Transcript Document

A&E data sharing: other
impacts and applications.
Presentation to Alcohol Learning Centre
Conference, Hilton Olympia
2nd June 2009
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Alcohol & Violence
Why A&E Depts?
• Large number of violent offences which
require A&E treatment do not appear in
police statistics;
• Info about location, time of assault can be
collected in A&Es to target police
resources more effectively;
• A&Es are the only sources of info about
serial (repeat) injury – a recognised
precursor to homicide;
1.
Reasons Not to Report?
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Potential for reprisals;
Can’t see value of reporting;
Don’t know who assaulted them;
Wish to avoid own conduct scrutinised;
• Anonymised data is essential for
understanding more minor woundings.
• Personal data in cases where patient or
others are at risk of future harm.
Why A&E Depts?
• Large number of violent offences which
require A&E treatment do not appear in
police statistics;
• Info about location, time of assault can be
collected in A&Es to target police
resources more effectively;
• A&Es are the only sources of info about
serial (repeat) injury – a recognised
precursor to homicide;
1.
Why A&E Depts?
• They can identify trends in weapon use:
the use of glasses and bottles as weapons
was first recognised not by police but by
A&E services ;
• They can facilitate increased reporting of
violence to the police by those injured who
are not in a position to report;
• A&E staff are powerful and effective
advocates for community safety when
they work in local crime prevention
partnerships;
2.
Why A&E Depts?
• A&E staff can act from patient/victim
perspective: crime prevention tends to be
orientated towards offenders and
offending;
• NHS is a statutory partner in local crime
prevention: A&Es have significant
contributions to make if harnessed;
• Burdens on A&Es can be reduced;
• A&Es have an ethical responsibility in
the public interest to report serious
violence.
3.
Southampton University Hospital A&E Reception
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Why Share?
Over the six months, work intensively with 10 police force areas to make visible, rapid progress to
reduce harm caused by teenage knife crime and increase public confidence.
Prevent young
people from
becoming involved
with knife crime
Reduce
illegal sale
of knives
Trading
standards
prioritise test
purchasing of
underage
sales of
knives
Promote
responsible
parenting
Increase
consequences
of being
caught
Deter young
people from
becoming
involved
with knife
crime
-Youth
forums
-Marketing
campaign
-Education
programmes
Increased risk
for those who
do carry a knife
-Support
for parents
(parentlin
e plus)
- Home
Visits and
letters to
parents
-Increase
visibility of
sentences
-Extend
expectation
to prosecute
-Support
witnesses and
victims
Reduce re-offending
by those convicted
of knife crime
Increase
likelihood
of being
caught
-Target the
most
dangerous
- Increase use
of search/stop
and search
-Work with
A&E to
improve info
sharing
Increase safety in
high risk premises
-Increase
knife
referral
projects
- Increase use
of licensing act
powers
-Safer Schools
partnerships
Improve
Evidence
Base
Extend BCS
Named
neighbourhood
police contact
for every
school in areas
Work with A&E
KCP data
Purpose
Objectives
Outputs
Medical Confidentiality
• Patients have a right to expect that doctors will not
disclose any personal information gleaned during
treatment.
• Any information disclosed requires patient
consent.
• Exceptions:
• Inability to provide consent;
• Court order/legal duty;
• Public interest.
• Duty of confidentiality owed to <16 year old is as
great as that owed to any other person.
Personal Data (Data Protection Act 1998)
• Identifies or expresses opinion about
individuals
• Must be lawfully processed in line with
patients’ rights
• Disclosure without consent is only
justified when there is a substantial
chance of preventing/detecting crime or
arresting/prosecuting offenders
GMC/ACPO/BAEM Guidance
• All gunshot wounds should be reported
promptly
• Police investigations should not delay care
• Patients may choose not to speak to police
• Disclosures in the public interest are justified:
• Where this may assist in the prevention,
detection and prosecution of a serious
crime
• Where failure to disclose would put the
patient or someone else at serious risk
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The Cardiff Model
The Cardiff Model
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Home Office Bid 1999
Prof Jonathan Shepherd
Tackling Alcohol Street Crime (TASC)
– Licensees Forum
– Door Staff
– Licensing Policy and Practice
– Awareness Campaigns
– Targeted Policing
– Servewise
– Education in Schools
– Support for victims of assaults
The Cardiff Model
 Electronic data collection system in A&E;
 Capacity to anonymise & share A&E data;
 Analyst in CDRP integrates and
summarises info about violence from
police & A&E sources;
 Senior NHS clinician committed to injury
prevention willing to lead A&E
implementation;
 A&E clinician attends CDRP regularly;
 Violence is prioritised as a public health
issue;
The Virtuous Circle
Alcohol-Related
Assault
Solution
to cause –
crime
reduction
Identify
Data Collected
in Emergency
Department
Police Action /
Targeted
Intervention
Data
Matching
and
Analysis
Share
Information
Community Safety
Essential A&E Data
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Victim age and gender
Violence date and time
Exact location
Weapon
Also Desirable
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Assailant gender and number
Repeat violence
Relationship with assailant(s)
Reported to Police?
EXISTING DATA
Age & gender
Postcode of
Residence
Incident Type
Date & time of
assault
Assault
NEW DATA - ESSENTIAL
Assault Type
Body Part
Weapon
Pushed
Unknown
Body Part
Weapon
Assault location
Bar/pub
Club
Street
Own home
Someone else’s home
Workplace
Other
Fist
Feet
Head
Other
Glass
Bottle
Knife
Blunt object
Gun
Other
Free text facility
to give specific
details of
location
Implementation in the South East
• Raising the profile of Cardiff model within
existing partnerships;
• Identifying key individuals who would act as
local advocates;
• Identifying early adopter sites;
Sub-regional conferences to promote initiative.
