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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.

Kay Gallacher PSG_lightened_cropped

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.

Connected Health Cities and the Greater Manchester PSTRC

2 Aug

Connected Health Cities logo_cropped

by Niels Peek, Research Lead for Safety Informatics theme, NIHR Greater Manchester PSTRC

The Safety Informatics theme in the Greater Manchester PSTRC extends and translates the principles of ‘learning health systems’ to develop technologies and information behaviours that create safer care systems. It does this by enabling:

  1. continuous professional and organisational learning
  2. accelerated translation of evidence into practice
  3. system-wide patient safety that crosses sector boundaries.

In all these activities, the Safety Informatics theme builds heavily on experiences and achievements in Connected Health Cities (CHC), a programme of work across 4 city regions in North England that is funded by the Department of Health and Social Care and commissioned by the Northern Health Science Alliance (NHSA). This programme aims to optimise care pathways by employing analytical technologies to routinely collected, local health data. In each of the 4 regions several pathways have been selected to develop and test this use of technologies. In addition the programme has extensive workstreams on workforce development, industry partnerships, and public engagement.

In the Greater Manchester Connected Health City (GMCHC), the two main care pathways project focus on:

  1. antibiotic prescribing in primary care (lead: Tjeerd van Staa)
  2. triage, diagnosis, and acute treatment of strokes (lead: Adrian Parry-Jones).

In both pathways there is a trade-off between safety of individual patients and population health generally. This trade-off can only be accurately studied by linking data from across different healthcare sectors, such as primary and secondary care. For instance, ambulance paramedics are sometimes risk averse and tend to bring everyone who might have had a stroke to one of the three specialised acute stroke units in Greater Manchester – but these specialised units have therefore become overburdened. Similarly, our analyses of antibiotic prescribing data indicate that these prescriptions are often not guided by risk of severe infection (e.g. pneumonia) and thus unnecessarily drive antimicrobial resistance in the community. In both care pathways we are now implementing electronic decision support tools for care providers to address the issues.

Greater Manchester provides a unique environment for implementing learning health systems, because the devolution context allows to offset investments in primary care with savings in secondary care and vice versa. Therefore GMCHC works closely with regional partners such as Health Innovation Manchester and the GM Health and Social Care Partnership. Both organisations have embedded the CHC principles in their digital innovation and health intelligence strategies.

 

Development and validation of a new approach to enhance patient engagement in late effects lymphoma research

2 Aug
Dr Kim Linton at the Manchester Christie Hospital. 16 May 2018.

Kim Linton, one of the supervisors on this project

by Kim Linton

Treatment for Hodgkin lymphoma (HL) is associated with a risk of late-effects (consequences of treatment occurring sometime after treatment took place), including secondary cancers of the breast and lung, cardiovascular disease, osteoporosis and infertility. All of these effects undermine long term patient safety and quality of life. Most survivors are unaware of these risks as late-effects education and lifestyle advice is not routinely offered despite a greater awareness of risk amongst clinicians. Moreover, the majority of cancer survivors have limited access to information, as they are not routinely followed up by oncology services.

Research to reduce late-effects is urgently needed, but there are no established methods of engaging, educating or supporting patients who are likely to have high levels of anxiety and support needs when approached.

This NIHR Greater Manchester PSTRC-affiliated project aims to develop tools to engage HL survivors to participate in research aimed at reducing the risk of late-effects and improving the long term safety of lymphoma treatment. Tools will be tested in a lung health check pilot study incorporating screening and lifestyle advice.

The study population will be identified from the Centre for Childhood Cancer Survivors Institute at Birmingham University.

  • In Part 1, around 16,000 HL survivors will be invited to complete a survey about their health, late-effects knowledge, follow-up status, risk factors, and to consent to future invitations to engage in late-effects research. Reasons for withholding consent will be explored. A case control study using collected data will be performed to identify risk factors for developing secondary lung cancer.
  • In Part 2, randomly selected consenting patients will be invited to focus groups to help develop/test tools to engage survivors in late-effects research, and education and support materials for publication in partnership with Lymphoma Action.
  • Part 3 will test the developed tools in a lung health check pilot study. Consenting patients with a calculated lung cancer risk of more than 1.5% per year will either receive a ‘standard’ letter or the new approach.  They will also be invited to participate in risk intervention, including smoking cessation advice and low dose CT thorax, using screening protocols established for the general population. Up to 100 participants will be scanned, and outcome measures collected including attendance rates, patient experience, quality of life, anxiety and results of intervention. Results will be compared in the two groups to validate the new tools. Applying standard screening protocols to high risk HL survivors will also be explored. Experienced study nurses will be available throughout to support participants engaged in all parts of the study.

