Research Outcomes & Impact

Respeck Chest Trauma – feasibility of a wearable respiratory monitor in older patients with chest wall injury

Awarded: 2025 – Dr Heather Robertson
Grant award number: RCEM25_SG_1

Injuries are common in older people, often resulting from falls. Injuries to the chest are particularly dangerous because pain from broken ribs can affect people’s ability to breathe effectively. Breathing problems may not occur straight away, instead developing over hours or days. It can be difficult to keep a close eye on breathing function, because measurements like breathing rate and blood oxygen level can only be taken intermittently. The Respeck device is a small, lightweight monitor that can be taped on the skin just below the chest. It continuously monitors breathing function, transmitting data to a mobile device and on to healthcare professionals. This device could be very useful in monitoring people with chest injuries but has never been tested for this purpose. We will apply the Respeck device to 50 older people with broken ribs, to establish if it can provide useful information to help with monitoring their condition.

Urine COLLECTion technique and novel UTI biomarkers in children (COLLECT – UTI)

Awarded: 2025 – Dr Tom Waterfield
Grant award number: RCEM25_SG_2

Urinary tract infections (UTIs) are common in young children and can cause non-specific symptoms like fever, stomach pain, and vomiting. Diagnosing UTIs relies on urine tests, but accuracy depends on sample cleanliness and collection methods. If a child is not yet potty-trained urine can be collected by different ways. Some methods are painless, such as catching urine in a container when the child urinates, but prone to contamination from bugs on the skin and gut, which can give false positive results on urine tests. Other methods such as placing a plastic tube (catheter) into the bladder have low contamination rates, but can be uncomfortable. New urinary markers may be less affected by contamination, allowing painless methods to be used without compromising test reliability. To evaluate these markers, we will collect urine samples from children with suspected UTIs and compare their accuracy across different urine collection methods.

Use of FACial monitoring Technology for recording vital signs in the Emergency Department waiting room: a feasibility study (FACT-ED)

Awarded: 2024 – Dr Jared Charlton-Webb
Grant award number: RCEM24_AG_1

In the Emergency Department (ED), recording heart rate, blood pressure, and oxygen levels (vital signs) is essential to assess patients’ health and detect if their condition is worsening. However, busy staff and overcrowded EDs often cause delays in this process, putting patients at risk, especially those waiting to be seen. We hope to find out if patients in the ED can use an internet application on their smartphone to measure their vital signs. By allowing patients to record their own vital signs while they wait, it could speed up the triage process, reduce workload for staff, and improve patient safety. The study will compare the smartphone’s accuracy to standard hospital equipment and see if this technology is easy to use and liked by both patients and healthcare staff.

Diagnostic Algorithms for VTE in Emergency Care (DAVE)

Awarded: 2024 – Dr Ben Clarke
Grant award number: RCEM24_AG_2

Every day, many people visit the Emergency Department with possible signs of a blood clot in the leg or lungs. It’s hard to tell if it’s a clot just by examination alone, so clinicians often request extra tests like an ultrasound or CT scan. However, these scans take time, cost a lot, and can expose patients to radiation. Some new approaches combine clinician assessment with blood tests to rule out clots. These methods may cut down the need for scanning by 20% but haven’t yet been tested in the UK. Our study will follow a large group of patients with possible clots. We will record symptoms, blood test results, scan outcomes (if they get one), and check their health at three months. Patients will be treated as usual. Then, we’ll test different approaches on our data to find out which one is the safest, most accurate, and most efficient.

Exploring calcium dysregulation in trauma haemorrhage

Awarded: 2024 – Dr Charlotte Lindsay
Grant award number: RCEM24_AG_3

Calcium is essential for blood clotting. Low levels of calcium (hypocalcaemia) are common during bleeding and linked to worse outcomes including worse blood clotting, greater need for blood transfusions and a higher chance of dying. To prevent this, calcium is commonly given by air ambulance teams to patients with life threatening bleeding. New evidence suggests some people may develop high levels of blood calcium (hypercalcaemia) after injury, even when no calcium is given. This group also appear to need more blood transfusion and have higher mortality.2 We don’t know whether giving extra calcium during bleeding can cause hypercalcaemia and whether this is also linked to worse outcomes. This project will use data from the observational Activation of Coagulation and Inflammation in Trauma II (ACIT II) study which recruits trauma patients as soon as they arrive in the emergency department and collects samples and data from injury to up to 28 days later. 4 We will analyse admission blood calcium levels in a subgroup of patients with life threatening bleeding who were enrolled in ACIT II. We will describe the groups who present with low, normal and high calcium and their outcomes, and look at how use of prehospital calcium affects this.

