Tag Archives: GM PSTRC

New Theme Overview: Safer Care Systems and Transitions

1 Feb

Safer Care Systems_banner_hospitalpatientdoctors

The research for this new theme will take place at the Universities of Nottingham (lead: Justin Waring) and Manchester (lead: Stephen Campbell) and sites of study include hospitals, mental health services, community pharmacy and primary care.

A patient’s journey through different parts of the health service is called a “pathway,” and it is already known that patients can be put at particular risk when they move along their pathway and receive care from different organisations. Concerns for patients might include: “Has all the relevant information been passed from my GP to my hospital consultant (or the other way round)? Am I getting the same advice from different health professionals about my health problems or are people giving me contradictory advice?” Patient transfers, i.e. when people are in between different services and perhaps reliant on self-care or support from family members, can bring additional risks.

In this theme, these issues will be explored in four main topics:

  • ‘mental health’ (also in collaboration with the Marginalised Groups theme)
  • ‘information storage and transfer systems’ and ‘patient-held care records’ (both in collaboration with the Safety Informatics theme)
  • ‘governance and regulation’ (in collaboration with the Medication Safety theme)

Specific research projects being worked up include threats to safety in mental health transitions, and the potential role of patient-held care records in improving safety across the patient pathway. Through this programme of work, the key factors in transitional safety will be identified, followed by the development and testing of new systems of routine data collection and analysis to measure them.

Innovative IT system that prevents prescription errors wins prestigious national prize

5 Dec

Richard Williams_John Perry award_CROPPED

Richard Williams, a Senior Software Engineer at The University of Manchester, based in the NIHR Greater Manchester Patient Safety Translational Centre (Greater Manchester PSTRC) and Centre for Health Informatics, has been awarded the respected John Perry Prize by BCS: The Chartered Institute for IT.

Announced at a glitzy ceremony in early October, the prize recognises Richard’s outstanding contribution to Primary Care Computing.  Having been awarded annually since 1985 it is one of the IT industry’s most respected accolades, acknowledging innovation and excellence in computer science.

The Prize along with £500 cash was awarded in recognition of Richard’s work developing and disseminating the Smart Medication Safety Dashboard (SMASH).  This potentially life-saving piece of software, which was developed with support from the Greater Manchester PSTRC and Health eResearch Centre (HeRC), was created to improve patient safety by reducing the number of prescription errors.  Such errors occur in 5% of prescriptions according to a recent study of English general practices with one in 550 considered to be life-threatening.

Richard’s work involved the development of an algorithm that trawls GPs’ patient databases in search of high-risk – and possibly dangerous – prescription and/or disease combinations. Once identified, these prescriptions are flagged up to a relevant pharmacist who is able to investigate, question and where appropriate refer prescriptions back to the GP for review.

The high-risk combinations that SMASH could identify might, for example include a patient receiving a complex blend of high-strength medications that need to be carefully managed or someone who has been receiving an un-checked repeat prescription for a long time.

Alongside the digital infrastructure required to develop and implement SMASH, Richard also created an easy-to-view front-end platform.  This allows pharmacists to clearly and quickly identify any risks without the need for complex and time-consuming analysis.

SMASH is now being used by 43 active practices across Greater Manchester. Richard created SMASH by building upon previous work conducted at The University of Nottingham. The team are in the process of analysing the impact, but preliminary results look good. As of January 2017 the number of patients at risk in practices using the dashboard had reduced by 50% – a mean reduction of 21 patients per practice.

Richard was named the overall winner of the prize in the face of tough competition and now joins a respected list of previous recipients including Kate Warriner and Dr Amir Hannan.  Speaking about the prize, Richard said:

“John Perry was pioneering in the field of primary care computing and for his work on developing the first clinical coding terminology for GPs. It’s a great honour to be associated with him, and is particularly relevant as my current research is around how researchers build, reuse and share sets of clinical codes.”

The Smart Medication Safety Dashboard (SMASH) was funded by the NIHR Greater Manchester Patient Safety Translational Research Centre and delivered by the Health eResearch Centre.  Find out more information about the development of the dashboard on the SMASH page of the PSTRC website.

