Emergency Medicine Research Priorities Refresh protocol

Purpose of this priority refresh PSP and background

The purpose of this protocol is to clearly set out the aims, objectives and commitments of the Emergency Medicine refresh PSP project in line with James Lind Alliance (JLA) principles. The Protocol is a JLA requirement and will be published on the PSP's page on the JLA website. The Steering Group will review the Protocol regularly and any updated version will be sent to the JLA.

The JLA is a non-profit making initiative, established in 2004. It brings patients, carers and clinicians together in PSPs. These PSPs identify and prioritise the ‘unanswered questions’, that they agree are the most important for research in their topic area. Traditionally PSPs have focused on questions about the effects of treatments, but some PSPs have chosen to broaden their scope beyond that. The aim of a PSP is to help ensure that those who fund health research are aware of what really matters to patients, carers and clinicians. The National Institute for Health and Care Research (NIHR – www.nihr.ac.uk) coordinates the infrastructure of the JLA to oversee the processes for PSPs.

It has been five years since the Emergency Medicine PSP published its Top 10 (and Top 30) research questions and priorities. In that time, our world and the landscape of emergency medicine have significantly changed. What’s more, some of these original priorities have been addressed through funded research studies.

Emergency Medicine is a broad, dynamic subject area and includes a variety of different medical areas such as acute medical emergencies, minor illness and injury, major trauma, acute mental health problems and the management of elderly patients with complex co-morbidities and social problems (not to mention the current challenges posed by COVID-19). Defining research priorities for such a diverse speciality and large potential patient base is a significant challenge.

In September 2015, the original PSP was launched at the Royal College of Emergency Medicine Annual Scientific Meeting. The PSP's initial question gathering survey received more than 200 research questions. Through a series of workshops and with the support of an information specialist, these questions were reviewed, explored, and prioritised by consensus by a steering group comprised of patients, carers, and clinicians.

The Emergency Medicine PSP published its Top 10 in January 2017.

After the success of the original PSP, the Royal College of Emergency Medicine would like to refresh the Emergency Medicine priorities for the next five years to ensure that priorities are current and representative of today’s patients, carers, and clinicians.

Aims and objectives of the Emergency Medicine priority refresh PSP

The aim of this work is to identify the unanswered questions in Emergency Medicine from patient and clinical perspectives and then prioritise those that patients and clinicians agree are the most important.

The objectives are to:

• work with patients, carers, the public and clinicians to identify questions about emergency medicine care and treatment
• to agree by consensus a prioritised list of those questions, for research
• to publicise the results and the process
• to take the results to research commissioning bodies to be considered for funding.

The Scope

As a refresh of the original PSP, the scope will essentially follow that of the original Emergency Medicine PSP. The scope is thus defined as:

1. Inclusive of whole of UK and Ireland
2. Focused on NHS settings
3. Will focus on care and what happens within the walls of the emergency department
4. Will include arrival at the emergency department and point of handover.

The work will exclude from its scope questions about:

1. Paediatric emergency care
2. Patients that have arrived at an emergency department, but are not in the care of an emergency department, e.g. patients waiting on an ambulance outside an emergency department.

The Steering Group is responsible for discussing what implications the scope of the PSP will have for the evidence-checking stage of the process. Resources and expertise will be put in place to do this evidence checking.

Steering Group

The Steering Group which will lead and manage this work includes patients, carers and clinicians, as individuals or representatives from a relevant group.

Patient and carer representative/s:

Louise Dunford

Ben McCullough

Hazel McCullough

Douglas Findlay

Moses Sokunbi

Clinical representative/s:

Jason Smith

Sarah Wilson

Rachel O'Brien

Dan Horner

Melanie Gager

Liza Keating

Thomas Shanahan

Project coordinator:

Theo Chiles, The Royal College of Emergency Medicine

James Lind Alliance Adviser and Chair of the Steering Group:

Toto Gronlund, JLA

The Steering Group will agree the resources, including time and expertise that they will be able to contribute to each stage of the process, with input and advice from the JLA.

Partners

Organisations and individuals will be invited to be involved as partners. Partners are organisation or groups who will commit to supporting this work to refresh the Emergency Medicine priorities, promoting the process and encouraging represented groups to participate. Partners represent the following groups:

• people who have had care in an emergency department setting
• carers of people who have had care in an emergency department setting
• health and social care professionals with experience of emergency medicine.

Exclusions

Some organisations may be judged by the JLA or the Steering Group to have conflicts of interest. These may be perceived to potentially cause unacceptable bias as a member of the Steering Group. As this is likely to affect the ultimate findings of the PSP, those organisations will not be invited to participate. As such, we have determined that disease/body specific parties and organisations may not be partners of the emergency medicine PSP so as to avoid potential conflict and bias in the question ranking. It is possible, however, that we can disseminate the survey to interested parties and organisations, and that they may participate in a the survey, so long as their questions are ranked without bias. It is also possible for interested parties and organisations to participate in a purely observational capacity when the Steering Group considers it may be helpful.

Partner organisations

The Faculty of Emergency Nursing

The methods we will use

This section describes a schedule of proposed stages through which the priority setting project aims meet its objectives. The process is iterative and dependent on the active participation and contribution of different groups. The methods used in any stage will be agreed through consultation between the Steering Group members, guided by the project's aims and objectives. More details of JLA methods can be found in the Guidebook section of the JLA website at www.jla.nihr.ac.uk .

