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Diagnostic Error in Medicine: key topics

2 Nov

by Sudeh Cheraghi-Sohi, Research Fellow in Safety in Marginalised Groups: Patients and Carers theme

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I recently attended the 10th International Conference on Diagnostic Error in Medicine (DEM) held in Boston and organised by the Society to Improve Diagnosis in Medicine (SIDM).  I was invited to attend the research summit as well as to display some of my work from the 2012-2017 NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (PSTRC).

The research summit was an excellent forum for discussing the key areas of interest in the field of DEM research.   This year’s topics of interest were around uncertainty and the role of the team and teamwork. For the first topic, I was really interested to participate in discussions as I have already done some work in the area of uncertainty in terms of a review[1] around the various aspects of uncertainty and the PSTRC has also developed a training package[2] to help peoples’ awareness of the issues and in managing their uncertainty.  The discussions were very lively and a keynote speech at the conference given by Dr Arabella Simpkin also resonated with the conference delegates.

The second topic is an area that the Institute of Medicine, in their 2015 report on Improving Diagnosis, placed a focus on. The role of team in making a diagnosis may not be obvious to many people, particularly in the context of UK general practice where patients probably think about the one-to-one consultation with their general practitioner, but even in general practice, there are often multiple people involved in making a diagnosis. For example, the phlebotomist and the practice nurse/nurse practitioner may have already seen a patient prior to the GP consultation and performed certain tasks and provided prior information for the GP to work with. Also, when GPs make referrals, they are seeking the expertise of others and then utilising all the gathered information to inform their diagnostic thinking and hopefully coming up with an accurate diagnosis. This is certainly an area that I would like to explore more. 

Finally, the main conference itself was fascinating. There was a superb talk given by Don Berwick, one the world’s leading patient safety experts, as well as many interesting workshops to attend. I am also happy to say people were very interested in the Greater Manchester PSTRC’s work around Missed Diagnostic Opportunities[3] and I will write another blog when we are able to share more of our findings from this project.

Learning from each other: the International Society for Quality in Healthcare (ISQua) Conference 2017

24 Oct

by Rebecca Morris, Research Fellow in the Safety in Marginalised Groups theme

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The International Society for Quality in Healthcare (ISQua) conference was held this year at the QEII conference centre in London next to Westminster Abbey and Palace of Westminster which was a prestigious backdrop to an interesting and diverse range of presentations.  This year’s conference focused on learning at the system level to improve healthcare quality and safety and was supported by the Health Foundation. It was great to see that the conference was awarded the Patients Included status which reflected the conference’s focus on incorporating the experience of patients whilst ensuring that they are not excluded or exploited. This was evident within presentations that I attended that included patients speaking alongside researchers and clinicians and I felt this was a welcome development from last year’s conference. Sharing and valuing different experiences and expertise is an important recognition of different types of expertise that need to be involved, particularly when we are looking at healthcare quality and safety.

There was a fantastic array of workshops, plenaries, oral and poster presentations. I wanted to be in more of the streams than I could attend in one day! I had both a 15 minute oral presentation and a poster presentation to discuss two of the projects in the NIHR Greater Manchester PSTRC. My oral presentation was part of the Quality in the community theme and it was great to hear about different community approaches to quality and safety across the world. I presented the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership and the top 10 priorities for future research. This is important in shaping the direction of future work which prioritises the questions which patients, carers and healthcare professionals need answering. Also in-keeping with the theme of incorporating the experience of patients and turning that into action, I presented a poster on the co-development of the patient safety guide for primary care where we have co-produced the guide package with patients, carers, GPs and pharmacists. The poster was a great opportunity to discuss the patient safety guide, co-production and networking with people from a range of places, from Canada to India, about the work and sharing ideas and building links.

