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Babylonian patient safety

11 Oct

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

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One of the twelve stone displaying the Code of Hammurabi

Every patient, every person, deserves safe quality care. The quality and safety of care varies between countries and within countries; even within hospitals or general practices, dental practices or pharmacies. Some people will benefit from exemplary care (both clinical and inter-personal) whereas most will experience safe quality care. However, the reality is that some people / patients will receive poorer care and, in a minority of cases, unsafe, or unacceptable quality of, care.

How should this be addressed? Quality and safety improvement literature refer to various forms of incentives and rewards or penalties to reflect the safety and quality of care delivered. These can relate to financial, professional, regulatory and reputational standards and reflection of performance. It’s important to emphasise that care is provided within organisations within systems and usually as part of a team. Most unsafe and poor care is often the result of systems errors.

The idea that there will be incentives or consequences for the safety and quality of care delivered is new…is wrong. There have been some interesting approaches over the centuries. Do they have anything in common with health and social care today? Yes – they reflect the fact that it’s been recognised that care varies and patient outcomes vary and that there is an arbiter (a regulatory body or an individual) of safety and quality who will decide on the consequences for patient outcomes. Leaving aside issues of ethics, morals and legality…not to mention fairness…

Between the fifth and third centuries BC, the Hippocratic Oath required a new physician to swear, by a number of healing Gods, to uphold specific ethical standards. In essence, “First do no harm” (Latin: Primum non nocere). The “do no harm” was not new. King Hammurabi (B.C.1795-1750) was king of Babylonia who is credited with the legal Code of Hammurabi (a set of 282 laws written on twelve stones and displayed publicly for all to see). These were designed to regulate Mesopotamian society. Perhaps the most well-known is: “Eye for eye, tooth for tooth.” Delve deeper and one law stipulates that “If a doctor has opened an abscess of the eye and has cured the eye, he shall take ten shekels of silver”… however…“If a doctor has opened an abscess of the eye and has caused the loss of the eye, the doctor’s fingers shall be cut off”.

The focus on quality and safety of healthcare is mostly a post-war agenda. While it would not be appropriate to compare any existing health and social care regulatory body such as the Care Quality Commission to Mesopotamian society, it’s interesting to reflect on the fact that “regulation” of healthcare and patient outcomes is certainly not new. Thankfully, however, the current focus on “each person receives appropriate person-centred care and treatment” does not require anyone to have their fingers chopped off.

Using Artificial Intelligence to help primary care triage

5 Oct

by Ben Brown, GP and Researcher in the NIHR Greater Manchester PSTRC’s Safety Informatics theme

Working on laptop, close up of business man

Researchers at The University of Manchester and Spectra Analytics are developing an Artificial Intelligence (AI) system to help support GP practices triage requests for appointments – the Patient Automated Triage and Clinical Hub Scheduling (PATCHS) system.

It’s often difficult to get an appointment with a GP, and it’s estimated that over a quarter of GP appointments could have been dealt with in an alternative way, for example by another clinician (such as a nurse) or through patient self-care. One solution may therefore be to allocate GP appointments to patients that really need them. 

While receptionists at GP practices can direct patients to the most appropriate care provider, not all practices do this, and often patients are unwilling to disclose their problems to them. PATCHS plans to tackle this by providing an online tool that will efficiently direct patients to the right place, 24 hours a day. Patients will input their reasons for requesting a GP appointment, and PATCHS will analyse this request, taking into account the patient’s medical history, in addition to other factors such as the weather, to come to a triage decision. It is hoped the system could ultimately be integrated into practice websites and medical records, ensuring effective triage at the beginning of a patient’s care pathway.

The project is funded by Innovate UK and is currently in the development stage: PATCHS is currently learning from existing data about how patients are triaged when booking a GP appointment. However, the team are looking for volunteers – both patients and doctors – to participate in the project. If you’d like to know more please contact Dr Ben Brown on benjamin.brown@manchester.ac.uk.

What can we learn from North America about the role of community pharmacy teams in suicide awareness and prevention?

10 Sep

by Hayley Gorton, Pharmacist and Research Associate

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Hayley Gorton (r) with Bloom pharmacist Melissa at Haliburton Pharmacy, Antigonish

It is the NIHR Greater Manchester PSTRC I have to thank for starting the metaphorical journey that is my study of community pharmacy teams in suicide prevention. I joined the original Greater Manchester PSTRC in 2014 to undertake, and later complete, a PhD in the epidemiology of suicide and self-harm (epidemiology looks at how often and where diseases or healthcare events happen). Throughout my time, I was acutely aware of my profession and practice as a community pharmacist: “how would I help someone with thoughts or actions of suicide or self-harm in my pharmacy practice?” I didn’t know, but made it my mission to find out.

This summer, I spent a month in the USA and Canada exploring this question, thanks to a fellowship from the Winston Churchill Memorial Trust (WCMT) and support from the Greater Manchester PSTRC. There is too much to cover in one short blog, but you can find out about each leg of my trip by reading my own blog series. I’ve been back for a month and only now getting some clarity on which (of my many) research questions to pursue, fostering collaborations with those people I met en route and looking at how I can inform UK policy and practice with my WCMT findings. It was a brilliant experience in chronological order from grassroots research to mandatory training.