Patient Safety: the way forward

8 Aug

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

University campus

Seventy five percent of patient safety research is focused on hospitals. Less is known about patient safety outside hospitals, yet 85% of NHS contacts happen in these settings, mostly in general practice and in pharmacies. The scale of primary care in England is huge. There are 340 million general practice consultations annually, with 2% involving a patient safety incident, which means 6.8 million times each year where a patient is potentially at risk of harm. There are one billion prescriptions issued per year outside of hospitals, with 4.9% having an error – 49 million every year. And 20% of patients discharged from hospital will report an adverse event, which could lead to costly readmission to hospital. On 1 August 2012, the Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC) started, funded by the National Institute for Health Research (NIHR).  Our PSTRC has been a groundbreaking centre as it was the first patient safety centre to focus on primary care (general practice, community pharmacies etc.) as well as the interfaces with hospital care. The focus on primary care was intentional and needed.

We have achieved many improvements in primary care safety over the last 5 years. For example, we have developed a “Safer Prescribing” e-learning course for GPs, which has reduced prescribing errors.  We have developed a Medication Safety Dashboard as a “missed opportunity detector” that has resulted in fewer patients being at risk of potentially hazardous prescribing. We have used mobile technology such as smartphone apps to deliver safer healthcare. As an example, ClinTouch monitors symptom change in people with serious mental illness. We have worked in partnership with patients, GPs and pharmacists to create a Patient Safety Guide for general practice.

I am a health services researcher who has focused on the quality and safety of primary care for 25 years. Over that time there have been many advances in improving quality and safety but equally people are living longer, often with several health conditions requiring care from many different sources, in a world that becomes ever more complex with new digital technologies and “intelligent healthcare communities”. Most research and advances in patient safety are typically found within single care settings, such as the emergency department. Less attention has been paid to safety between (transitional) community providers and hospital care settings. Delayed diagnosis, incomplete patient information and medication errors are examples of problems, which may occur both within settings and across an interface. That is why we shall focus on primary care but also on transitional care settings in our second period of 5-years of funding from the National Institute for Health Research (NIHR), which started on 1 August 2017.

Over the next 5 years, our research will focus on:

  • Safety Informatics – developing technologies and behaviours that create safer care systems and to prevent diagnostic errors – working with the Health e-Research Centre
  • Medication Safety –developing safety management systems to ensure safer prescribing and treatment and to prevent medication errors
  • Safer Care Systems and Transitions – a new theme, to make care safer for patients moving between care settings
  • Safety in Marginalised Groups – a new theme – to enable patients and carers to take control of their care. There will be a key focus on patients and carers as well as mental health, working with the Centre for Mental Health and Safety

Service responsibility and patient responsibility for patient safety go hand-in-hand. They are equal. A member of the public seeking healthcare as a patient for themselves or a loved-one deserves the safest and best quality care possible. That is the duty of healthcare providers and professionals. Avoiding errors, or identifying and correcting them, is a high priority. Equally, patients can do much to keep themselves safer in terms of accessing care appropriately, taking medications as prescribed, self-managing a healthy lifestyle with sensible eating and drinking as well as exercising etc. This is the responsibility of each member of the public. It is a shared responsibility that requires co-design and partnership working, which underpins everything we do.

A key aspect of our work, and something which I think is crucial to the PSTRC, is capacity building and training people to be able to conduct and apply research. This includes recruiting PhD students, helping a group of pharmacists to work together on research projects in their own pharmacies, and training researchers as well as members of the public and patients. Healthcare isn’t just about a medical procedure or treatment option, it is about people, both those who deliver the care and those who receive it or work in partnership together. The PSTRC aims to be an interactive research centre working with healthcare professionals, the NHS, local authorities, industry and patients, carers and members of the public to make healthcare safer.

Much is happening in Greater Manchester that gives us opportunities to make a real difference. We will work across Greater Manchester’s newly-integrated Health and Social Care Partnership which serves 3 million people. The Connected Health Cities programme across the north of England will help us get our research implemented. We will continue to work in partnership with colleagues at the University of Nottingham, especially in the research on safer transitions and medication safety. We look forward to new collaborations with colleagues at the Christie NHS Foundation Trust and Central Manchester NHS Foundation Trust. There is much we can do using new digital technologies and behavioural interventions to improve safety and healthcare for the benefit of patients.

I want to thank everyone who has been involved with the PSTRC over the last 5 years. I look forward to working with everyone in the new PSTRC to continue our exciting, innovative and important research. The PSTRC has many outstanding and world-leading researchers and an excellent core staff. There is much to do but we will continue to build the capacity to make care safer.

The PSTRC has a strong involvement and engagement agenda working alongside members of the public and patients as well as healthcare professionals. If you would like to find out more about our research and how you can get involved then please email Zarina Saeed at zarina.saeed@manchester.ac.uk .


