Tag Archives: Patient Safety

New research reveals a significant drop in the general practice diagnosis of several common health conditions in Salford from March to May 2020

24 Sep

Electronic health records of approximately a quarter of a million people were analysed to identify the impact of COVID-19 on general practice (primary care) by a patient safety research centre between 1st March and 31st May 2020.  

According to the research published in The Lancet Public Health, for many common physical and mental health conditions, there has been a significant reduction in the rate of initial diagnoses compared to the expected levels for this time period. The biggest reductions were for mental health conditions and Type 2 diabetes as there were half the expected number of diagnoses.  

For malignant cancer the reduction was 16 per cent for the time period analysed, but for the month of May there was a drop of 44 per cent. For circulatory system diseases such as stroke, heart failure and coronary heart disease there has been a reduction in diagnoses of 43 per cent.  

The research, published in the paper, ‘Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study’, was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.  

The study used 10 years’ worth of data for Salford to create statistical models which gave predicted levels of new diagnoses for the health conditions identified in general practice to be routine.  

Richard Williams, research lead for the study at the GM PSTRC, said: “We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the COVID-19 pandemic. Thanks to electronic health records it is possible to investigate whether this is true across a large urban area like Salford.  

“Importantly our research has revealed which conditions people are not seeking medical attention for. This means that, potentially, there are high numbers of people living with undiagnosed Type 2 diabetes, mental health conditions and circulatory system failure.”  

Richard will join internationally renowned experts in a special Lancet journals session to present this work at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus disease (ECCVID), taking place online 23-25 September.   

Dr Owain Thomas, GP at a practice in Salford, said: “The research from the GM PSTRC looking at the diagnosis of physical and mental health conditions in primary care during the pandemic in Salford is so significant because it quantifies the effect COVID-19 is having on the diagnosis of routine health conditions in General Practice.  

“Since the initial lockdown in March the whole way in which patients consult with their practice has changed – there has been a dramatic shift away from face to face consultations to keep everyone safe from the spread of COVID-19.  

“However, it is important to recognise the unintended consequences of reducing patient contact with primary care face to face services.  The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised.  This will have an impact individually on those patients – the longer a patient goes undiagnosed, the more complications they are likely to suffer.  As we move forwards careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed.”  

Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the mental health work at the PSTRC, said: “One of the great strengths of the GM PSTRC is the opportunity to look at safety across different settings and clinical conditions. For me the reduction in mental health diagnoses and consultations was particularly striking. Going forward, I think there are two urgent priorities. First, to understand why this has happened and second to monitor and mitigate the consequences of reduced healthcare use.”  

Richard Williams, concludes: “It is vital that healthcare services use the findings in our research to proactively prioritise diagnosing patients who may be living with conditions which could be dangerous if left untreated. This will help to avoid health services becoming swamped when people feel confident enough to return to healthcare settings.”

Health worker safety equates to patient safety

17 Sep

by Maria Panagioti, Research Lead for the ‘Safer Care Systems and Transitions’ theme at the NIHR GM PSTRC

The universal policy goal for patient safety research in the past decade has been the discovery of innovative models of healthcare delivery to improve the patient experience of healthcare while reducing the costs of healthcare. However, health worker safety has been rarely seen to be within the scope of patient safety research, policy and financial investments. 

The NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) co-produces innovative research projects with patients, health workers and the public to achieve this policy goal.

Our investments and innovations in applied patient safety research have made health and social care services and interaction between services safer for patients in the UK and internationally before and during the Covid-19 pandemic.

Despite this, a study led by GM PSTRC researchers showed that one in 20 patients are harmed while receiving healthcare. At least half of these instances of patient harm could be prevented by putting measures in place to account for the human factors involved and to improve safety culture within the healthcare setting, whether that be in a hospital or a care home. This led us to advocate that successful patient safety improvements must include the safety and well-being of healthcare workers and the organisational safety culture within healthcare systems.

Healthcare workers and the environment where they work

Health workers are based in fast-paced environments with high mental and physical work demands to oversee the needs of frail and very ill people, often in unpredictable conditions. They experience some of the highest rates of occupational illness and injury, exceeding even construction and manufacturing industries, and are often the victims of violence, abuse and job stress. In the US alone, there are 500,000 healthcare workers injured each year, with an impact of $20 billion annually and the figures in the UK look similar.

Within the NIHR GM PSTRC, we are progressively embracing the view that safe health workers are more likely to provide care that leads to optimised patient safety. For this reason, we have designed and applied tools and frameworks to evaluate organisational safety culture and toolkits to help health organisations and health workers undertake simple patient safety needs assessments. This includes looking at hazards posed by human factors and acknowledging gaps while identifying solutions and training programs.

