The role of translational patient safety research during and after the Covid-19 crisis

3 Jun

by Prof Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

Health and social care research and capacity building in this country are embedded and integral to local and national policy and decision making, including in the area I work in, early transitional exploratory work related to patient safety.  

It has been both noteworthy and impressive, but unsurprising, how quickly the academic and clinical research communities have responded to Covid-19. It is admirable also and helpful that national bodies, and our funders at the National Institute for Health Research (NIHR), as well as The University of Manchester, have been supportive to the need to adapt our working practices (from home). While in some instances there has been a delay in some ongoing research, it has also enabled us to adapt some existing projects and set-up new studies relevant to the pandemic.  

The three Patient Safety Translational Research Centres (PSTRCs) at Greater Manchester, Imperial, and Yorkshire & Humber use an applied approach for developing and testing new methodologies. They also share learning, on improving the safety of services and care, before any wider roll-out.  Any new approach or intervention can have unintended consequences or do unintended harm to patients or staff. That is why it is better to test things and ask people about their experiences of the early innovation, which is what the PSTRCs are designed to do.  

Our four main research themes at Greater Manchester PSTRC focus on medication safety, safer care systems and transitions, safety informatics and marginalised groups, which includes two sub-themes on mental health, and patients & carers.*  

The Greater Manchester PSTRC has two other key aims. In addition to developing and testing new ideas in relation to patient safety, it aims to build capacity in patient safety of people, patients/carers, families, health & social care staff, organisations and systems. This will help to anticipate, prevent and address patient safety issues in workplaces and organisations while ensuring research is co-designed and led by lived experience.  

Our third key aim is to build and share learning across health and social care systems locally and nationally, so there is an innovation pipeline that ensures rapid uptake of new ideas. It is imperative that those who are going to use the innovations are involved in development and testing.  Covid-19 shows clearly the importance and value of teamwork and communication with individuals, organisations and systems learning from each other and together; with a parity of focus on health and social care.  

Covid-19 is, rightly, the predominant issue at the moment. However, the essentials of patient safety remain the same as does the need to address existing known patient safety priorities that have affected, and continue to affect, so many people daily. Some of these issues, and the health, economic and social inequalities that often accompany them, have been, or are at risk of being, exacerbated by Covid-19. Most are not a direct result of it. Below are some examples of how the Greater Manchester PSTRC has responded so far to the Covid-19 context.  

Covid-19, mental health and the GM PSTRC  

The Greater Manchester PSTRC has a research theme looking at suicide and self-harm prevention, led by Prof Nav Kapur and Prof Roger Webb. During Covid-19, alongside the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), we are part of a national academic response to suicide prevention.**  This work is expanding on the NHS England’s national suicide prevention quality improvement programme. Nav and Roger are also members of the Expert Rapid Reviewing of the Emerging Scientific Evidence for Links between Covid-19 and Suicide Risk.

There will need to be a focus on a wider set of issues relating to mental health for people who have survived severe-critical levels of Covid-19, as well staff working in social care and NHS agencies. In addition, research will need to look at the effect on wellbeing and health of lockdown, shielding and social distancing.  

Covid-19 has affected, and will continue to affect, people in many ways. People who contract it are first victims. Those who care for patients with Covid-19, as well as the families of both patients and staff, can be second victims due to the personal harm that can be caused.  In addition, there may be those who become third victims – people who are responsible for investigating the outcomes of the pandemic and for safety improvement activities at a local and systems level***.              

Covid-19 and digital/informatics interventions at the GM PSTRC

Interventions developed by our Safety Informatics researchers, led by Prof Niels Peek, such as SMASH (The Salford Medication Safety Dashboard) and PINGR (Performance Improvement plaN GeneratoR) focus on using digital platforms to see if people are receiving appropriate care. Such examples develop and test computer software to analyse patient Electronic Health Records within GP practices, and increasingly across the health system, to suggest what steps could be taken to make a patient’s care safer. In essence, #DataSavesLives. It emphasises the importance of learning health systems, with universities and the NHS/health and social care, working together in partnership.  

Greater Manchester PSTRC staff, led by Richard Williams and Prof Niels Peek, are examining the indirect health impact of Covid-19 in our local populations by exploring patient presentation rates to services before, during after the pandemic for conditions such as cancer, cardiovascular disease, and mid-moderate and severe mental illnesses, as well as mortality rates in the longer term. Looking at data from the Office for National Statistics, the age-standardised Covid-19 mortality rate was 93 per 100,000 in Salford during the 1st March 2020 to 17th April 2020 observation period.  Whereas in neighbouring Trafford it was 31 per 100,000. During March and April 2020 Salford experienced the highest Covid-19 mortality rate outside Greater London and the South East region.  

People from a BAME**** background have been found to be at higher risk.  Understanding and addressing such existing inequality is fundamental to a societal and national response to improving patient safety and outcomes. For example, 1 in 4 people who have died of Covid-19 have a pre-existing diagnosis of diabetes. Ongoing management of people with long-standing conditions and those who have a number of underlying health conditions remains crucial to enable people to be as healthy, and therefore as safe as possible.    