Reflections on the power of a patients’ story and glimpses into the future

14 Jul

by Aneez Esmail, Director of the Greater Manchester PSTRC


One of the advantages of being the Director of the Centre is that occasionally I get asked to attend and speak at interesting conferences. One of these was the Patient Safety Congress, which is billed as the premiere patient safety event in England. This is a monster of a conference with hundred’s of NHS staff mainly from acute trusts attending. And of course the ubiquitous NHS managers who in my opinion are developing even more complex titles to describe what they do. Some no longer have safety in their title (patient experience is the new buzz word) and I am always asking people who are introduced to me – so what is it that you do? The sad thing is that I still don’t know after what is inevitably a 2-minute explanation- perhaps an interesting barometer of the NHS in 2014. It was also sad to see so little focus on patient safety in primary care, though there was a surprisingly good attendance from researchers and clinicians at the workshop that I was speaking at.

However the highlight for me was meeting Margaret Murphy who I first met when she gave a heart breaking account of how her son died as a result of a patient safety incident that had its origins in primary care. Listen to her presentation that she made at the final Linneaus Conference (a large European project on patient safety which I led). If you ever need reminding why patient safety is important, listen to Margaret and commit to doing something about it http://www.linneaus-pc.eu/frankfurt_conference.html (Look at the Video’s – Margaret Murphy –Importance of involving patients).

The other interesting conference was an invitation to the Health Service Journal Innovation Summit. This was supported by the NHS Innovation Unit and some private companies, who are already muscling in and making a pitch for the billions of funding that the NHS has. From the patient safety perspective there were some very interesting presentations made by companies developing apps for smartphones – many of which have a patient safety angle. So for example ‘apps’ which remind patients of possible side effects of medication, ‘apps’ that monitor patient bio data like mood, BP, pulse and blood sugar. I of course talked to them about how we can engage patients in primary care and they may be potential partners as we start work on some of the projects in the GP theme. There are many working in the area, one such company is www.uMotif.com

Interestingly there was also a company (doing very well apparently), which has directly used ideas that we developed on patient safety culture in Manchester (www.verita.net). They billed themselves an investigatory unit, working to improve things after disasters such as Mid Staffs and working with Boards to improve their resilience. Really what they are doing is assessing safety culture. So here is an interesting concept – they use publicly funded research to develop tools that they then repackage and sell back to the NHS! Brave New World. It did make me wonder whether we as academics are missing a few tricks here.

Ancient Egypt and the ‘hierarchy of evidence’

30 Jun

by Jonathan Stokes, PhD student in Multimorbidity theme


One of the first things you learn when training in any sort of biomedical research is the ‘hierarchy of evidence’ (picture above), what counts as the ‘best’ type of evidence in our field. As you can see from this pyramid, randomised controlled trials (RCTs) – where a population is randomly split into two or more groups, an intervention is carried out on one, and the other acts as a ‘control’; results look at the difference between the two groups after a period of time – are at the very top (not counting ‘Systematic reviews’ which are simply compilations of many studies from the lower points of the pyramid). RCTs work so well, and are rated so highly in the hierarchy, because by definition and set-up they control for as much variation as possible. They control for variation both between the two groups involved, as well as between the settings they are subjected to. This is great from a statistical point of view, but stripping context and the variation naturally found in any population between individuals gives us extremely unnatural results i.e. the interventions assessed in this way don’t work in the same way when these are used in the much more complex, real world. And this is especially true when we look at more and more complex interventions e.g. integrated care, for more and more complex patients with multimorbidity – you can find more details on this specific issue in my personal blog page here. Not only do RCTs apply only incompletely to the actual context they’ll be used in, but they also cost an absolute fortune, and take years to do properly. Not always the most practical solution perhaps, particularly in assessing an intervention which has particularly low risk of harms for instance. This lack of real-world applicability can be a real problem, especially when working in a ‘translational’ research centre, where we try to focus on crossing the ‘translational gaps’ between evidence and actual practice. Surely, we want to create evidence here which applies and can be used in the ‘real world’. For this reason, I’d argue that the age old ‘hierarchy’ of evidence in biomedical research is as outdated as its architectural equivalent of the ancient Egyptians. By no means am I arguing not to use RCTs under any circumstances by saying this! RCTs are a great source of evidence in the appropriate circumstances, and for example, I wouldn’t want to be taking any medicine that hadn’t been thoroughly tested with one. But, we need to move away from the simplistic attitude that our evidence can sit neatly in a hierarchy. For starters, look how low down experiential, person-centred, qualitative evidence sits. This is an important area of understanding for the type of care we want to provide to patients! We have a new ‘multimorbidity’ disease paradigm. Our health system needs to adapt to this, and so does our research. Particularly in a time where budgets are being squeezed, if we can save money on a completely inappropriate RCT here and there, for instance, and can instead put some of the abundant routine data we have lying around to good use, we shouldn’t be afraid to do so because of some ancient paradigm.