The study aims to deliver a validated approach to enhance patient participation across a variety of late effects research topics. Results of the lung pilot will inform the feasibility and design of a further lung screening study in HL survivors.

The project falls within the Safer Care Systems and Transitions, Medication Safety and Marginalised Groups themes of the PSTRC, and has been endorsed by the National Cancer Research Institute (NCRI) Screening, Prevention and Early Diagnosis Advisory Group and The Manchester Biomedical Research Centre (BRC). The project will be supervised by experts in cancer sciences, lung cancer screening, psychology, population health and epidemiology.

Supervisors: Kim Linton, John Radford, Chris Armitage, Phil Crosbie and Mike Hawkins

What patient safety incidents are causing the most harm to my patients?

21 Jun
Andy Carson-Stevens_300x300

Andrew Carson-Stevens MBBCh PhD
Cardiff University PI for the Avoidable Harm study. Patient Safety Lead, PRIME Centre Wales

by Andy Carson-Stevens

340 million primary care consultations take place across the UK each year.  Of those, around 2% of patients experience a so-called ‘patient safety incident’ which is defined as any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving healthcare.(1) Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? With upwards of 6.8 million people experiencing unsafe primary care in the UK each year, there are a lot of opportunities to learn how to make future care safer.

Efforts to learn from medical error in hospitals have enabled an era of implementing interventions to reduce the burden of harm. Patient safety research in primary care is often talked about as lagging behind hospital efforts. However, in the UK, a collaboration comprised of Cardiff University, the University of Nottingham, the University of Manchester and the University of Edinburgh, have led major studies of national and international relevance to move this agenda on. We have undertaken the largest analysis of patient safety incidents from general practice internationally, (2) and have developed methods like coding frameworks aligned to the World Health Organization’s International Classification for Patient Safety to support the detection of incidents that cause the most severe harm to patients.(3,4) With the Royal College of General Practitioner’s Spotlight programme, we launched a workshop series for primary care teams, developed an open access e-learning module on RCGP learning, and have written a practical guide for practices to identify and learn from patient safety incidents experienced by their patients. (5) However, at workshops, attendees want to know, “What patient safety incidents are causing the most harm to my patients?” The problem is our best answers can only be informed by insights from previous studies of variable quality,(1) or based on hypotheses generated from patient safety incident reporting and learning systems.(2)

Led by Professor Tony Avery at the University of Nottingham, with collaborators from the aforementioned universities, the Department of Health and Social Care has funded a study called ‘Understanding the Nature and Frequency of Avoidable Harm In Primary Care’. The study’s aim is to identify the most severe harm experienced by patients in primary care to start to prioritise the design of safer care processes for future patients. We  recruited 12 general practices from across England to review the electronic case notes belonging to their patients. Our specially trained GPs reviewed the notes for evidence of omissions (i.e. not doing what they should have done to reduce the risk of harm, as per evidence-based guidelines) or commissions (i.e. doing something wrong and causing harm) made in care delivery. This process has enabled us to identify the systemic weaknesses that contributed to error(s) and to outline priorities for intervention development to prevent future recurrences.

For further information, we’ve published the study protocol with BMJ Open.(6) We complete the study at the end of June 2018 and will report on our findings shortly afterwards.

References

  1. Panesar SS, deSilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, Javad S, Netuveli G, Larizgoitia I, Donaldson LJ, Bates DW, Sheikh A. How safe is primary care? A systematic review. BMJ Qual Saf. 2016 Jul;25(7):544–53.
  2. Carson-Stevens A, Hibbert P, Williams H, Evans HP, Cooper A, Rees P, Deakin A, Shiels E, Gibson R, Butlin A, Carter B, Luff D, Parry G, Makeham M, McEnhill P, Ward HO, Samuriwo R, Avery AJ, Chuter A, Donaldson LJ, Mayor S, Panesar S, Sheikh A, Wood F, Edwards A. Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. Southampton (UK): NIHR Journals Library; Health Services and Delivery Research 2016 4(27).
  3. World Health Organization. The conceptual framework for the international classification for patient safety. World Health Organization. 2009;2009:1–149.
  4. Cooper J, Williams H, Hibbert P, Edwards A, Butt MA, Wood F, Parry G, Smith P, Sheikh A, Donaldson L, Carson-Stevens A. Classification of patient-safety incidents in primary care. Bulletin of the World Health Organization. Available online first from: http://www.who.int/bulletin/online_first/BLT.17.199802.pdf?ua=1
  5. Carson-Stevens A and Donaldson L. Reporting and learning from patient safety incidents in general practice: a practical guide. Royal College of General Practitioners; 2017 Apr. Available from: http://www.rcgp.org.uk/-/media/Files/CIRC/Patient-Safety/Reporting-and-learning-from-patient-safety-incidents.ashx?la=en
  6. Bell BG, Campbell S, Carson-Stevens A, Evans HP, Cooper A, Sheehan C, Rodgers S, Johnson C, Edwards A, Armstrong S, Mehta R, Chuter A, Donnelly A, Ashcroft DM, Lymn J, Smith P, Sheikh A, Boyd M, Avery AJ. Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study. BMJ Open. 2017 Feb 17;7(2):e013786.

