seekers and refugees face particular challenges in accessing healthcare, as we found in our recent HEAR study (HCRW). Our new HEAR2 study is focusing in particular on this patient group’s use of interpretation services (HCRW).

Delivering health care during the COVID-19 pandemic

In 2020, ambulance services across the UK introduced pandemic protocols – ways of prioritising calls to make sure that those most in need get the care they need. The TRIM study is evaluating the models of triage introduced under these protocols, to see what it the safest and most effective way for ambulance services to respond. EVITE Immunity is examining the impact of the shielding programme for vulnerable people.

New roles for paramedics in primary care

Paramedics are joining primary care teams to bring their unique skills to delivering proactive care in the community. The PARE study is examining the Pacesetter initiative in North Wales which rotates advanced paramedics between primary care and roles in the ambulance service. The ARRIVE study, with the Welsh Ambulance Service, is exploring the feasibility of conducting a larger scale evaluation of the impact of paramedics working in primary care.

Our research programme has led to:

Impact on policy and practice in the real world, e.g. 999 care of people who have fallen; pre-hospital care of patients with myocardial infarction; avoiding emergency admissions
Methodological development – in particular, working with HDRUK and the SAIL team, incorporation of anonymised linked outcomes in experimental and quasi-experimental research studies including SAFER 2, PRISMATIC, TIME, STRETCHED
Capacity building and career development in the Swansea Health Services Research team and in ambulance services. We have supported the 999 EMS Research Forum for over 20 years, and organise an annual conference with open peer reviewed submissions from researchers working in emergency prehospital care

Attraction of significant infrastructure and project funding to Swansea University through PRIME Centre Wales and related studies.

Informing Prudent Investment in Primary Care

Informing Prudent Investment in Primary Care

Primary care clinicians have been encouraged to use predictive risk stratification software to help them target care and so reduce emergency admissions to hospital. Our study evaluated this approach in one area of Wales, and found that it led to increased admissions and increased costs. As a result, policy in Wales changed, so predictive risk stratification is no longer encouraged in primary care, saving an estimated £200 million per year in avoided additional hospital admissions, days spent in hospital and other healthcare contacts.

Improving Emergency Care for People with Hip Fracture

Professor Helen Snooks has worked with the Welsh Ambulance Service and Swansea Bay University Health Board to develop and test the safety and feasibility of paramedic administered fascia iliaca block (anaesthetic) to provide pain relief at the scene of 999 calls for people with suspected hip fracture. The RAPID feasibility trial, funded by Health and Care Research Wales (£230,000) and carried out in the Swansea area, has led to the development and funding of a large scale multi centre definitive randomised trial with 5 ambulance service and Emergency Department sites across England and Wales. A team led by Professor Snooks and supported by Swansea Trials Unit has been awarded £1.8 million by the National Institute for Health Research through its Health Technology Assessment programme to undertake the RAPID 2 trial over the next 4 years. This programme of work has also included doctoral training and studies, leading to the award of PhD to Dr Jenna Jones, in 2021.