Implementing Emergency Dept. data sharing to reduce alcoholrelated violence.

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Implementing Emergency Dept. data sharing to
reduce alcohol-related violence.
Second National Alcohol Conference 28th November
2007
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David Sheehan Regional Public Health
Group Department of Health
Saturday, 21 November 2009
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Objectives of workshop

• Selling data sharing
• Using the Cardiff model
• Other resources
• Technology and the NHS
• Data sharing between EDs and CDRPs
• Relationship building
• Exit strategies/sustainability
• Strategic use of ED intelligence.

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.

• Violence the NHS

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Violence and NHS Staff

• The number of staff experiencing violence or
  abuse
• from patients has remained relatively steady
  over
• the four years of the survey
• 31 experienced violence or abuse in 2006, 30 in
  2005, and 32 in 2003 and 2004.
• In the 2006 survey, 13 of staff said they had
• experienced violence from patients in the
  previous
• year, while levels of harassment, bullying and
  abuse
• were up by two percentage points.

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Violence Against NHS staff

• 11,428 physical assaults on NHS staff in acute
  hospitals and 1,329 against ambulance staff
  across England in 2004/05
• Follows a concerted campaign to improve conflict
  resolution of staff skills and confidence
• August 2005 SoS Health announced 15-fold increase
  in number of successful prosecutions identified
  involving physical assaults on NHS staff from
  51 in 2002/03 to 759 in 2004/05.

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Site type of injury inconsecutive assault
victims
Face Other head/neck Thorax Abdomen Lower
limb Upper limb
Number of Patients (n530)
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The Costs of Violence

• Police investigation of one glassing incident
  can
• cost up to 10,000
• Glassware accounts for 10 of assault injuries
• in EDs
• A glassing incident can cost the NHS up to
• 184,000 and involve upwards of 40 NHS staff in
• treatment and rehabilitation
• 4 of the 125,000 violent facial injuries
  sustained
• annually were caused by glassings (1998)

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(No Transcript)
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• How Should the NHS respond?

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What can Health offer?
Epidemiology/Public Health Data
analysis Prioritisation The injury
framework Advocacy / CommissioningAccident and
Emergency Data Advocacy InnovationOral and
Maxillofacial Surgery
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A few problems

• From the outsidethe NHS is difficult to
  penetrate
• Large, amorphous, target-driven.
• Lack of clarity about who should lead
• Role of PCT, acute Trust, SHA, CDRP?
• NHS needs to be more involved in crime reduction
  activities associated with alcohol and violence

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• Emergency Department Role

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Why Emergency Depts? 1.

• Large number of violent offences which require ED
  treatment do not appear in police statistics
• Info about location, time of assault can be
  collected in EDs to target police resources more
  effectively
• EDs are the only sources of info about serial
  (repeat) injury a recognised precursor to
  homicide

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Why Emergency Depts? 2.

• EDs can identify trends in weapon use the use of
  glasses and bottles as weapons was first
  recognised not by police but by ED services
• ED staff can facilitate increased reporting of
  violence to the police by those injured who are
  not in a position to report
• ED staff are powerful and effective advocates for
  community safety when they work in local crime
  prevention partnerships

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Why Emergency Depts? 3.

• ED 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 EDs have significant contributions to
  make if harnessed
• Burdens on EDs can be reduced
• EDs have an ethical responsibility in the public
  interest to report serious violence.

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Violence and the Health Sector

• In the Emergency Dept
• Routine enquiry re alcohol violence
• Record location time of violent injuries
• Share Anonymous Information with CDRP
• Domestic Violence support Nurse
• Alcohol Brief Interventions - ED, GUM, 1 Care
  
• Embed Protocols Training
• Alcohol Violence Support - info leaflets
• Confidential Police-direct phone in ED waiting
  area
• Ambulance forensic blankets
• Referral pathways to GUM/SARC, GP, Drug
  Services,
• Mental Health Vol Community Sector.

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• The Cardiff Model

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The Cardiff Model

• 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

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TASC Data

• Data sources
• Police incident records
• Police custody records
• Police crime records
• Statistics from the hospital AE Unit
• AE Nurses
• Data victim support and supplementary data
• Domestic Violence (later)

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Essential Ingredients

• Electronic data collection system in ED
• Capacity to anonymise share ED data
• Analyst in CDRP integrates and summarises info
  about violence from police ED sources
• Senior NHS clinician committed to injury
  prevention willing to lead ED implementation
• ED clinician attends CDRP regularly
• Violence is prioritised as a public health issue

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The Virtuous Circle
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Data delivery

• 24 hour electronic data collection by ED
  reception staff when patients present
• Weekly anonymisation and sharing of data by Trust
  IT staff with CDRP
• Regular combination of police and ED data by CDRP
  analyst
• Summary data of violence times, locations and
  weapons by CDRP staff
• Continuous implementation and updating of
  prevention action plan by CDRP
• Continuous tracking of violence trends.

