Mark Rhys Kingston

Swansea University | SWAN · Medical School

Background Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients’ risk of emergency hospital admission and can be used t...

Background Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barrier...

Background The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report t...

Background The NIHR HTA funded RAndomised trial of ParamedIc Delivered FICB for hip fracture (RAPID2) aims to test the safety, clinical and cost-effectiveness of paramedics providing fascia iliaca compartment block (FICB) as pre-hospital pain relief for patients with suspected hip fracture. A vital part of this trial is the recruitment of paramedic...

Introduction Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, inc...

Background: The EVITE Immunity study investigates the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, UK, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of...

Introduction: The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. Methods: Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the...

Introduction Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the COVID-19 pandemic. Clinically extremely vulnerable people identified through algorithms and screening of routine National Health Service (NHS) data were individually and strongly advised to stay at home and s...

Background Pressures of patient demand and GP shortages have prompted a major workforce shift in primary care. Increasingly, paramedics are joining the primary care team but with wide variation in how they are employed, managed and supported. With numbers of paramedics in primary care rapidly increasing, evidence is needed to understand how PPC can...

Background TRIM is an evaluation of the models used to triage and manage emergency ambulance service care for patients with suspected Covid-19 during the first wave of the pandemic in 2020. We aimed to understand experiences and concerns of clinical and managerial staff about implementation of triage protocols in call centre and on-scene. Methods...

Background Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating—with a high associated mortality rate—and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less eff...

Background TRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic’s first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols. Method Research paramedics interviewed stakeholders from four ambulance s...

Background Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated, despite limited evidence about effects. In a trial evaluating the introduction of a Predictive Risk Stratification Model (PRISM), statistically significant increases in emergency hospital admissions and use of ot...

Background Asylum seekers and refugees often experience poor health in host countries. The United Nations High Commissioner for Refugees requires hosts to ensure these sanctuary seekers have access to basic health care. Aim To identify barriers and facilitators that affect access to health care by asylum seekers and refugees in Wales. Design & se...

Objectives: During the first wave of the COVID-19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used. Methods: Semistructured electronic survey of all UK ambulance services...

Aim In a trial evaluating the introduction of a predictive risk stratification model (PRISM) into primary care we reported statistically significant increases in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS. The aim of this study was to explore the views and experiences of general p...

Background In response to rising healthcare demand and shortages of general practitioners (GPs), policy across the UK supports paramedics joining the clinical team in primary care. Numbers of paramedics in primary care (PPC) are increasing in England and Wales through a range of local initiatives. As the first stage in the ARRIVE feasibility study...

Background Due to medical advances, the population of care homes is becoming increasingly frail, often with co-morbidities. Recent innovations have seen paramedics take on non-emergency roles within or supporting care homes. This workforce innovation requires urgent evaluation, taking account of the multiple perspectives at stake. Research is more...

Background Half a million people live in UK care homes. General practices struggle to deliver primary care for residents due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In response, some areas are involving paramedics in proactive support to care homes, part of a shift towar...

Background: Stratifying patient populations by risk of adverse events was believed to support preventive care for those identified, but recent evidence does not support this. Emergency admission risk stratification (EARS) tools have been widely promoted in UK policy and GP contracts. Aim: To describe availability and use of EARS tools across the...

Background Policy initiatives have incentivised use of EARP tools in primary care to reduce emergency admissions. A recently published trial in South Wales found that EARP increased emergency admissions and emergency department attendances without clear benefits. This cost the NHS an additional £76 per patient per year. But the use of EARP in prima...

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data...

Background In response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have recently been introduced wit...

Background Numbers of asylum seekers and refugees living in Wales have increased sharply. Many are liable to have unmet health needs and difficulty accessing services. We investigated the experience of, and access to, unplanned and emergency health services by asylum seekers, refugees and those refused asylum living in Wales. Method We surveyed 21...

Background In response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have been introduced over the pas...

There has been concern that some of those seeking sanctuary in Wales have unmet health needs and experience difficulty in accessing services, but there is little evidence other than anecdotal. There has also been concern that possible stigma of disclosing mental and physical health problems, and fear of adverse effects on their immigration status, ca...

Aim We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the cost...

Background The ageing UK population needs safe approaches to reduce emergency hospital admissions. Predictive risk stratification modelling (PRiSM) estimates risk that individuals will suffer emergency admission to hospital within 12 months and selects patients for preventative community care to avoid admissions. Aim To evaluate the introduction o...

Background With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim To evaluate the introduction of predictive risk stratification in primary care. Objectives To (1) measure the effects on servi...

Objectives • To present an efficient privacy-protecting model (PRIDAL) for linking routine and identifiable patient-reported research data. • To describe the application of the PRIDAL model with within a major portfolio trial linking a range of health and demographic datasets pertaining to >230,000 patients, alongside >2,300 questionnaires. • To...

INTRODUCTION A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the...

INTRODUCTION Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and it...

INTRODUCTION New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk....

Introduction Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. Aim To identify and review the published evidence on the costs, effects and implementation of emer...

Background: Rising demand for health care has prompted interest in new technologies to support a shift of care from hospital to community and primary care, which may require clinicians to undertake new working practices. A predictive risk stratification tool (Prism) was developed for use in primary care to estimate patients' risk of an emergency h...

Introduction Patients with chronic conditions account for a third of emergency hospital admissions, many of which are not life-threatening and result in unnecessary hospital stays. Focussed primary and community care could prevent one-in-five emergency admissions, improving health outcomes and saving money. Predictive risk models which use routine...

Background Through new contractual arrangements, general practitioners (GPs) are encouraged to use computer-based predictive risk tools to identify patients who might benefit from community interventions to avoid inappropriate emergency admissions. However, little is known about how receptive GPs and their colleagues are likely to be to adopting su...

An ageing population increases demand on health and social care. New approaches are needed to shift care from hospital to community and general practice. A predictive risk stratification tool (Prism) has been developed for general practice that estimates risk of an emergency hospital admission in the following year. We present a protocol for the ev...

Background: Achieving knowledge translation in healthcare is growing in importance but methods to capture impact of research are not well developed. We present an attempt to capture impact of a programme of research in prehospital emergency care, aiming to inform the development of EMS models of care that avoid, when appropriate, conveyance of pat...