Is admission hypocalcaemia associated with haemodynamic instability in paediatric major trauma? A multi centre retrospective cohort study

Awarded: 2024 – Dr Owen Hibberd
Grant award number: RCEM24_SG_1

Deaths among children with injuries often occur as a result of bleeding. If we better understand the factors within the body that can worsen bleeding, then we can try to recognize and treat these early. Normal calcium levels help blood clot, make the heartbeat strongly, and make blood vessels responsive to the body’s demands. We know that blood transfusions can cause calcium levels to be low because of the chemicals used to keep the blood transfusion safe. However, recent research in adults has shown that the injury itself may cause low calcium levels and that adults who have low calcium levels are more likely to need more aggressive treatment and are at greater risk of dying. We do not know whether this is the same in children. This study aims to see what factors can cause low calcium and whether low calcium has a negative effect on injured children.

A survey of vulnerable migrant health services in UK Emergency Departments

Awarded: 2024 – Dr Natasha Matthews
Grant award number: RCEM24_SG_2

Vulnerable migrants, including refugees and asylum seekers, have high levels of complex mental and physical health needs, but previous research shows they have difficulty accessing healthcare. This means they often present to the Emergency Department (ED) as their first point of contact for health care. It is important that EDs are equipped to address the health needs of these diverse communities. This study will gather insights from healthcare professionals working in EDs about the support services available for vulnerable migrants and examine the policies and guidelines that inform these practices. The aim is to identify successful approaches and areas for improvement, ensuring that everyone, regardless of their origin, has access to necessary emergency healthcare. The findings will inform recommendations to enhance how EDs support vulnerable migrants, striving for equitable and effective healthcare provision for all.

Understanding Psychological Distress And Therapeutic Environment in the Emergency Department (UPDATE-ED)

Awarded: 2024 – Dr Rajendra Raman
Grant award number: RCEM24_SG_3

This research aims to establish the number of patients coming to the Emergency Department (ED) with issues relating to mental health, alcohol or drugs, or in some form of psychological distress, including those for whom this was not the main reason for attending ED.  We will collect anonymous information on age, gender, ethnicity, when and how they came to the ED, where and how they are cared for whilst in the ED, and what happens to them afterwards. With this information we hope to build a better picture of these patients so we can go on to design and test ways to improve their care in the future.

Publications/presentations: EUSEM 2025

Understanding escalation area and corridor care in UK emergency departments: An observational cohort and Delphi study

Awarded: 2024 – Dr Fraser Birse & Dr Tom Roberts
Grant award number: RCEM24_SG_4

Crowding in emergency departments is a recognised public health challenge. Crowding leads to patient care in areas not originally designed for this use known as ‘escalation areas’. Although a formal definition of ‘escalation area care’ does not exist, examples include repurposed clinical areas outside the usual emergency department footprint and non-clinical areas such as hospital corridors. There is a lack of data about how many patients are receiving care in such environments, and how this impacts their outcomes. In this study, we will begin to address these questions by:

1. Estimating the number of patients cared for in escalation areas.
2. Describing which patients experience escalation area care.
3. Defining emergency department escalation areas.

The results will provide much-needed data on escalation area use, which will inform discussions on how best to address this problem and future studies related to escalation area care and its impact on patient outcomes.

