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NIHR Greater Manchester PSTRC Meet the Team – Sudeh Cheraghi-Sohi

26 Aug

The fifth in our NIHR Greater Manchester PSTRC ‘Meet the Team’ series introduces Sudeh Cheraghi-Sohi, Research Fellow in General Practice theme.

Sudeh Cheraghi-Sohi_Meet the Team

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Recruiting GP practices to validate the Primary Care Patient Measure of Safety (PC_PMOS)

3 Feb

by Sally Giles, Research Fellow in Core theme

Receptionist and Patient GP Surgery_cropped_small

Study aims

The NIHR Greater Manchester PSTRC project is looking to validate a tool which captures patients’ views of safety in primary care (PC_PMOS). The aim of this tool is to provide feedback to practices about the strengths and weaknesses of the safety of the care they provide from the patients’ point of view. It is intended to be part of practice’s continual quality improvement processes. Details of its development can be found here: http://qualitysafety.bmj.com/content/early/2015/07/03/bmjqs-2015-004268.full

 

What we are asking practices to do?

We are asking local general practices to help us recruit patients to complete this tool which is a survey. Patients will be recruited by the reception/administration staff at general practices on the researcher’s behalf. Every adult patient (over the age of 18) presenting for their appointment at the practice over a designated 4 week period will be invited to participate in the study until 50 patients have completed it. They will be asked by the reception/administration staff at the practice to complete the PC_PMOS survey either before or after their appointment. Each practice will be provided with a secure questionnaire return box for patients to put their questionnaires in. Participants will also be invited by the reception/administration staff at the practice to complete the questionnaire again within one week of undertaking the first questionnaire for test-retest reliability purposes. Those who are willing to complete the questionnaire again will be given the opportunity to opt in and are asked to provide their email address and phone number so a link to the questionnaire can be emailed to them. The first 10% of patients who respond will be emailed a link to the questionnaire to complete.  The anonymised feedback provided by patients on this survey will be made available to practices after the study has been completed. In addition, each staff member at the practice will be required to complete a safety culture survey which should take no more than 20 minutes to complete. Demographic information about the practice and patient profile would also need to be provided to the research team.

 

What are the benefits of being involved in this study?

Completing the questionnaire will help the researchers to develop a reliable and valid tool that patients can use to provide feedback about the safety of their care to general practices. Each GP practice will receive a summary of the findings for their practice.

 

Payment

Each practice will receive £500 for taking part in the study. They will need to provide their financial details so that a contract can be drawn up and they are added to the University of Manchester financial system as a ‘supplier’. Once they have signed the contract, we then raise a requisition for a purchase order that relates to the services the practice has agreed to supply.

 

Contact

For further information about the study and to sign up to take part, please contact:

Dr Sally Giles, Research Fellow, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Tel: 0161 306 8020, Email: sally.giles@manchester.ac.uk

 

 

Can computer software programmes be used to help clinicians with their diagnoses?

23 Jun

by Rahul Alam, Research Associate in General Practice theme

Isabel screenshot

Figure 1 Screenshot of a differential diagnosis list

General Practitioners (GPs) and nurse practitioners in general practice are required to recall a large number of illnesses and diseases as well as a large number of tests and drugs that can be ordered and prescribed. Given such breadth, arriving at the correct diagnoses can be a difficult task, particularly when patients present with unusual symptoms. As a result, diagnostic errors can, and do, occur. One potential resource for helping clinicians to make the correct diagnoses are specialised computer software programmes, otherwise known as differential diagnosis (DDx) generators. They are aimed at helping clinicians with the diagnostic process to reduce the possibility of clinicians missing, delaying or making incorrect diagnoses. In principle, clinicians can enter the patient’s clinical symptoms and the DDx generator produces a list of potentially relevant diagnoses the clinician might want to consider (please see figure 1). This information may be utilised by clinicians as part of the differential diagnostic process to whittle the potential diagnoses down to those most likely. Isabel is one such commercially available web-based DDx generator.

However, little is known about how DDx generators will be viewed and whether they can be used by clinicians in routine practice.  There is also limited evidence on how accurate programmes like Isabel are. In order to ascertain the potential feasibility and utility (benefits) of using this program, we are conducting a small one-practice study divided into two separate components.