New Patient Safety Translational Research Centre PhD network

2 Aug

Young man using laptop with female student watching and smiling

by Karen Considine (Centre Manager, NIHR Greater Manchester PSTRC), Kelsey Flott (Centre Manager, NIHR Imperial PSTRC) and Beth Fylan (Programme Manager, NIHR Yorkshire and Humber PSTRC)

PhD students linked to the three NIHR Patient Safety Translational Research Centres (PSTRCs) have a new opportunity to register for a PhD student network. The national drive for high quality patient safety research means that the NIHR has now invested in three PSTRCs from 2017-2022. Greater Manchester and Imperial PSTRCs retain their funding and there is now a new third Centre in Yorkshire and Humber. This extension to the PSTRC infrastructure has created opportunities to expand the number of NIHR funded patient safety projects and develop new patient safety research partnerships and networks.

One of these collaborative initiatives is aimed at offering development activities to PhD students by creating a network bringing together PSTRC research students from the three Centres into a dynamic research community. The PSTRC PhD network will encourage students to share information about their research projects and their developing research expertise and then collaborate to develop dissemination plans for their work. The network will be a showcase for the patient safety research projects students are delivering as well as a route to further enhance patient safety research skills by accessing expertise across the PSTRC infrastructure.

Rebecca Lawton, Director of the Yorkshire and Humber PSTRC, said:  “As a new PSTRC we are committed to collaborating with our partners at Manchester and Imperial. We pitched the idea of a PhD network to NIHR and they were extremely supportive. The aim of this network is ensure that the patient safety research leaders of the future have an opportunity to learn from each other and also from the wealth of expertise across the three Centres. I am looking forward to watching the network grow and to learning from the next generation of patient safety researchers ”.

Stephen Campbell, Director of the Greater Manchester PSTRC, said: “Research capacity building is a core and crucial priority for us and all the PSTRCs. The PhD network provides a splendid opportunity for researchers from across the three settings to learn from  each other, research leaders from each site and the importance of collaboration in research”.

Ara Darzi from Imperial PSTRC adds: “Together the three PSTRCs aim to develop evidence based interventions to improve safety across the NHS and health systems abroad. Central to this mission is the training of our students and researchers. This PhD network will provide an opportunity for students across the PSTRCs to collaborate, share insights and create a national network for patient safety research.”

How was it for you? Reflections on involvement

2 Aug

This edition’s reflection comes from Kay Gallacher, a member of the public who is involved in the NIHR Greater Manchester PSTRC Patient Safety Guide.

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Why did you become involved in the Patient Safety Guide project?

I have long been aware of the issues that elderly family and neighbours, in particular have experienced trying to manage contact with their GPs and pharmacies.  The brilliant, simple idea behind this Patient Safety Guide seems to address many of the concerns in a practical and tangible way.  I was also attracted by the fact that this was a collaborative project where patients, carers and medical professionals all have an equally important input into the design and delivery of both the paper- based Guide and the mobile app, hopefully making it a 360 degrees (all round) useful tool.

How do you think the Greater Manchester PSTRC benefitted from your involvement – what difference do you feel that you made?

I guess it’s for others to judge what impact, if any, I’ve had on the project.  However, I’ve brought a genuine understanding of the problems patients face when coming into contact with primary care and producing leaflets and guides was bread and butter for me in my marketing career.  So, I hope I’ve been helpful in producing and delivering an effective product.

How do you feel that you benefitted from your involvement?

I am involved with several projects, but this one in particular has sharpened my understanding of how the GP/ patient dynamic operates.  I came to this project with a patient’s viewpoint but I now have a better insight into the challenges GPs face in establishing and maintaining effective communication with patients.  Also, the deep personal satisfaction of feeling that I’ve made a positive contribution.  Importantly, I can’t overstate the pleasure I’ve derived from being part of a cohesive, effective and well-led team composed of great people from a wide range of backgrounds.

Would you recommend becoming involved in research to other patients and carers? If so, why?

Definitely!!  What you get from being involved largely depends on what you put into it but I can absolutely guarantee that, regardless of your starting point, you will have a better understanding of the workings of medical research and the wider world of medicine in general.

PhD fellow focus: Anna-Sophia Wawera

2 Aug

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by Anna-Sophia Wawera

Anna-Sophia Wawera joined the PSTRC Marginalised Groups theme as a PhD Fellow in April 2018. Before coming to the University of Manchester, she completed a Master of Science in Public Health at Sheffield Hallam University. Throughout her Masters, she was involved in several research projects examining student experience and health-related issues within the university. In addition, she worked for a medical device company in Berlin, Germany, which developed a therapy for patients with long-term conditions causing visual impairments. Based on her previous experience, her main research interests lay in the field of public health promotion among vulnerable population groups, with particular focus on young people and chronic condition management.

Anna’s PhD will focus on supporting and promoting safety in the context of childhood long-term conditions, with Susan Kirk and Caroline Sanders as her lead supervisors. With the rising prevalence of long-term conditions among children and the increasing focus on self-management, a growing number of children are being cared for at home instead of within the hospital setting. While this trend provides many benefits for children, as it enables them to grow up within their family environment, it also poses considerable challenges for primary caregivers, mainly the parents, as they are faced with additional responsibilities related to the care and management of their child’s chronic condition.

To date, this trend towards home-care and the increasing transfer of responsibilities from care professionals to families has been inadequately examined in relation to patient safety and the potential risks it may pose to young people with long-term conditions. This research will therefore examine how children/young people, parents and healthcare professionals perceive, monitor and manage safety within the home setting.  The final  aim is to co-design safety tools in close cooperation with key stakeholders to further support the promotion and improvement of patient safety among this vulnerable population group.