Publications/presentations: EUSEM 2025

An exploratory cross-sectional study of the role of the consultant nurse/practitioner in UK Emergency Departments

Awarded: 2023 – Professor Heather Jarman
Grant award number: RCEM23_AG_1

Demand for emergency care services continues to grow; we need to develop a multidisciplinary approach to managing this demand. Innovative roles have been developed, such as the consultant nurse/practitioner (CP) role and the successful RCEM emergency care advanced clinical practitioner role. These highly experienced senior roles provide clinical expertise alongside other complementary skills to improve the quality of care through research and leadership, helping to shape future service provision. RCEM recommend there is one of these posts (CP) in every UK emergency department, but we do not currently know if this is being achieved or how these roles are configured. We aim to ask all EDs to see if they have a CP and then ask CPs about their practice, experience and role. We are doing this so that we can ascertain current numbers in the UK and explore the contribution of CP roles to patient care and ED practice.

Publications/presentations: EUSEM 2025

Defining Paediatric Emergency Medicine Research Priorities in the UK and Ireland through Patient, Parent, and Clinician Collaboration

Awarded: 2023 – Dr Tom Waterfield
Grant award number: RCEM23_AG_2

We aim to improve the care provided to children and young people in emergency settings by identifying the current top research priorities in the field of Paediatric Emergency Medicine within the United Kingdom and Ireland.

This will be achieved by engaging patients, parents/carers, and healthcare professionals collaboratively through the Paediatric Emergency Research in the UK and Ireland (PERUKI) network utilising James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. This collaboration will ensure that research questions generated are values-based, addressing not only healthcare professionals’ research questions but also the concerns of children and young people, families, and caregivers. This project will help to ensure that future research projects are designed to address key research priorities as identified by children, their families, and healthcare professionals. We expect that the output of this project will support successful grant applications for research into the questions identified.  Utilising the JLA PSP methodology as successfully applied to adult Emergency Medicine, this project will ensure that research into the emergency healthcare needs of children and young people is placed in an equitable position to the adult population.

Publications/presentations: RCEM ASC 2024 – Gateshead

A pilot ethnographic study of how shopfloor emergency medicine practice is influenced by working in pre-hospital emergency medicine

Awarded: 2023 – Dr Anisa Jafar
Grant award number: RCEM23_SG_1

The cost of having doctors on helicopters (and to a a lesser extent, in road ambulances) responding to emergencies is high,.  There has been lots of research done to try to understand whether this cost is too high in comparison with the benefits it can offer (as compared to just road ambulance, or to just having paramedics responding). The results are sometimes in favour of having doctors responding on scene and at others they are not.  It is likely that when considering costs/benefits, we are not capturing all possibilities. Doctors (with an emergency medicine background) who work out of hospital almost always work in emergency departments (ED)s. They have different training and clinical experience and therefore a different skillset as compared to their colleagues. It is likely that these skills lead to hidden benefits to the wider ED team and importantly, to patients.  This study aims to understand what these benefits are, whether they can be captured, and whether they can be taken into account in the overall calculation of cost and benefit.

Barts Bingli Validation Study

Awarded: 2023 – Dr Ben Bloom
Grant award number: RCEM23_SG_2

This study is designed to test the accuracy of a web-based tool that generates a list of possible diagnoses an emergency patient might have. Patients answer questions about their reason for coming to the ED. The questions vary depending on the answers given. The possible diagnoses are generated based on the answers to the questions. Patients will answer the questions on their mobile phone whilst in the waiting room. It takes around 5 minutes. We will compare the list of diagnoses with the real diagnoses made in the ED. The diagnoses will not be shared with clinicians and will not affect clinical care. Patients that do not take part will be described to ensure people without smartphones or capacity to use them would not be disadvantaged. This could make the earlier stages of assessment in EDs more efficient. It is not intended to replace a clinical consultation with a practitioner.

Publications/presentations: RCEM ASC 2024 – Gateshead

PREparing to IMprove Prehospital Analgesia in Children with Traumatic injuries (PRE-IMPACT)

Awarded: 2023 – Caitlin Wilson
Grant award number: RCEM23_SG_3

Evidence suggests that injured children attended by ambulance services often do not get good pain relief. The strongest pain-killer available to UK paramedics is morphine. This can be difficult to administer because it requires inserting a needle into a vein. An alternative pain-killer commonly used in accident and emergency departments is ketamine. Ketamine is fast-acting, effective and avoids needles by being sprayed up the nose (‘intranasal’). Recent evidence from the United States suggests paramedics can safely administer intranasal ketamine to children. A small number of UK paramedics already use intranasal ketamine but this has not yet been thoroughly investigated or become part of normal care for children. This study proposes interviews and surveys to find out if children, parents/carers, paramedics, doctors and pharmacists think paramedics should give intranasal ketamine to injured children. The results will be used to design a clinical trial involving paramedics treating injured children with intranasal ketamine.