After last year’s conference where there was a limited discussion of primary care and the community, it was great that there were so many of us there to represent the work that we’ve been doing working with patients, carers and clinicians. Fellow Greater Manchester PSTRC researchers, Caroline Sanders and Sudeh-Cheraghi Sohi, were part of workshops discussing the use of patient experience data and diagnostic safety respectively, along with posters from Penny Lewis and Christian Thomas exploring safety in community pharmacy.

To finish off an interesting day I was invited to a Health Foundation reception at Westminster Abbey to carry on the conversations and it was great to meet and discuss how our work can lead to improvement in the system and experiences of people who use and deliver healthcare services. A great way to end the day and I’m looking forward to how we can build on this over the next year.

Thinking outside of the box: presenting patient safety issues creatively

30 Mar

by Sally Giles, Research Fellow in PPI Research and Jackie Nightingale, member of the Greater Manchester PSTRC Research User Group

In 2016 Sally Giles (Research Fellow, Core Theme) took part in the Academy of Creative Minds programme which brought together a dynamic, disparate group of artists, from composers to circus performers, directors to writers. These artists shared their ‘tricks of the trade’ with health researchers, to help them build confidence and expertise in using the creative arts to convey research messages in a more powerful and meaningful way.

As part of the programme Sally was required to work with one or more of the artists to produce a creative way of conveying a research message of her choice.  Sally worked with a circus performer to develop a way of highlighting communication issues in general practice and how this can affect patient safety.  As part of this process Jackie Nightingale (a member of the Greater Manchester PSTRC Research User Group) was asked to get involved in developing this performance.  Jackie played a starring role as the main patient in the scene.  Their full performance was a major part of the NHS R+D North West Annual Research Conference (video above).

Both Jackie and Sally thoroughly enjoyed the experience and would recommend the course to anyone who would like the opportunity to think outside of the box when trying to get research messages across in an enjoyable and innovative way.

Greater Manchester PSTRC Dissemination Event: A Lay Delegate’s Perspective

28 Mar

by Moira Lyons, member of the NIHR Greater Manchester PSTRC Research User Group (RUG)

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As a Core Member of the Greater Manchester Primary Care Patient Safety Translational Research Centre (GM PSTRC)’s Research User Group (RUG), I was delighted to be invited to attend the Centre’s recent flagship dissemination event, “Safer Primary Care: A shared responsibility for system-wide learning”, which was held over two days at the Manchester Conference Centre. For me, the inclusion of members of the public in the delegate list (and not purely as spectators – several RUG members took part in the delivery of workshops, alongside researchers) underlined the genuine commitment to patient and public involvement apparent in every aspect of the Centre’s work.

It was very exciting to see the evidence of how much had been achieved over the last five years and to hear something of the plans for the new PSTRC! The atmosphere was one of expectation and enthusiasm and an inextinguishable optimism for the future. One theme resonated throughout – communication and sharing data. The more we can make use of the data available to us and share the information we have with all parties involved, the better it will be for everybody and the easier it will be to progress all aspects of patient safety. And what better exemplification of that than this event!

The speakers were relevant, informative and entertaining, the organisation was faultlessly streamlined – even the catering was of a high standard, plentiful and varied. A balance was struck between opportunities to listen and learn and opportunities to discuss and ask questions. The poster session was a lively event, as presenters eagerly approached delegates who showed an interest in their work. The diversity of research within a common theme was impressive, as was the dynamic exchange of information that drew everybody in. For example, I had a very interesting discussion with two GPs about the differences in diagnosing practice between the UK and other parts of the European community; a Dutch GP will routinely consider the option of whether or not there is “a need to treat” – a relevant concept in view of the current concern about overprescribing. It was also good to hear a GP decry the use of the “one appointment one issue” policy that has been adopted in some general practices.

The Event Dinner at the Principal Hotel, on the evening of the first day, was well attended. The after-dinner speech, delivered by Professor Richard Roberts, was a highlight. Even though, as he pointed out, he was all that stood between diners and dessert, his audience was captivated by a superb combination of thought provoking comment and insightful reflection, informed by personal experience, as he considered the future of primary care.

The two days passed all too quickly.