GM PSTRC Newsletter – second edition now live

14 Apr

by Philip Hammond, GM PSTRC PPI Coordinator


The latest edition of our newsletter is now available online.

With some key updates from the work of our research themes as well as other articles of interest including:

  • Learning materials for safer prescribing valued highly by GPs
  • MAXIMUM moves ahead, piloted by involvement
  • Healthcare hashtag project [#]
  • Closing the Gap
  • early details of our forthcoming Research Symposium
  • opportunities for people to get involved.

Make sure you don’t miss out on our free quarterly newsletter by signing up to become a Friend of the Centre at http://bit.ly/GMPSTRC


Exploring issues around our personal health data

3 Apr

by Cara Afzal, Vice-Chair of the GM PSTRC Research User Group and Matthew Sullivan, member of the GM PSTRC Research User Group Image

The Interface and Informatics theme cuts across all of the GM PSTRC research themes and is focused on developing information systems to allow access to and use of routine healthcare data. What does this mean – well it means that researchers, health professionals and other interested parties would like to look at our routine patient data to improve our care. Yet, public confidence in electronic patient records is at a low ebb. Stories in the press about international security services routinely harvesting data from internet and email traffic, stolen laptops, lost memory sticks and cyber-criminal hackers all fuel fears over what might happen to our healthcare data. Against this background, in February this year, the roll-out of care.data, the scheme to unify GP records with the Health and Social Care Information Centre (HSCIC), was delayed by at least six months. This seems to have been due to concerns from some GP and patient groups over security and privacy. If you have ever been in a hospital you may recall sitting through consultations and reeling off information about medications being taken, procedures completed, last time you/your loved one saw the GP etc and thinking how easy would be if clinical staff could just look at the patient record and get the information needed, without relying on us, the patient and/or carer to recall all of the information. Also, patient safety might be helped by allowing hospital data (Secondary care) and GP data (Primary care) information sources to be linked and accessible to staff involved in the delivery of our care. We enter into this debate with an open mind, if data access can improve patient care and save the NHS money then we need evidence to demonstrate this, which should reassure us, at least, that the benefits far outweigh the risks, but this evidence cannot be collected if access is not given. Some of us may recall that the NHS Connecting for Health Programme – designed to have a single patient record, accessible to the public – didn’t work and a lot of public money was wasted. As members of the user group we are asking ourselves how can the Interface and Information theme and the RUG gather evidence to evaluate the case for the introduction of care.data? There are two levels at which our work might be relevant.

  1. The first level for the I&I theme is the overall research project which is looking at some of the mechanics of combining records and building prescription alerting tools for GPs and primary care providers. However, in this blog we are introducing a second level:
  1. Understanding and addressing factors that affect individual patient confidence.
    1. The RUG I&I group have initiated two projects jointly with HeRC (Health e-Research Centre) that have different time scales. The first of these is a project to involve groups of the public in the use of mobile/wearable technology to monitor wellness indicators such as activity. The aim is to find what barriers to wearing these sensors might be and to see if this can be improved through personalization of the kit. This might seem somewhat removed from care.data, but it will enable us to explore issues around what data is and how we feel about sharing it when we have more ownership of its collection.
    2. The second project has a longer time scale and will look in more detail at patient involvement in access to their electronic records. Again, this could show how we might break down some barriers to sharing data.

We believe that access to patient data will continue to be a contentious area, until more work is done in engaging directly with the public on such issues. If we think back to when people were debating whether or not online banking was a good thing and now it’s become the norm – lessons can be learnt. It would be better if the debate for access to patient data is driven from the patients themselves and the public given a clearer stake in the decision making process for access to their data and a stronger case needs to be made for how such access will benefit patient care and importantly who will have access. It could be that the NHS considers limiting access to NHS and its affiliated organizations as a first stage and uses this learning to demonstrate benefit and consider the merits of allowing others to have access. Across all themes, the RUG can build patient trust through demonstrating improvement of safety in primary care and by collecting and explaining evidence for the benefits of sharing data