Impact of GM PSTRC research

Our pioneering work has reduced medication errors in primary care improving both patient and health worker safety. Members of the GM PSTRC design and evaluate strategies to improve the mental well-being of health workers and prevent burnout and turnover. Our parallel investments in clinical technology like new software, NHS improvement technologies, and behaviour change science have allowed us to come up with practical solutions to improve patient and health worker safety in primary care and transitions to secondary care and social care.

The GM PSTRC has been bridging patient safety with occupational safety and has a strategic mission to support the delivery of exemplary patient care while ensuring the health and safety of workers, patients and the public.

The WHO focus on health worker safety in this year’s World Patient Safety Day will help health policy organisations, research institutes, professional organisations and educational curriculums make this much-needed shift to equate health worker safety with patient safety.

Patient Safety from a health worker’s perspective: Adam Sutherland

17 Sep

by Adam Sutherland

Adam’s PhD examining medicine safety in children and young people in hospital is affiliated to the GM PSTRC. He is a clinical pharmacist at The Royal Manchester Children’s Hospital. To mark World Patient Safety Day 2020 here Adam talks about his research and its importance in improving patient safety from the perspective of someone working on the NHS frontline.  

As a pharmacist working with critically ill children and young people my primary focus is on the health and safety of the children under my care, working collaboratively with a diverse healthcare team comprising doctors, nurses, physiotherapists, cleaners and myriad other care providers.   

My research focus is human factors as a way of explaining patient safety events, but also as a way of exploring how we can improve things. There’s a lot of people who compare healthcare to aviation as a way of comparing two industries – one that has made huge safety gains in the last 30 years, and one that still struggles to adapt and change to meet the safety challenge.

However, comparing a system made of humans working in an emotionally and politically driven organisation with the latest Airbus just doesn’t pass muster. A modern aircraft and a human can fail in a million different ways but critically aircraft fail in predictable ways that can be predicted and remedied. Humans on the other hand are unpredictable and are influenced by unmeasurable things like what they had for dinner last night, or the way Karen from Finance shouted at them in the car park.   

It’s this complexity that makes the human element of healthcare profoundly important.  

Adaptability is a strength

As a pharmacist I write guidelines and policies to underpin and support medicines safety. In the past I did that blindly – working with colleagues and friendly clinicians I’d draw up a list of rules and reminders so healthcare providers could safely and effectively administer a medicine. What could be better?  It was “idiot proof.”  And yet, in clinical practice, these guidelines were barely used or were misinterpreted. This used to be a source of deep frustration for me. At the time I struggled to understand why this was the case.  

But actually, when the rubber meets the road it’s impossible to predict what bumps and curves will be in the way of what I perceived as “flawless” guidance. Caregivers need the skills and information to be able to interpret patient status and make decisions about how to respond when the rules and guidelines don’t fit their situation. The guidelines from pharmacists should provide the information needed to help them do that. And yet, recent research suggests that this isn’t the case, and the information we provide is often too complicated to understand  

This needs to change so we can support professionals to adapt, and make decisions about their prescribing choices and medication administration. This will ensure they can respond to unexpected changes in patient condition or working circumstances.  

Medicines security

If you have experience of caring for a teenager you’ll be used to the constant need to remind them to tidy their room or to put their stuff away. In my experience it’s no different with medicines in a busy caring environment like Intensive Care. There are very strict regulatory demands for how medicines in clinical areas are stored and cared for.  

Well cared for and organised medicines storage assures the safety and integrity of the medicines that we’re using by ensuring they’re used safely and appropriately. And we know that compromised medicine security leads to patient safety events like patients taking the wrong medication or it being stolen.   

But, when you’ve got 350 staff members who don’t have the same grounding in medicines storage that we do as pharmacists you can find yourself sounding like a broken record. It’s busy, it’s dynamic and it’s easy to forget to put medicines back into cupboards.   

It can be extremely stressful finding and using medicines in a busy clinical environment.  Nursing colleagues often report that locating the keys to the drug room can consume as much time during a shift as administering medicines. We go back to the analogy of the untidy teenager…              

“Dad, have you seen my shoes?”            

“They’ll be where you left them!”            

“Yeah but I can’t remember where that was…”  

If everything is in the right place at the time that it’s needed, it can save someone else 15 minutes later on. But that is easier said than done.  

Holistic care

And finally, I reflect on the importance of giving everyone a voice. Healthcare is a hierarchical construct with clear definitions of rank and stature and it can be difficult to speak up and advocate for others in this environment. We know that working effectively as a team and encouraging everyone to say their piece leads to positive outcomes. But, even if this is true, some voices can be drowned out or ignored. Going back to aviation, in 1976 a similar hierarchy led to the deaths of 550 people when two Boeing 747s collided on the runway at Tenerife airport.  

