Health Systems Impact

Data analysis and utilisation for healthcare

The PRANA registry will contain crucial, currently unavailable information for other UK in-hospital critical care registries and data linkage will improve the content and accuracy of data analysis and interpretation for other national registries.

A national PRANA registry will generate a nationally collated report defining supply, demand and outcomes for current pre-hospital critical care services and describing the case mix of the patient population using the services across the UK. This will support healthcare professionals to understand what works for critically ill and injured pre-hospital patients in the UK, the risks that patients and clinicians are exposed to and how to iteratively reduce risk. PRANA will enable organisational learning within a national governance structure.

The PRANA registry report will support healthcare planning, quantify resource requirements, support resource allocation and allow local and national service evaluation. The impact of pre-hospital critical care doctors on the UK health economy will be quantifiable for the first time.

The epidemiology of pre-hospital critical care provision in the UK

Feedback of centrally linked data to local services

For local services working through their iterative service developments, the knowledge of patient outcome provided by the PRANA registry will be transformative. The interventions carried out within the pre-hospital domain for the patient can be placed in context of their outcome. The detailed diagnostic imaging results obtained through the PRANA registry data linkage can be contrasted with clinical assessment in the pre-hospital domain. This depth of feedback will enable services to more accurately develop their services in line with the needs of patients, which will in time reduce risk to patients.

The PRANA registry will expand on the international consensus model for documenting and reporting data in Physician Emergency Medical Systems. It will inform the development of international standardised codes for pre-hospital care in collaboration with SNO-MED. This innovation will promote clarity when comparing and assessing pre-hospital care models around the globe.

Development of database standardisation

Informing future research

A major challenge for pre-hospital critical care is the relatively small numbers of patients treated within any one geographical or service delivery area. The much larger population within the PRANA registry will greatly enhance pre-hospital research capacity by informing research priority setting, generating baseline data for clinical trials and improving the ability of providers to contribute to portfolio studies. Descriptive and analytical epidemiological studies could also be facilitated. As has been shown with other national clinical audits, the availability of reliable data can support important translational patient centred research.

The PRANA registry will collect information pertaining to the 5 international consensus priority questions facing pre-hospital critical care:

Appropriate staffing in pre-hospital critical care
Dispatch criteria for pre-hospital critical care
Pre-hospital advanced airway management
Time windows for key critical interventions
The role of pre-hospital ultrasound

Analysis of PRANA data will support an increased understanding of each of these topics and inform the UK and international knowledge base regarding the future key research and service questions facing patient within pre-hospital care. In this way, in time, the PRANA registry will improve safety for patients.

Through analysis of PRANA registry data, it will be possible to describe the characteristics of patients who benefit from pre-hospital critical care. In collaboration with ambulance services across the country it will then be possible to retrospectively assess how many patients exist each year who share these characteristics but have not been delivered pre-hospital critical care. This quantification of unmet need would enable planning of future service delivery in a data driven fashion and in response to demonstrated patient need. Such analysis of the PRANA registry would support adjustment of ambulance service tasking systems to recognise critically ill and injured patients more accurately in order that appropriate resources be directed to these patients. The importance of the PRANA programme to this type of analysis was described in May 2023 by the Faculty of Pre-Hospital Care in their formal response to the Manchester Arena Inquiry (please see figure 3, pages 13-14) and by NHS England in July 2023.

Quantification of national unmet need and more accurate ambulance tasking systems

Creation of standardised mortality scoring systems for the whole pathway of patient care

Hospital based critical care and trauma systems utilise standardised mortality ratios to describe the likelihood of death given specific physiologic and anatomic disease. Separate and specific models are used by TARN, ICNARC and PICANet to assess trauma patients, adult intensive care patients and paediatric intensive care patients respectively. These models enable systems of care to be assessed for the presence of unexpected deaths and unexpected survivors. This knowledge has driven incremental improvements for in-hospital care pathways. Current standardised mortality scores exclude pre-hospital physiology and anatomy entirely. In collaboration with TARN, ICNARC and PICANet, analysis of the linked physiological data within the PRANA registry will enable assessment of the impact of pre-hospital physiology and anatomy on mortality. This would enable creation of new and potentially more accurate standardised mortality models which assess whole care pathways rather than just the in-hospital component. If these models prove effective, they will enable objective analysis of a previously unquantifiable domain of national care provision; supporting systematic and incremental care pathway improvements.