The first component of the study will investigate the diagnostic ‘accuracy’ of Isabel in relation to cases of diagnostic uncertainty. Two situations that are likely to involve elements of diagnostic uncertainty relate to referrals to secondary care for follow-up investigations and people who frequently attend the practice (those whose attendance rate is in the top 3% of the practice). Two GPs will review and select all cases of diagnostic uncertainty and the patient details will be entered into Isabel and compared to the final discharge diagnosis from the hospital or the final recorded diagnosis to determine Isabel’s accuracy rate.

In the second component we aim to ascertain the feasibility of clinician’s using Isabel in routine practice when diagnosing patients. We have conducted 11 interviews with 9 GPs and 2 nurse practitioners to ascertain their views and experiences of using a differential diagnosis tool such as Isabel.  We then trained all clinical staff at the practice to use Isabel and they have now had a 6-month opportunity to use Isabel. A remote monitoring system captured wider data such as usage rates, links accessed and time taken to use. We are now conducting post-use interviews with the clinicians to obtain their feedback and opinions on Isabel as a diagnostic aide in routine general practice.

We hope that the findings of the two components of this study can help assess the diagnostic accuracy of Isabel in UK general practice as well provide useful insights in to the feasibility of utilising Isabel in routine clinical practice.

Should the public have access to written patient complaints and is it time to re-badge “patient complaints”?

30 Sep

by Rahul Alam, Research Associate in General Practice theme

Rahul Alam blog picture_Sept 14

Affording patients the opportunity to “complain” regarding the care they receive is now seen and recognised as an essential part of improving patient safety. The Francis report described the short comings in patient safety when patient complaints are not heeded [1]. “Provide every patient with a pen and paper by their bedside to provide comments and concerns” was one recommendation for improving patient safety in another recent government review [2].

Recognising these concerns, the NHS has embraced and pro-actively encouraged the collection of complaints, which have soared from 148,200 written complaints in 2010-2011 to 174,872 in 2013-2014. Over 60,500 were reported from primary care and they contribute to a staggering 3,300 written complaints a week within the NHS in England and Wales alone! [3]

Given the wide-ranging healthcare services that are available and the varying levels of patient interactions, it is likely that complaints vary in their properties and dimensions. Currently, patient complaints are not easily accessible to the public, so there is no easy mechanism for identifying and acting on complaints raised by patients. Concerns have been raised around patient consent and confidentiality which means that only some senior NHS staff can access and act on these complaints. However, should anonymised patient complaint data be made available to the public? Benefits could be considerable. For example, second-hand experiences could empower patients to act, if and when they experience similar events themselves. Healthcare organisations can learn from each other, foresee potential problems from previous complaints and adopt examples of good practice. And finally, the research community, with input from patients and the public can explore salient issues in an attempt to improve patient safety and minimise harm.

Issues around confidentiality and consent could be mitigated if “complaints” are used as an opportunity to tap in to patient’s feelings, experiences and knowledge and used to drive patient-driven improvements. The complaint could be seen as an opportunity not only to say “what went wrong” but also to emphasize and ask “what can be done” to prevent future episodes of failure.

When health, well-being and patient safety is at stake, the patient complaints can be used to make improvements from the perspective of the patient. Complaints from patients and their families can often be emotionally charged but at the same time, patients and their families are probably best positioned to answer these key questions around improvement. Asking patients for a “suggestion for improvement” is likely to funnel patient emotions and discontent. This may lead to patients producing material that can be useful to improve care and patient safety at the same time as addressing their concerns and reassuring patients that preventative efforts are being made. We need to think of mechanisms of how we can harness these views for improvement.

Given the increasing numbers of patient complaints, it seems prudent to capture as many patient suggestions as possible. I would argue that a complaint coupled with a “suggestion to improve” is better than a complaint alone. There may be occasions when a “suggestion to improve” is not possible or some may argue that they do not wish to provide a “suggestion to improve”. My counter argument would simply be that we all have a shared responsibility to contribute to the system’s well -being, just as the system has a responsibility for our own well-being.

