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WellMed and clinical uncertainty

8 Jun

WellMed

Dr Sudeh Cheraghi-Sohi recently attended the Third International Meeting on Wellbeing and Performance in Clinical Practice (WELLMED 3) held in Thessaloniki, Greece.  The conference, which takes place every two years, focuses on the connection between physician health and the quality and safety of care they provide.  The keynote presentation was from Professor Christina Maslach, University of California, Berkeley, USA. As the author of the most widely used tool to measure burnout, the Maslach Burnout Inventory (MBI), Professor Maslach’s perspective on burnout in health care staff, which is a growing problem , was informative as was her recommendation for policy-makers to  focus on the workplace environment and not just the individual.

Dr Sudeh Cheraghi-Sohi chaired and presented a symposium on Clinical Uncertainty, which comprised of three presentations followed by discussion.  Dr Sudeh Cheraghi-Sohi introduced the topic and discussed two recent studies in the area to illustrate how uncertainty is composed of cognitive, emotional and ethical aspects as well as being dynamic. She also noted that the literature in the area is scarce but that uncertainty has real consequences on patients, physicians and the health system.

Dr Evelyn Tsiga presented a study on physicians’ emotional reactions to uncertainty and its impact on decision making in primary care to illustrate how physician behaviour can be affected by uncertainty resulting in undesirable behaviours, such as over-referrals.

The final presentation was given by Dr Avril Danczak. Dr Danczak presented her work on training to manage uncertainty, which highlighted that physicians value such training. She emphasised that clinical uncertainty is normal and it has consequences, yet medical curricula and professional training does not acknowledge or equip clinicians to manage it.

The symposium generated much discussion and the need to address the issue of uncertainty was agreed to be an area of importance for future research.

Working together to help patients and carers to be more involved in safety

3 May

Patient Safety guide logo_cropped

The patient safety guide has been co-developed with patients, carers, general practitioners and pharmacists. We have worked together from the initial idea, to decide the focus of the guide, the first draft all the way through to refining it.

One key discussion we had early was a preference to develop a digital app based version to compliment the paper version which we are now doing. In March we held two more co-design events. In the first event we discussed what the app should include and key features that people like in an app, what they don’t like and what the guide app should include.

At the second event we discussed testing and piloting the guide package in practice for patients and carers and how would it be used with GPs, pharmacists and other healthcare staff. These discussions will be used to shape the next phase of the guide project to develop an app and test the full guide package.

Thanks to everyone who came along and got involved! If you’d like to find out more about the patient safety guide project or future opportunities to get involved please contact Dr Rebecca Morris.

British Journal of General Practice Research Conference 2018

3 May

BJGP banner & Sudeh combined

Dr Sudeh Cheraghi-Sohi recently attended the inaugural British Journal of General Practice (BJGP) Conference, held at the Royal College of General Practitioners (RCGP), on March 23rd. This one-day conference was opened by Dr Helen Stokes-Lampard, Chair of the RCGP, and the journal’s editor Professor Roger Jones. Plenaries were provided by Professor Richard Hobbs and Professor Pali Hungin, who gave an overview of some the key primary care research successes and discussed the future of general practice respectively.

Common to both talks was the focus on the growing primary care workforce crisis and the increasing workload that the diminishing workforce is attempting to deliver. From a patient safety perspective, safe staffing levels in hospitals and from an access perspective, GP provision are critical to safe service delivery.

Various solutions were suggested and the acknowledgement that there was no magic bullet. Dr Cheraghi-Sohi gave an oral presentation on her work on measuring diagnostic errors in UK general practice. An audience of primarily clinicians attended the fifteen minute presentation and engaged in a lively and positive debate on the topic once the presentation finished covering various aspects of the methods and findings. Indeed, the issue of workload was discussed and how this may contribute to the increasing occurrence of diagnostic errors.

In addition to the oral presentations, poster sessions and workshops on critical reading, peer review and how to beat procrastination in your writing were offered throughout the day.  In summary, there was a well-balanced structure to the conference programme with plenty of free-time for networking.

University of Michigan shares informatics research

18 Apr

michigan medicine-logo_small

In February, researchers Zach Landis-Lewis and Dahee Lee from the University of Michigan, Ann Arbor (USA), visited the NIHR Greater Manchester PSTRC Safety Informatics team at the Health eResearch Centre (HeRC) and gave a seminar on feedback interventions. Zach is Assistant Professor of Learning Health Sciences at the University of Michigan Medical School. Currently he is working on developing a system to support automated tailoring of clinical performance feedback for healthcare professionals. He leads the DISPLAY (Design, Implementation, Systems, Performance, Learning, and Y they matter) lab. Dahee is a MSc student in Health Informatics at the University of Michigan.