Step 1: Identification and invitation of potential partners

Potential partner organisations will be identified through a process of peer knowledge and consultation, through the Steering Group members’ networks. Potential partners will be contacted and informed of the establishment and aims of the priority refresh work

Step 2: Awareness raising

• to present the proposed plan to refresh the research priorities for emergency medicine
• to generate support for the process
• to encourage participation in the process
• to initiate discussion, answer questions and address concerns
• to include the original priorities in the refresh exercise.

Step 3: Identifying unanswered questions

The partnership will carry out a consultation to gather unanswered questions from patients, carers and clinicians. A period of 12 weeks will be given to complete this exercise (which may be revised by the Steering Group if required).

As the target audience is representative of the general population, no specific groups are to be targeted as part of its dissemination. However, we do recognise the need to reach seldom heard or marginalised communities. The Steering Group will therefore liaise with the Royal College of Emergency Medicine’s Equality, Diversity and Inclusion, and Women in Emergency Medicine Special Interest Group committees around meaningful strategies and networks for dissemination. In addition, the Steering Group will compile key contacts in a master contact spreadsheet to ensure networks are best utilised.

The Steering Group will use the following methods to reach the target groups

• Method 1: utilise an online survey for dissemination
• Method 2: ensure diverse representation in the steering group, for wider and inclusive dissemination
• Method 3: to develop a communications plan with the Royal College of Emergency Medicine's Communications Manager including a communications pack to facilitate wider dissemination
• Method 4: engage existing patient group networks
• Method 5: to reach out to partner organisations, with a view to dissemination
• Method 6: to run or coincide launch with some kind of event (if possible).

Existing sources of unanswered questions may also be searched.

Step 4: Refining the questions

The consultation process will produce ‘raw’ questions and comments indicating patients’, carers’ and clinicians’ areas of uncertainty. These raw questions will be categorised and refined into summary questions which are clear, addressable by research, and understandable to all. Similar or duplicate questions will be combined where appropriate. Out-of-scope and ‘answered’ submissions will be compiled separately. The Steering Group will have oversight of this process to ensure that the raw data is being interpreted appropriately and that the summary questions are being worded in a way that is understandable to all audiences. The JLA Adviser will observe to ensure accountability and transparency.

This will result in a long list of in-scope summary questions. These are not research questions and to try and word them as such may make them too technical for a non-research audience. They will be framed as researchable questions that capture the themes and topics that people have suggested.

The summary questions will then be checked against evidence to determine whether they have already been answered by research. The PSP will complete the JLA Question Verification Form, which clearly describes the process used to verify the uncertainty of the questions, before starting prioritisation. The Question Verification Form includes details of the types and sources of evidence used to check uncertainty. The Question Verification Form should be published on the JLA website as soon as it has been agreed to enable researchers and other stakeholders to understand how the PSP has decided that its questions are unanswered, and any limitations of this.

Questions that are not adequately addressed by previous research will be collated and recorded on a standard JLA template. This will show the checking undertaken to make sure that the questions have not already been answered. The data should be submitted to the JLA for publication on its website on completion of the priority setting exercise, taking into account any changes made at the final workshop, in order to ensure that PSP results are publicly available.

The Steering Group will also consider how it will deal with submitted questions that have been answered, and questions that are out of scope.

Step 5: Prioritisation - interim and final stages

The aim of the final stage of the priority setting process is to prioritise through consensus the identified priorities. This will involve input from patients, carers and clinicians. The JLA encourages PSPs to involve as wide a range of people as possible, including those who did and did not contribute to the first consultation. There are usually two stages of prioritisation.

• Interim prioritisation is the stage where the long list of questions is reduced to a shorter list that can be taken to the final priority setting workshop. This is aimed at a wide audience, and is done using similar methods to the first consultation. With the JLA’s guidance, the Steering Group will agree the method and consider how best to reach and engage patients, carers and clinicians in the process. The most highly ranked questions (around 25) will be taken to a final priority setting workshop. Where the interim prioritisation does not produce a clear ranking or cut off point, the Steering Group will decide which questions are taken forwards to the final prioritisation.
• The final priority setting stage is generally a one-day workshop facilitated by the JLA. With guidance from the JLA and input from the Steering Group, up to 30 patients, carers and clinicians will be recruited to participate in a day of discussion and ranking, to determine the top 10 questions for research. All participants will declare their interests. The Steering Group will advise on any adaptations needed to ensure that the process is inclusive and accessible.

Dissemination of findings and research

The Steering Group will identify audiences with which it wants to engage when disseminating the results of the priority setting process, such as researchers, funders and the patient and clinical communities. They will need to determine how best to communicate the results and who will take responsibility for this. Previous PSPs’ outputs have included academic papers, lay reports, infographics, conference presentations and videos for social media.

It should be noted that the priorities are not worded as research questions. The Steering Group should discuss how they will work with researchers and funders to establish how to address the priorities and to work out what the research questions are that will address the issues that people have prioritised.

The JLA encourages PSPs to report back about any activities that have come about because of the PSP, including funded research. Please send any details to jla@soton.ac.uk.

Agreement of the Steering Group

The PSP Steering Group agreed the content and direction of this Protocol on 27/04/22.