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Cardiff ED Attendances
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Task

• In your groups consider
• Existing relationships with the local NHS or
  CDRP
• Who are the leaders who could take on the role of
  implementation?
• What existing NHS/community safety/crime
  reduction initiatives could be used to promote
  data sharing?

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• Implementation Issues

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Implementation Issues

• 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.
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Implementation in the South East

• 33 EDs in the South East not incl MATS
• Home Office provided 10k per ED/CDRP
• Bidding process initiated July 2006
• Invitations about bids sent to
• Lead ED consultants
• Domestic Violence co-ordinators
• DAATs
• CDRPs.

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Implementation in the South East
Requirements

• Establish electronic ED 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

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Data fields 1.
Incident type
Assault
Date time of registration
Fist Feet Head
Assault type
Body part Blunt object Sharp object Pushed Unknown
Body part
Sharp object
Glass Bottle Knife
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Data fields 2.
x 1 x 2 x 3 or more unknown
Number of assailants
Male Female Male and female Unknown
Gender of Assailants
Have you been attacked by this person before?
Yes No
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Data fields 3.
Bar / pub Club Street Own home Someone elses
home Workplace Other
Free text facility to give specific details
of location
Assault location
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Results of bidding

• 22 have signed up and received 10k to develop
  local model
• 8 additional EDs have started negotiating their
  participation for 2008
• Not all are using electronic data capture
• Paper based data can be effective
• Significant variation in addressing criteria
  among EDs
• Transfer of data started in some EDs before April
  2007 deadline.

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• Data Protection.

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Assault data 1.
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Assault data 2.
Focus on consumption of drugs and assailant.
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Assault data 3.
Focus on consumption of alcohol and DV.
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• Lessons Learnt

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Learning the lessons 1.

• Audit EDs get better intelligence on what was
  going on
• Target existing partnerships to enlist support
  build a groundswell of support with senior
  clinicians and managers
• Work with champions/leaders - develop successful
  schemes and then promote to peers across the
  patch

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Learning the lessons 2.

• Embed the work with local Alcohol Harm Reduction
  Strategies and LSP/LAA work
• Place a greater emphasis on Public Health
  leadership influencing the partnerships money
  was useful but not the key factor.
• Resist the temptation to try this during an NHS
  reorganisation!

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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

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Using the data strategically?

• Sharing the data is only the first step
• Making data sharing a routine
• operation between the CDRP and NHS
• Using the data in a dynamic fashion?
• Being clear about strategic value of
• data
• Feedback to NHS more than polite
• letters!

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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 ED data (strategic
operational) in conjunction with other violence
data sources
Regular exchange of ED data with CSP (monthly
electronically)
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• ED and Health
• Routine enquiry re alcohol
• violence AE, MH, 1 Care
• Record location time
• Of violent injuries
• Share Anonymous
• Information with CDRP
• DV support Nurse
• Alcohol Brief Interventions
• AE, GUM, PHC
• Embed Protocols Training
• Alcohol Violence
• Support/ info leaflets
• Police direct phone in
• AE Waiting area
• Ambulance forensic blankets
• Referral pathways to GUM/ SARC,
• GP, Drug Services, MH VCS

• Licensing Committee
• 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

• Drinks Industry
• Local sponsorship
• Policy Staff training
• Social Responsibility Standards

LSP- LAA Priority, CDRP ensures Action

• Children YP
• Parenting Skills
• Violence Prevention skills
• Schools high risk groups
• School Bullying Policy
• CAMHS Conduct Disorder
• Child Protection-
• Health SS

Prevent Violence
-Crime Reduction -Safer Communities -Improving
Health
VCS Support Ensure sufficient Capacity,
Resources Standards

• 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

Promote Social Well-Being

• Police
• Increase Reporting of Crime
• Analyse police AE
• 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

Shepherd J, Sheehan D Nurse J, 2005
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Contact Details
David Sheehan Regional Public Health
Group Department of Health Government Office
South East Bridge House 1 Walnut Tree
Close Guildford Surrey GU1 4GA 01483
882498 david.sheehan_at_dh.gsi.gov.uk