Back in 2015 the James Lind organisation helped us set research priorities for emergency medicine in the UK. St Emlyn’s were proud to support the process at that time as we are advocates for open, transparent and fair processes to set research priorities, and especially for those that embrace broad groups from patient, researcher and clinician groups.
In brief the James Lind process is a structured system to find, collate and the prioritise answerable research questions in different specialities. We love it because it is based on the experiences of front facing clinicians and patients, rather than industry or other special interest groups. In other words it’s a way of setting the research agenda by people who actually use the service.
2015 Top 10 research priorities
- What is the best way to reduce the harms of emergency department crowding and exit block? We need a better measure of crowding that drives sensible improvements for the seriously ill and injured, adolescents and the frail elderly.
- Is a traditional Emergency Department the best place to care for frail elderly patients? Would a dedicated service for these patients be better (involving either a geriatric Emergency Department, or geriatric liaison services within the Emergency Department), or given that this population is expanding should our current services be tailored towards this group?
- How do we optimise care for mental health patients; including appropriate space to see patients, staff training, early recognition of symptoms, prioritisation compared to physical illness, and patient experience?
- With regard to how Emergency Department staff development is managed, what initiatives can improve staff engagement, resilience, retention, satisfaction, individuality and responsibility?
- How can we achieve excellence in delivering end of life care in the Emergency Department; from the recognition that a patient is dying, through symptomatic palliative treatment, potentially using a dedicated member of staff to work with palliative patients and their relatives, and handling associated bereavement issues?
- The effects of implementing new techniques in assessing patients with chest pain (which include new ways of using high sensitivity troponin tests, and decision rules such as the MACS rule and the HEART score) in practice. Would patients like a say in what is an acceptable risk, and should these tools be used alongside shared decision making to provide safe and appropriate care, minimise unnecessary risk and inconvenience for patients?
- What is the ideal staffing for current UK Emergency Medicine practice, including doctors, nurses, health care assistants, porters, radiographers, clerical and reception staff?
- Do early undifferentiated (broad spectrum) antibiotics in suspected severe sepsis have a greater benefit and cause less harm to patients than delayed focussed antibiotics in the Emergency Department?
- In adults who are fully alert (GCS 15) following trauma does cervical spine immobilisation (when compared to no cervical spine immobilisation) reduce the incidence of neurological deficit, and what is incidence of complications?
- Which trauma patients should be transferred to a Major Trauma Centre rather than going to another hospital first?
The original process was incredibly successful with many of the top 20 research priorities leading to significant funding and subsequent studies. This has been hugely important for the further development of UK emergency medicine research, supporting projects and careers. In fact the process has been so successful that we need to do it again to set the next round of research priorities and we are delighted to share the links and information here on the blog.
What do you need to do?
We need you to think about your current practice and to develop questions that can be triaged for the team. Ideally these will be in three part format and submitted online. They do not need to be perfect, but we do need your thoughts. What matters to you? What do you need to be answered? What would make a difference to patients, departments, systems and staff?
You can do this alone, or in groups. If you’re a clinician why not get a group together to generate ideas? Maybe use your journal clubs to develop new questions and submit them. Please involve as many people as possible. This is not about senior researchers developing ideas, but rather everyone. It may well be that the 3rd year med student on placement may have a fabulous idea. If so encourage them to share it, and support them in the process.
How do you submit your ideas?
You can do this online using the following link. Feel free to share this widely.
Can you submit if not in the UK?
Yes you can, although we will be triaging out topics that are not relevant to UK practice. However, we know that many issues in emergency medicine are global in nature and so if you are an international colleague and have a topic that would be relevant to UK practice +/- your own then please do submit.
Do you want to know more?
No problem. Visit the James Lind sites below.
- Main JLA site https://www.jla.nihr.ac.uk/
- EM JLA site https://www.jla.nihr.ac.uk/priority-setting-partnerships/emergency-medicine/
- EM Funded research from last JLA Process https://www.jla.nihr.ac.uk/funded-research/emergency-medicine/24425
Key Messages and Themes
- Emergency Medicine is a huge topic and there’s a limited amount of funding out there
- Help us to ensure that Emergency Medicine research priorities are up to date and impactful
- Take part and help to connect researchers and funding with real world experience
- Help Emergency Medicine to compete effectively for funding by justifying research
- Share decision making between patients, caregivers, EM staff and clinicians
- Collective learning, open dialogue – join the discussion
- Tell us your priorities
The bottom line
The bottom line is that this process is incredibly important in setting the agenda for the next 5-10 years of UK emergency medicine research. Please take a moment to get involved and help shape that future.
Simon Carley, “James Lind and the RCEM needs you (and you, and you). St.Emlyn’s,” in St.Emlyn’s, October 23, 2015, https://www.stemlynsblog.org/james-lind-and-the-rcem-needs-you-and-you-and-you-st-emlyns/.
Simon Carley, “Here’s the top 10 (and more) research priorities in EM. James Lind & St.Emlyn’s,” in St.Emlyn’s, January 23, 2017, https://www.stemlynsblog.org/heres-the-top-10-and-more-research-priorities-in-em-james-lind-st-emlyns/.
Simon Carley, “Research Priorities in Emergency Medicine: We need your help. St.Emlyn’s,” in St.Emlyn’s, September 24, 2016, https://www.stemlynsblog.org/research-priorities-emergency-medicine-need-help-st-emlyns/.
An Emergency Medicine Research Priority Setting Partnership to establish the top 10 research priorities in emergency medicineJason Smith 1 2, Liza Keating 3, Lynsey Flowerdew 4, Rachel O’Brien 5, Sam McIntyre 6, Richard Morley 7, Simon Carley 8 9, JLA EM PSP Steering Group PMID: 28473529 PMCID: PMC5502232 DOI: 10.1136/emermed-2017-206702