Helping parents of children with respiratory tract infections decide when to consult primary care

19 Jun

Mother taking care of her sick child

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

Primary care is under extreme pressure and struggling to cope with demand for care. Children with Respiratory Tract Infections (RTI) are the most common reason for parents contacting primary care internationally. Parents and patients are offered little, if any, advice on if, when or how to use primary care services. Methods to improve the appropriateness of seeking help could assist primary care to deliver an improved service to the patients in most need. There is considerable parental uncertainty regarding if and when to consult a general practice healthcare professional when children fall ill with RTIs and RTI consultation rates vary widely between GP practices. Safer, cost-effective and more practical interventions are needed urgently to help parents make better use of scarce resources. This requires clear, relevant and unambiguous advice. Valid and reliable criteria are needed to support parents when they are deciding whether (and when) to consult when their child has a (suspected) RTI.

Funded by the NIHR School for Primary Care Research, researchers from the NIHR Greater Manchester PSTRC (Stephen Campbell, Rebecca Morris) and the Universities of Bristol (Alastair Hay) and Oxford (Gail Hayward) will see if professional consensus can be reached on the signs and symptoms that should be used by parents / guardians when deciding if and when to consult, both during the day and out of hours. It will use the RAND/UCLA Appropriateness Method to develop symptom scenarios and appropriateness criteria.  These will enable us to work with patients / members of the public and health professionals to develop a practical guide to support parents in deciding whether they need to contact clinical services for their child. A study working group will oversee the study involving representation from relevant health professions and including PPI/parental representation as an integral part of the research. Co-design events with parents, patients, GPs and pharmacists will then be used to develop the practical guide for parents as well as to develop the support tool for using the guide.

The guide for parents will inform the design of future interventions that could (once proven safe and effective) be implemented by GP practices and other NHS primary care providers (such as NHS 111), e.g. via general practice and NHS websites.

Risk Management: developing a learning resource to support pharmacy teams across England

3 May

Risk man guide supported by NIHR GM PSTRC

Good risk management is well recognised as the cornerstone of safe practice in the workplace and risk assessment has long been part of legal requirements for health and safety in UK workplaces.

In 2017, the World Health Organisation highlighted the importance of medication error by choosing the issue of medication-related harm as the focus of its Global Challenge. In response to this, the Medication Safety theme of the Greater Manchester PSTRC worked with CPPE (The Centre for Pharmacy Postgraduate Education) to develop their learning resources on Risk Management.

This was an ideal opportunity for the PSTRC, allowing the team to apply their broad expertise in theoretical risk management concepts to the challenges of the pharmacy context but also enabling them to incorporate the expertise and insights from the PSTRC’s Community Pharmacy Patient Safety Collaborative – a group of current in-practice community pharmacists working in the Greater Manchester region (see blog post for more information).

This ensured that the guide would be both theoretically sound in terms of risk management but also enriched with examples that pharmacists saw as pertinent to their day to day work.

Through the co-development of this guide, it was recognised that this could be part of something with much greater impact and, as a result, CPPE dedicated their 2018 learning campaign to be focussed on the topic of Patient Safety, using the guide as a focal point to provide the theoretical background for the campaign.

The guide was distributed to over 67 500 pharmacy professionals as part of CPPE Patient Safety campaign. The PSTRC continued to support CPPE designing appropriate learning activities that would be delivered by CPPE – including face to face “focal point” sessions with over 100 events due to run nationally throughout England and online weekly activities in Feb/Mar 2018 – including an e-challenge quiz and encouraging involvement via Twitter, Instagram and Facebook. This resulted in over 1500 individuals signing up to the campaign activities over the six week period and continuing beyond this with pharmacists still adding their intentions to improve patient safety on CPPE’s ‘Pledge Wall’.

Matthew Shaw, interim director of CPPE, was delighted at the opportunity to collaborate with PSTRC recognising the huge value of building an evidence base into this core learning programme. He commented “It has been a great opportunity to work with PSTRC to link theory with practice and through this to support pharmacy professionals across the country to make their practice safer, and to reduce the risks to people using our services.”