Feedback interventions play a key role in the Greater Manchester PSTRC Safety informatics theme; examples are the Salford Medication Safety Dashboard (SMASH) and the Performance Improvement plaN GeneratoR (PINGR), both of which are being used in primary care in Salford.

The work of Zach and Dahee aims to develop a formal knowledge base of feedback interventions, based on psychological theory.  The seminar talk featured:

  • an ongoing project at the University of Michigan looking at antimicrobial stewardship
  • preliminary results on the development of a classification system of performance summary displays
  • a set of mechanisms for tailoring displays to improve how GPs process performance summaries.

The Safety Informatics team is planning to work with Zach and Dahee on the further development of the knowledge base of feedback interventions, involving also collaborators from Amsterdam and Toronto. A meeting has been planned at the Audit & Feedback Summit that will be held in May 2018 in Toronto.

NAPCRG 45th annual meeting

1 Feb

NAPCRG17BannerScreen

Sally Giles, Penny Lewis, Sarah Rodgers and Patient and Public Involvement (PPI) representative Antony Chuter presented a workshop at the recent Annual Meeting of the North American Primary Care Research Group (NAPCRG) in Montreal. The objectives of the workshop were to provide an overview of examples of current research into medication safety in primary care, discuss the challenges to medication safety and some of the tools that can be used in practice to improve medication safety.

Sarah highlighted the work of the ‘PINCER’ prescribing intervention and workshop participants worked through clinical scenarios using the PINCER indicators. Antony discussed his role as a PPI member in various medication safety research projects. This stimulated discussion around patient involvement in healthcare research, as this is a relatively new concept in North America.

Penny and Sally discussed patient involvement in medication safety and the development of the Manchester Patient Safety Framework (MaPSaF) with workshop participants engaging in discussions about how they currently involve patients in the prevention of safety incidents. The workshop was well attended by a mixture of primary care physicians, pharmacists and healthcare researchers and the topic fitted well with the patient-centred care theme of the conference.

Sally also presented her work on the primary care patient measure of safety (PC_PMOS) in a well-attended oral session. Sally’s work stimulated interest in the audience with US researchers hoping to carry out similar work in this area.

Drug Utilisation Research Group (Euro DURG)

1 Feb

Euro DURG logo
Stephen Campbell attended the European Drug Utilisation Research Group (Euro DURG) Conference 2017, in Glasgow in November 2017 to present at a workshop on the “Quality of quality indicators”. Healthcare and medication use are changing and the field of drug utilisation research is evolving in a digital world.

Drug utilisation is an eclectic scientific discipline that includes many methods for the “quantification, understanding and evaluation of the processes of prescribing, dispensing and consumption of medicines and for the testing of interventions to enhance the quality of these processes”.  It has overlap with the PSTRC focus on medication safety, transitional care for those with multimorbidity and safety informatics but is linked also to the broader field of pharmacoepidemiology (the study of the uses and effects of drugs in defined populations) and health outcomes research and health economics.

The overall aim is to improve the safe and efficient use of medicines in populations to shape health policy and clinical practice.  The economic and health consequences of inappropriate drug use are substantial and patients are the end users of medicines. Those in marginalised groups can experience more inconsistent outcomes due to medication. The conference emphasised the need for a partnership between researchers, policy-makers and patients.

ISQua 34th annual conference

1 Feb

ISQua 1_CROPPED_Becci Morris

In October 2017, Sudeh Cheraghi-Sohi chaired a workshop at The International Society for Quality in Health Care (ISQua) 34th annual conference. The workshop was entitled “Developing and improving a systems approach to diagnostic safety in primary care” and was developed with collaborators Hardeep Singh from the Veterans Affairs organisation based in Houston, Texas and Ian Litchfield from the Institute of Applied Health Research, Birmingham University.

The workshop covered three major areas in diagnostic error and safety.  Firstly, Sudeh introduced the concept and various definitions of diagnostic error, along with the various causes of such errors and how to measure them. This was followed by Ian Litchfield presenting some work on a specific cause of diagnostic errors: poor or non-existent test results follow-up. Ian Litchfield described where these issues commonly occur e.g. clinicians being unaware that ordered tests had not come back from the lab. Finally, Hardeep Singh summarised the future research agenda in this area and highlighted how Information Technology will play an increasing role in diagnostic safety.

Many in the audience expressed surprise as to how little focus there had been on this area given its importance and expressed support of our current work and the future research agenda. Diagnostic error is still a niche area, but is gaining prominence due to America’s Institute of Medicine’s 2015 Improving Diagnosis report and The World Health Organization’s Technical Series on Safer Primary Care, which both prioritised errors in diagnosis as a global priority for patient safety.