Overview Summary of Project
People with adrenal insufficiency cannot produce enough of the hormone cortisol, which is vital for coping with physical stress, illness, or injury. Without enough cortisol, the body cannot respond properly, which can lead to a life-threatening complication called an adrenal crisis. Each year, around 6–8% of people with adrenal insufficiency experience an adrenal crisis, most often triggered by infection, vomiting, or another illness. Symptoms can include severe weakness, vomiting, confusion, dangerously low blood pressure and collapse. Immediate treatment with an emergency hydrocortisone injection and fluids is vital to prevent avoidable hospital admissions and deaths. Around one in 200 patients who experience an adrenal crisis may die, despite its preventable nature. However, despite clear clinical guidelines and the availability of emergency tools and protocols, delays in recognising and managing adrenal crises are still common in emergency care settings. With fast recognition and proper treatment, most adrenal crises can be effectively managed and prevented from becoming life-threatening.
This research study aims to understand how adrenal crises are currently managed by emergency services, both before arrival at the hospital by ambulance staff and in the emergency department. We also want to learn about the experiences of people living with adrenal insufficiency who have recently had an adrenal crisis. Understanding how well the current system works (and where it does not) can help identify ways to improve care and reduce preventable harm.
The study focuses on two population groups:
· Group A: Healthcare professionals who work in ambulance services, A&E, or urgent care settings.
· Group B: Adults with adrenal insufficiency who have had an adrenal crisis in the past 12 months.
In both groups, participants will first complete an online survey. This will include questions about their experiences, challenges, and what helped or got in the way of timely treatment. Participants will then have the option to take part in a follow-up interview by video call to explore these issues in more depth. For example, patients will be asked how they recognised their symptoms, whether they had an emergency injection kit, and how long it took to get
treated. Healthcare professionals will be asked about how confident they feel in recognising and treating an adrenal crisis, and what support or training they have received.
The information collected will be analysed using a framework called the COM-B model, which helps identify what people need in order to carry out certain behaviours, in this case, recognising and managing adrenal crisis. It considers three key areas: Capability (knowledge and skills), Opportunity (resources and system support), and Motivation (confidence and beliefs). The findings from patients and professionals will then be compared and brought together to create a Systems Model, a step-by-step map of how adrenal crisis care is currently delivered, and where breakdowns or delays occur. This model will guide the development and co-design of future interventions (solutions).
The goal is to design a set of practical, evidence-based interventions, such as improved training, new tools, or changes to care pathways, that can be tested in future research. By improving the way adrenal crisis is managed in emergency care, we hope to reduce avoidable harm, improve patient safety, and help healthcare professionals feel more confident in providing life-saving treatment when it is urgently needed.
Questions
The study aims to evaluate the behavioural, organisational, and systemic factors influencing the management of adrenal crisis in emergency settings (pre-hospital and emergency care). The study seeks to: · explore experiences, knowledge, and practices related to adrenal crisis recognition and management, · identify behavioural and systemic barriers and enablers to timely treatment, and · develop a systems model to inform future interventions.