Sonic Ethnography of an Emergency Department

Awarded: 2023 – Dr Joanna Sutton-Klein
Grant award number: RCEM23_SG_4

We know that loud environments can cause stress for people in them, but we know little about how the sounds in hospital Emergency Departments (A&E) make staff and patients feel, and their impact on their wellbeing and relationships. In this work, we aim to find out how staff feel about the sounds in A&E. This will inform future work with patients. We will train and mentor a group of staff in a Manchester emergency department to follow a deep listening practice over a 2-week period. We will collect data through participant journals and through a focus group at the end of the project. We will work with participants to generate ideas that could improve the situation in future. We will present our findings in both an academic paper and a public-facing creative output in a gallery setting.

Publications/presentations: ASC 2024 – Gateshead

Dissociative seizures (DS) in the emergency department: exploring the patient experience

Awarded: 2023 – Dr Salini Zain
Grant award number: RCEM23_SG_6

Dissociative seizures look like epilepsy or blackouts. They can be hard to tell apart but are not the same. Epileptic seizures are caused by abnormal electrical discharges in the brain. Dissociative seizures are an involuntary psychological response to distressing triggers. Both seizure types can cause unresponsiveness for over 10 minutes and lead to attendance in the emergency department (ED). When epileptic seizures do not stop on their own, they need to be stopped with medication. The medication for epileptic seizures can make dissociative seizures worse. Dissociative seizures can stop with reassurance and the removal of factors increasing anxiety. People with dissociative seizures often say that their experience of emergency care is poor but there are no studies so far that focus on their care in the ED. We plan to see how we can improve the emergency care for this group of patients.

ABC Sepsis Neuro – Understanding brain injury secondary to sepsis

Awarded: 2022 – Dr Daniel Whitehouse
Grant award number: RCEM22_AG_1

Patients who experience severe infection, including sepsis, frequently experience problems with brain function. In the Emergency Department , this might be in the form of confusion or coma. Even as the underlying sepsis resolves, many are left with ongoing problems including with thinking, concentration, and fatigue. These may be pervasive and prevent or delay complete recovery; even when mild they form a large part of the burden suffered by patients with sepsis. Compared with other types of brain injury, relatively little is known about the type seen in sepsis. Certain blood markers have been shown to predict severity of brain injury when caused by traumatic injury. We will test blood samples from patients presenting to Emergency Departments with suspected sepsis to see if these markers are high. If raised, indicating brain injury, it may help us understand how this occurs, how to predict it, and possible treatment options.

Publications/presentations: RCEM ASC 2024 – Gateshead

Pilot Study to Evaluate the Potential Diagnostic Utility of Serum Biomarkers in Cauda Equina Syndrome

Awarded: 2022 – Dr Muhammad Faisal
Grant award number: RCEM22_AG_2

Cauda Equina Syndrome (CES) is a condition associated with back pain whereby the small nerves in the spine are compressed. If missed it can lead to life changing consequences like permanent leg weakness, and loss of bowel and/or bladder control.

The diagnosis of CES requires a Magnetic Resonance Imaging (MRI Scan) to look at the patient’s spinal cord. These scans are uncomfortable for the patient, expensive and difficult to obtain in the Emergency Department. Only a minority of patients have diagnosis of CES after MRI.

We aim to measure blood markers which may be raised in patients with CES. We will compare differences in these markers between patients with and without CES to see if we could use these tests to reduce the need of MRI scans. We aim to publish our results in a journal and spread our findings via social media.