Reflections on ISQua 2016

16 Nov

by Sally Giles, Research Fellow in Core theme

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This year’s International Society for Quality in Healthcare (ISQua) conference took me to the vibrant city of Tokyo, famous for its incredible technological growth, its seismic activity and geological features. For me, as a former geographer, this diversity was certainly fascinating and a real attraction! The Tokyo International Forum was the chosen venue, and with its numerous different levels, it even provided a challenge to those with the best sense of direction! 

The conference this year covered eight main themes, with hundreds of concurrent sessions to choose from; including 50 minute plenary sessions, 90 minute workshops and 15 or 5 minute oral presentations. There was also an impressive display of posters in the exhibition hall. One of the main highlights of the conference was the Japanese Bento lunch boxes, which made a welcome change to the often bland and uninteresting lunches provided at conferences. I was however slightly disappointed to see so little primary care research. I therefore challenge all Greater Manchester PSTRC researchers to place primary care patient safety research on the ISQua agenda in 2017.

This year I was allocated a 15 minute oral slot as part of the Person Centred Care theme. I took to the rather large stage and presented the findings from an NIHR Research for Patient Benefit (RfPB) study, “Developing a Patient-Led Electronic Feedback System for Quality and Safety within an existing Electronic Health Record”, which has since been accepted for publication in the Journal of Renal Care. My presentation was well received with particular interest in how we were going to take the patient reporting system forward and what training would be required for the patients who may wish to use it. Definitely food for thought!

A lay member view – NIHR Greater Manchester PSTRC Away Day 2016

11 Nov

by Angela Ruddock, member of the NIHR Greater Manchester PSTRC’s Governance Research User Group (RUG)

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I and three other lay members of the Research User Group, David, John and Kay, attended the recent NIHR Greater Manchester PSTRC Away Day.

I have to say that I was not keen about the prospect of being ‘holed up’ for two days (well, an evening and a day) with a group of academic researchers.

This is no offence to researchers (!) but I confess that after many years of working in both an NHS Trust and a University environment, I was regrettably turning into a hardened old cynic when it came to these so-called ‘bonding’ sessions.  However, I can safely say that I found myself enjoying the sessions on the day.

The evening before the sessions gave me an opportunity to have some completely off the wall conversations with 2 or 3 people I did not know that well and probably had not spoken to before although I had heard them present research projects over the year. The subject matter was in fact not about research but about Prince the singer who was found dead that morning. We got into a conversation about rock stars who had made an impression on us. It turned out to be a pretty good if a bit sad leveller.

The main business commenced 9.30 the following morning with a presentation from Stephen about the James Lind Alliance, its role and its purpose. It was useful for me in appreciating the input that we as part of the PSTRC- Research User Group can make in improving communication, exchanging views and contributing the patient/public perspective in the debate about priorities.

It was really good to hear in the second and third presentations how the work of the PSTRC has had an impact on a wide range of clinical issues from mental health issues such as suicide prevention to multi medication prescribing. What particularly interested me was how many of the tools used in these research projects could be used in a variety of practical settings, for instance by GP practices, in identifying where their own Practice is in relation to others on a particular patient safety issue, by  Clinical Commissioning Groups in identifying particular areas  of concern in Greater Manchester and to share good practice or, as a final example, by pharmacists in recording and identifying where there may be particular concerns relating to certain prescribed medications when combined with others.

The only area I felt could further benefit from exploration was the patient/lay contributor input in terms of more qualitative data in some research areas and perhaps more ideas in identifying a diversity of lay input (but I would say that wouldn’t I!). I think my colleagues John and Kay from the discussion groups were well able to contribute to this area and give some clear views about added value from a patient/public perspective.

In summary I admit that I wrongly prejudged the significance of the opportunity to get into some real and practical conversations with the research teams and am convinced that it helped me understand better the issues and dilemmas facing them.  Hopefully they also had an understanding of our perspective and are more able to shape the projects in more rounded way as a result.