Project Name Start Date Project Description Healthcare utilisation and intermediate outcomes in patients with blunt 1/10/21 Injuries to the chest (blunt chest trauma) accounts for over 15% of all trauma admissions to Emergency Departments chest wall trauma following worldwide. The most common causes of injury include falls from a standing height (>2m), high velocity falls (>2m), road discharge from the Emergency Department / Urgent Care Centre: a traffic accidents, assaults and sporting injuries. Over 1500 patients presented to the Emergency Department in Morriston retrospective, population-based, observational datalinkage study Hospital in 2019 with blunt chest wall trauma. Difficulties in the management of blunt chest wall trauma patients in the Emergency Department are becoming increasingly well recognised in the literature. Longer-term complications after blunt chest wall trauma have been investigated. In a recent study, chronic pain was reported by 64% of patients, and disability by 67% of patients. Currently in most hospitals, patients are simply discharged home with no follow-up care. The majority of patients are discharged directly home from the Emergency Department or Urgent Care Centre (previously called a Minor Injuries Unit), without requiring admission to hospital. It is well known that a number of patients who are discharged directly home from the Emergency Department without hospital admission, re-attend the hospital with complications. Using hospital and GP records, the main aim of the study is to investigate healthcare utilisation and intermediate (≤12 weeks) outcomes in all adult patients with blunt chest wall trauma, discharged directly from the Emergency Department in Morriston Hospital, Swansea Bay University Health Board (previously Abertawe Bro Morgannwg University Health Board), from 1st January 2016 to 31st December 2020. The study findings will also be used to further test the accuracy of our STUMBL Score, which we developed and tested in previous work. The STUMBL Score is a simple tool that leads to a risk score that Emergency Department staff can use to decide which patients are likely to have complications. Using the score, the staff can decide which patients are safe for discharge home, without admission to the hospital. The score is based on patient information, routinely collected in the ED: 1) Age 2) Number of ribs broken 3) If the patient already has lung disease 4) If the patient uses medication that thins their blood 5) Oxygen levels, measured by a finger monitor. Overall, the findings of the study will provide background evidence supporting the development of co-produced guidance that can be used in Emergency Departments and Urgent Care Centres for patients with blunt chest wall trauma. What is the incidence of lymphoedema following cancer surgery and can 5/9/21 Our aim is to identify the number of patients who develop swelling (Lymphoedema) following cancer surgery in Wales and we predict who will get it describe their characteristics (e.g. age, sex, cancer location and extent and type of surgery). Presenting a picture of these patients may help to develop a ‘prediction’ tool in the future to identify which patients may be more likely to develop Lymphoedema. This information will improve understanding of which patients may need more support and Lymphoedema monitoring. Improvements in cancer treatment mean that patients are surviving longer. One side effect of cancer surgery that involves the lymph nodes is Lymphoedema. This can cause uncomfortable symptoms and affect quality of life. Around 20% of patients undergoing cancer surgery develop Lymphoedema. Lymphoedema requires constant self-management and lifelong treatment and has lots of complications including cellulitis (skin infection). We will carry out this work using anonymised data that are routinely collected on patients as part of their care. We will identify patients who have undergone surgery for cancer. Three members of the study team have worked extensively with Lymphoedema patients and have detailed knowledge of the issues faced by them and the treatment they receive. We will recruit two patients with Lymphoedema to be part of our advisory group. We will also gain input from a patient advisory group that oversees data management projects in Swansea University. STRETCHED (STRategies to manage Emergency ambulance Telephone 17/6/21 The project is part of a larger study into people who make frequent calls to ambulance services. Over recent years, Callers with sustained High needs – increasing numbers of 999 calls to ambulance services have presented challenges in providing timely and appropriate an Evaluation using linked Data) response. A small number of people call 999 a lot, and are classified by ambulance services as ‘Frequent Callers’ if they call more than five times a month, or 12 times in three months. The needs of these callers are not being met through traditional 999 responses. They don’t always have a medical problem which will require urgent help, and there may be a better way for their needs to be met without them having to phone 999. One approach to meeting the needs of people who are making high use of the 999 service is case management. The case management approach means the person is referred to a team from different agencies - including social services, primary care (GP), community mental health and the Emergency Department - who work together with the ambulance service to consider what the caller may need. These professionals and the person agree a treatment plan setting out what will happen and. The aim is to help people so they don’t need to contact emergency services again. UK ambulance services are involved in local case management initiatives in many areas for people who make high use of the 999 service. In this research, we are examining whether case management works better than the traditional ‘within service’ ambulance service response for people who make high use of the 999 service. • Do they have fewer emergency episodes if a case management service is available? • Is this help safe? • How much does case management cost to deliver and what costs, if any, are saved? • How do people feel about this help? • How easy or difficult is it for services to give this kind of help? How will we do this? We are working with four ambulance services (the East of England Ambulance Service, the London Ambulance Service, the West Midlands Ambulance Service, and the Welsh Ambulance Service) where the new case management approach has been introduced, in partnership with local agencies, and in other areas where the standard response is still in operation. We will then be able to see what difference the new partnership approach makes. Across the four ambulance services we aim to include 1200 people who have been classified by the service as a 'Frequent Caller' - 600 in areas where case management is in place and 600 in areas where it is not. We will use NHS information which is routinely collected to find out whether case management reduces further emergency calls in the six months following classification as ‘Frequent Caller’. This includes information from the ambulance services about 999 calls the patient makes in this period (dates and times of calls, why they made the call, and how the ambulance service respond). We will also use hospital data to see if there is any difference in service use between patients classified as frequent callers that do or do not receive case management. This data includes dates of ED attendances, outpatient appointments, planned and unplanned admissions; the reason for these visits, the outcome of these visits, and the date the patient was discharged. We will also collect data on deaths (the date, and reason for, death). Comparing these data between patients that do and do not receive case management will let us investigate if there are any unexpected consequences of the case management process. For example, it may affect patient safety, or shift demand from the ambulance services to other parts of the NHS. We will interview some patients who are treated through case management (and who have agreed to be contacted), to hear about their experiences, how they feel about the care offered to them, and whether or not it has helped them. We will interview health, social care and other professionals who are involved in case management initiatives so that we can understand what helps or hinders service delivery. Involving people who phone 999 in our research Two people who have experience Real World healthcare resource utilisation for CFTR modulators using the 7/6/21 In the UK, approximately 10,500 people have cystic fibrosis (CF), one of the most common life-threatening genetic sail databank and UK CF registry in diseases. In recent years, precision medicines called CF transmembrane conductance regulator (CFTR) modulators have Wales been developed to treat people with CF. They work through targeted effects on CFTR processing and function and are specific for certain CF-causing gene mutations. Clinical trial research has clearly demonstrated the benefits of CFTR modulators in treating cystic fibrosis (CF); however further real-world evidence is needed to better understand their impacts on health care resource utilisation in clinical practice and over longer time intervals than trials typically allow, and to estimate the associated costs/economic burden. This project seeks to investigate health care resource utilisation among CF patients prior to and following initiation of CFTR modulator treatment, using linked data from the UK CF Registry and the SAIL Databank. COVID-19 Symptom Tracker – Cabinet Office 3/6/21 There is an urgent need to map the spread and impact of COVID-19 across the UK. Researchers will analyse data from the C-19 Symptom Tracker app, which is now used by close on 2m people, to understand the spread of the illness and present these data to key decision makers and public health officials to help them identify areas that need focused attention through, for example, more targeted social distancing campaigns or diagnostic testing.