Implementation in the South East
Requirements:
• Establish electronic A&E data collection system
with a minimum data set;
• Produce protocols - data safety and transfer &
management of patients who are identified as
vulnerable/at-risk;
• Create a system to transfer de-personalised data
to local CDRP/Community Safety data collation;
• Regular summary report for the CDRP, partners
and GOSE;
Challenges
• Connecting for Health;
• Sharing data with CDRPs;
• Ethical issues – giving data to the Police to
prevent further assaults;
• Ownership of follow-through by senior
clinicians and NHS managers;
• Embedding comprehensive approach to
community violence prevention.
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From Tactics to
Strategy
Violence and the Health Sector
In the Emergency Dept:
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Routine enquiry re alcohol & violence;
Record location & time of violent injuries;
Share Anonymous Information with CDRP;
Domestic Violence support Nurse;
Alcohol Brief Interventions - A&E, GUM, 1° Care;
Embed Protocols & Training;
Alcohol & Violence Support - info & leaflets;
Confidential Police-direct phone in A&E waiting area;
Ambulance forensic blankets;
Referral pathways to GUM/SARC, GP, Drug Services,
Mental Health & Vol & Community Sector.
Degrees of engagement
Routine evaluation of the
impact of these decisions
Strategic & operational decisions
routinely based on this analysis
Regular commissioning & consideration of
analytical products by RAG and TCG
Regular analysis of the A&E data (strategic & operational) in
conjunction with other violence data sources
Regular exchange of A&E data with CSP (monthly & electronically)
Licensing Committee:
Drinks Industry:
•Licence & Opening hours
•Reduce happy hours, increase
lager price
•Soft drinks & ‘cooling down’ period
•Door Supervisors & staff training
•Alcohol Disorder Zones
•Toughened bottles & glasses
•Public awareness posters
•Local sponsorship
•Policy & Staff training
•Social Responsibility Standards
Children & YP:
•Parenting Skills
•Violence Prevention skills
Schools & high risk groups
•School Bullying Policy
•CAMHS: Conduct Disorder
•Child ProtectionHealth & SS
Local Authority:
•Workplace violence &
Bullying policies
•Housing & support for
Offenders & drug misuse
•Improve Street Lighting
•Night time public transport
•Disperse fast food venues
& Taxi ranks
•Reduce litter & graffiti
•Night time litter collection
•Increase Pedestrian Areas
•Alcohol Misuse Enforcement
Campaigns
LSP- LAA
Priority,
CDRP ensures
Action
-Crime Reduction
-Safer Communities
-Improving Health
A&E and Health:
•Routine enquiry re alcohol &
violence: A&E, MH, 1° Care
•Record location & time
Of violent injuries
•Share Anonymous
Information with CDRP
•DV support Nurse
•Alcohol Brief Interventions:
A&E, GUM, PHC
• Embed Protocols & Training
•Alcohol & Violence
Support/ info leaflets
•Police direct phone in
A&E Waiting area
•Ambulance forensic blankets
•Referral pathways to GUM/ SARC,
GP, Drug Services, MH & VCS
VCS Support
Ensure sufficient
Capacity,
Resources
& Standards
Police:
Shepherd J, Sheehan D & Nurse J, 2005
•Increase Reporting of Crime
•Analyse police & A&E
data to inform activity
• Inform location of CCTVs
•Share data with CDRP
•Refer Child Protection & DV unit
•Refer Victim Support
•Fixed Penalty Notices, ASBOs &
Drink Banning Orders
Child Protection
• A pathway was developed to identify vulnerable carers with
dependant children at home
• During a 2 year period over 300 children at risk were
identified from carers with drug/ mental health/ alcohol/
Domestic abuse related issues. These children were not
present at the time of their carers attendance to A&E
• Over 60 cases of high risk DA were identified and referred to
relevant agencies during a 5 month period
• The A&E joined the Multi Agency Risk Assessment
conference
• Teaching sessions were developed
• Links were made with maternity services
Ambulance Data
A collaborative project between the Directorate of
Public Health East Midlands, the East Midlands
Ambulance Service NHS Trust (EMAS) and the East
Midlands Public Health Observatory (EMPHO).
To explore the contribution that CAD (Control Ambulance
Dispatch) data can make to alcohol harm reduction by:
• developing a methodology to identify which calls to the
ambulance service were likely to be alcohol-related
• mapping these alcohol related pickups to identify
locations where alcohol harm is taking place
Alcohol-related pickups interpolated heat map
Warmer colours indicate a greater number of expected alcohol-related pickups. Map
based on actual counts of pickups (July September 2007). Using this map areas of
interest were identified for closer examination.
Alcohol-related pickups by ambulance
The counts of pickups
were 'clustered' by laying
a 100m grid over the
surface and counting the
number of pickups
occurring within each
100m square.
Alcohol-related pickups by ambulance
Centre of Nottingham,
corresponds well with
local knowledge.
Cost of alcohol-related pickups
Each pickup is estimated to cost
£193 (EMAS 2006/7).
Nottingham centre is overlaid
with concentric circles of radius
0.5km, 1m and 1.5km.
The cost due to alcohol-related
pickups in each ring is shown in
red within the ring.
The cost for the centre of
Nottingham was £63,304.
Contact Details
David Sheehan
Department of Health South East
Government Office South East
Bridge House
1 Walnut Tree Close
Guildford
Surrey GU1 4GA
01483 882498
[email protected]