Publications/presentations: RCEM ASC 2024 – Gateshead

Streaming and redirection of adult minor acuity patients attending the Emergency Department (STREAM-ED)

Awarded: 2022 – Professor Jonathan Benger
Grant award number: RCEM22_SG_2

STREAM-ED was originally planned as an evaluation of the local implementation of a digital tool (EDST) that streams and redirects patients on arrival at the Emergency Department. This tool was due to be implemented within an ICB area (BNSSG) in January 2022, however due to some local challenges this study has re-framed its approach to encompass the consideration of a wider range of patient experience of different types of streaming and redirection on arrival at the ED. This includes the addition of NHS Hospital Trusts from the Surrey Heartlands Integrated Care System (who are already using the EDST).

After successfully gaining approval for this amendment to the research plan from the HRA to include the addition of new Trusts in February, other minor amendments are currently being devised to make it easier for clinical staff to support recruitment remotely. Recruitment to the study is planned for summer this year.

Activation of inflammation and Coagulation after Trauma II (ACIT-II)

Awarded: 2022 – Dr Daniel Horner
Grant award number: RCEM22_SG_4

Activation of Inflammation and Coagulation after Trauma II (ACIT-II) is a multi-centre, prospective cohort study investigating the biological mechanisms of acute traumatic coagulopathy and the inflammatory response to trauma. It aims to identify how tissue damage and cellular hypoperfusion activate the coagulation and inflammation systems, leading to increased bleeding, transfusion needs, and organ failure in severely injured patients. The study collects clinical and laboratory data from patients at several European trauma centers to better understand these processes and improve patient outcomes. 

Sampling in Sepsis: Exploring and characterising routine data in patients with sepsis presenting

Awarded: 2021 – Dr Andrew Ferguson & Dr Jack Cafferty
Grant award number: RCEM21_AG_1

Patients with systemic infection (sepsis) need several tests when they attend hospital. These include blood tests of different types and imaging, which includes X-rays, many of which can be uncomfortable. These are important to understand the cause and severity of their illness, and how best to treat it. When patients are participating in research, they may additional tests. There is national guidance about what tests these patients should undergo, and how often they should be done, but it isn’t known how well hospitals adhere to this.

Using an electronic database of patients presenting to the hospital with suspected sepsis, we will look at how often patients get tests and what type of tests they get. We will see whether this meets the requirements of the national guidelines, and whether future research studies can rely on routine tests, which may make participation in studies more efficient and less burdensome.

Thromboelastography and blood protein biomarker profiles in patients presenting with isolated traumatic brain injury in the emergency department

Awarded: 2021 – Dr Liam Barrett
Grant award number: RCEM21_SG_1

Traumatic brain injuries are a leading cause of death and disability. After an injury some patients develop problems with their blood clotting. We want to see if this inability to clot is associated with higher elevations in blood proteins compared to patients in whom clotting is normal. This may help us to understand why these clotting problems occur.

Variability of childhood atraumatic limp management study

Awarded: 2021 – Daniel Murrell
Grant award number: RCEM21_SG_2

This study will explore the reasons why children who don’t have an injury develop a limp, and what happens to them when they present to an Emergency Department. Lots of children who have a limp without injuring themselves get better with not treatment. There are some other rarer causes of limping, which clinicians must exclude using blood tests or x-rays. Not all children will need these tests. This study will help develop the best pathway of care for these children when they come to the Emergency Department.

Mechanistic Inflammatory Sub study embedded in the Albumin versus Balanced Crystalloid in Sepsis trial – ABC Sepsis

Awarded: 2021 – Andrew Ferguson
Grant award number: RCEM21_SG_2

Infection in the body (sepsis) causes significant harm to patients, partly due to the inflammatory response of the body. This inflammation can lead to low blood pressure and reduced blood supply to organs. International guidelines advise us to treat this low blood pressure using fluid, given through a cannula into a vein.  Multiple types of resuscitation fluid are available, each with differing chemical properties and potential advantages/disadvantages. The ideal fluid for initial resuscitation of patients with sepsis is unclear. As part of an ongoing study, the ABC Sepsis trial, comparing two types of fluid (albumin and balanced crystalloid), we will take blood samples to look for evidence that one type of fluid leads to reduced inflammation in the body.