  1. Francis, R., The Mid Staffordshire NHS Foundation Trust. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. ID 2535334 01/13, ISBN: 9780102981476. London: The Stationery Office, Crown copyright. 2013.
  2. Clwyd, A. and T. Hart, A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Final Report. Crown copyright 2901299. 2013.
  3. HSCIC, Workforce and Facilities Team, Health and Social Care Information Centre. Data on Written Complaints in the NHS 2013-14. 2014.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Dangerous GP surgeries are named and shamed… Why is the patient’s voice unheard?

12 Dec

by Jill Stocks, GM PSTRC Research Fellow for Core theme Jill Stocks blog 1 image 2_cropped Most patients receive safe quality care from their general practice. However headlines such as these will not be surprising to many of us. Prof Steve Field, the CQC’s new chief inspector of GPs, commenting on the Care Quality Commission’s preliminary report, said the problems highlighted in the checks had sometimes been known about locally for years. “We are hearing about problems that people are very worried about but no-one has tackled in the past.” If our concerns about our GP practices are not being acted on then should we be complaining louder and more often? Most of us are probably unaware of how to raise our concerns with our GP practices. If we look at the information provided by the NHS we are encouraged to complain to our GP first (NHS complaints). Naturally we feel intimidated and uncomfortable about complaining directly to the GP yet the means to raise our concerns with an independent body is not readily accessible. We can go to the Parliamentary and Health Service Ombudsman, although we are supposed to complain to our GP practice in the first instance, or we can read the NHS constitution to discover the formal procedures. However a recent survey by the Patients Association shows that even those who are aware of the NHS constitution do not know how to enforce these rights. The National Reporting and Learning System collects reports of patient safety incidents. Only NHS staff can report to this and only about 0.5% of reports come from GP practices. Does this mean the complaints are not being reported or are they not being made by the patients to the NHS staff? I have made a complaint on behalf of my mother who was prescribed a dose of a drug large enough to kill her. I felt that the investigation by the Primary Care Trust did not deal with the problem adequately yet I never had the opportunity to comment formally on the investigation. This is why we just grumble to anybody who will listen when we have a problem with our GP practice, even when that might seriously affect our own or someone else’s safety. We need an accessible, fast-acting, responsive route to raise our safety concerns about primary care now. Not until we ask the patients about safety in GP practices will we have the true picture.

 

 

Errors in General Practice? Yes, but how many and where…

13 Nov

by Sudeh Cheraghi-Sohi, GM PSTRC Research Fellow on General Practice theme

NEVER EVENTS

Since the publication of the landmark report ‘To Err is Human’ in 1999, patient safety has received considerable attention worldwide. One area that hasn’t, is General Practice. General Practice is not necessarily somewhere that one thinks of as ‘unsafe,’ and of course thankfully for the most part it isn’t, however the sheer volume of patient contacts, approximately 300 million per year, mean that there are plenty of opportunities for safety incidents and errors to occur.

So what types of things am I talking about? Well the two most common areas for errors to occur are thought to be in 1) diagnosis, in terms of diagnoses being missed, delayed or simply wrong; and 2) treatment, for example, prescribing the wrong drug or dose etc. (Sandars et al. 2003).  We now have good evidence for the latter via The PRACtICe Study,but beyond prescribing errors, the evidence base in the UK is not robust and therefore we have no idea of the true prevalence of error more generally.

One of our major tasks in the GP theme therefore is to produce an estimate of the prevalence of error in general practice. This is a huge and complex undertaking and we are currently designing our study to hopefully produce this figure and I will update you on this once we have finalised our plans.

So what will we do when we have calculated our prevalence estimate? Well by knowing how many errors are occurring and more importantly where they are occurring, we can direct our attention to how we might reduce the frequency of them actually happening. One way we can do this is via educational interventions.

This neatly leads me into another project that we are developing namely, Simulation Laboratories. In partnership with Salford Royal Foundation Trust, we are going to design and build our simulation lab as well as develop the materials used within them to help train clinicians such as General Practitioners to practice safely. That’s the plan anyhow!

Finally, you can also find out about another area of work we are currently doing around so called ‘Never Events’ by looking at another post I wrote for our Centre for Primary Care blog by clicking here