Covid-19, behavioural science and the GM PSTRC  

Behavioural science is crucial at all times but vital during the Covid-19 pandemic. It underpins much of our work and the  research of  all 3 PSTRCs. Prof Chris Armitage of the  Greater Manchester PSTRC has been part of the British Psychological Society’s Covid-19 Research Priorities Group as well as the British Psychological Society’s Covid-19 Behavioural Science and Disease Prevention taskforce.*****  Behavioural approaches reinforce the importance of #COMBATCOVID19TOGETHER.  

Digital technology and behavioural science go hand-in-hand. This is why much of what we do is based on the lived experience of patients and the public.  We are extremely conscious that every item of data is about a person and every new approach or intervention has the ability to have an impact on the lives of patients.  

Behavioural science is about understanding and learning from peoples’ own lived experiences how best to support individuals to engage in behaviours that enhance their own safety and the safety of others. This involves a focus on the benefits and trade-offs or sacrifices of the individual as well as their families and families for the wider benefits of the wider population.  

An important component of patient safety is safeguarding, which is enhanced by appropriate, secure and confidential use of both clinical and behavioural information. Understanding behaviour is crucial to preventing infection and improving outcomes.  

It is crucial to understand the drivers of sustained public adherence to UK government Covid-19-related instructions. Evidence suggests there are currently high rates of public adherence. However, interventions to sustain adherence to government instructions in the long-term can only be developed if we know why people do or do not adhere to them. Prof Chris Armitage is part of a study to assess levels of public adherence to UK government Covid-19-related instructions; to gauge people’s perceptions of their capabilities, opportunities and motivations; and identify predictors of adherence. It is the first step in developing interventions to support continued public adherence to government instructions.  

Transitions of care during the pandemic  

Covid-19 has highlighted existing inequalities in health and safety and also those already at higher risk, such as residents in care homes and/or those with dementia. The Greater Manchester PSTRC’s Safer Care Systems and Transitions theme, led by Dr Maria Panagioti, focuses on the safer movement of patients between health and social care settings. Care pathways can involve many transitions, where the responsibility for patient care is transferred or handed over from one team, department or organisation to another. Patients and their carers and families can feel vulnerable and learning from their lived experiences is imperative.   Patient safety is about protecting the vulnerable and in care homes residents are elderly and often have multiple existing health conditions, which puts individuals at risk anyway. Recent figures show 25% of reported deaths from Covid-19 are in care homes, emphasising the underlying risks to residents and the unprecedented conditions that staff are working under.

Delivering primary care during Covid-19 has produced unparalleled changes to general practice as new ways of delivering GP services were set up in a matter of days. These include remote consultations via telephone, or ‘virtual’ consultations via video technology. This builds on the policy objective in the NHS Long Term Plan 2019 of implementing digital innovations to increase staff capacity and access to primary care services. In response to this rapidly changing shift in primary care consultations from face-to-face to remote consultations, Dr Ben Brown, Prof Niels Peek, Richard Williams and colleagues are supporting the Innovate UK-funded PATCHS feasibility study which assesses the opportunity and potential impact of applying Artificial Intelligence (AI) in online primary care triage. The system is currently being piloted by Salford Clinical Commissioning Group (CCG).  

It is imperative to understand the issues and problems faced by patients and carers when coming into contact with GPs and pharmacies. Our researchers, led by Dr Rebecca Morris, are involving patients and the public in the design of a Patient Safety Guide.  It is being used to help patients, GPs and pharmacists to identify key points where care can be made safer, including remote consultations.  

However, again, Covid-19 highlights existing inequalities with concerns about a ‘digital divide’, whereby some people or population groups may be excluded from digital approaches or technologies that could then exacerbate the pre-existing health inequalities. For example, of relevance is our work, led by Prof Caroline Sanders and Dr Kelly Howells, on access and experiences of primary care for people who are or have been homeless.

Last, but by no means least (indeed, most of all), is recognising and championing the exceptional commitment and work of all frontline NHS, social care and key workers during the Covid-19 crisis. The word “thank you” is not enough. It is to be hoped that Covid-19 produces a legacy of continuing to respond to and address existing health inequalities and safeguarding those most at risk and marginalised; as well as the value and importance of both key workers and the underlying health and social care infrastructure needed to enable rapid response to such events.  

*http://www.patientsafety.manchester.ac.uk/research/themes/

**https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext

***https://journals.sagepub.com/doi/full/10.1177/2516043519850914

****Black, Asian and minority ethnic

***** https://www.bps.org.uk/news-and-policy/bps-launches-new-behaviour-change-guidance-help-reduce-spread-covid-19

******https://www.theguardian.com/world/2020/may/15/coronavirus-care-home-residents-deaths-england-wales

******* https://www.longtermplan.nhs.uk/

2 Responses to “The role of translational patient safety research during and after the Covid-19 crisis”

Trackbacks/Pingbacks

  1. Patient Safety and COVID-19 – the importance of NIHR PSTRCs | GM PSTRC - June 4, 2020

    […] To learn more about the work of the Greater Manchester PSTRC during the COVID-19 pandemic, read Centre Director Professor Stephen Campbell’s thoughts in his latest blog. […]

  2. Patient Safety and COVID-19 – the importance of NIHR PSTRCs – Patient Safety Translational Research Centre - June 4, 2020

    […] https://gmpstrc.wordpress.com/2020/06/03/the-role-of-translational-patient-safety-research-during-an… […]

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