Bizarrely, despite everything that event changed in the world of aviation, it was barely ten years ago that we started to promote and encourage caregivers and the wider care team to voice concerns in healthcare. We now know that when a parent vocalises concern about their child this gives us vital early warning of a very sick child or an imminent deterioration in their condition.   

When we look at research around patient and carer voice in studies of medication safety for children and young people, it isn’t there. Caregivers continue to make assumptions about medication needs and perceptions of parents and caregivers, but this is not the same as the actual stories and experiences that parents and carers have to share. For me this is an enormous gap in our understanding of what the needs of children and young people are in relation to medicines and it needs to be addressed.    

So, to begin to address this gap, in my PhD examining medicines safety in children and young people in hospital, parents and carers have a strong voice, acting as contributors to the management of the study, and as participants themselves.

Implementation of new technology in general practice to reduce errors in prescribing medication for patients

18 Jun

by Mark Jeffries, Research Associate in the Medication Safety theme at the NIHR Greater Manchester PSTRC

A new dashboard developed by the Medication Safety and Safety Informatics themes at the Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) to reduce prescribing errors has been successfully piloted across Salford. Recent research* into its implementation has revealed the positive impact it is making and how its use in general practice is improving medication safety.

The dashboard, Salford Medication safety dASHboard (SMASH) searches clinical records and provides feedback to doctors, nurses and pharmacists prescribing in general practice. It is designed to identify patients who may have been exposed to hazardous prescribing or those who need to be monitored with regular blood tests due to the medication they’re taking. Alongside the dashboard, pharmacists working in practices are supported by prescribers to resolve the errors found. Unlike other similar dashboards, SMASH updates every night allowing near real-time feedback on any medication changes made.

The purpose behind recent research looking at the implementation of the dashboard was to understand how it was used in practice. Researchers from the two GM PSTRC themes working on the dashboard, bought together findings that are both qualitative (looking at reasons, opinions and motivations) and quantitative (using numerical data to generate statistics). This helped to improve understanding of how the dashboard was used, as well as emerging usage patterns. As a result of a mixed methods approach, an understanding of both the broad use of the dashboard, as well as the fine detail of what individual pharmacists and prescribers did, was achieved.

Researchers undertook 25 face-to-face interviews with 22 different people all of who work with SMASH such as GPs, pharmacists, and a practice nurse. They also logged 2626 sessions from 55 users. The findings highlighted that the main users of the dashboard were pharmacists, and the use of the dashboard changed over time.

In the early stages of the dashboard being introduced to a practice it was checked on average 12 times a month. This changed over time to an average of 5.5 times a month. Pharmacists talked of checking the dashboard frequently at first to resolve instances of prescribing error, often starting with the most serious cases, and then only checking every two or four weeks as case numbers declined. Pharmacists and practice staff would work together in a series of steps to try to resolve the cases they found. First they checked that the dashboard’s information was correct, then they looked at the patient’s records and made a decision on what, if any, changes needed to be made to the patient’s medicines.

This research showed how an interactive dashboard for medication safety was used in practice and highlighted its ability to make a difference, reducing prescribing errors. People working in general practices were able to adapt and change the way they used the dashboard to fit in with their normal work. The pharmacists were particularly important to the dashboard but worked collaboratively with GP staff. An important benefit identified by the research was that the dashboard allowed for a decline in use so was sustainable.

The research findings are so useful in assessing the successful of the dashboard due to the mix of approaches used. The quantitative data looked at the patterns of dashboard use and the qualitative data was used to help explain that use.

Importantly this research can help to understand how, in the future, similar dashboards can be used. Also, as SMASH is being rolled out across Greater Manchester, the research findings will prove incredibly useful in the new settings where it is implemented.

Covid-19 views from frontline community pharmacies

18 Jun

by Lisa Riste, Research Fellow in Medication Safety theme at the NIHR Greater Manchester PSTRC

Since coronavirus and Covid-19 became common vocabulary, our TV channels and radio stations have been filled with reports from hospitals about how they are coping, doctors advising us what symptoms to look out for and politicians telling us what we must do to stay safe. Running alongside this have been daily mortality updates and infection rates, along with conspiracy theories and misinformation spreading almost as quickly as the virus itself via social media.

Community pharmacists have not featured as widely in the media. The workload for community pharmacists has increased hugely with up to 40% extra business and three times the number of home deliveries to those shielding at home.

Our PSTRC’s Community Pharmacy Patient Safety Collaborative has continued to meet in the brave new virtual world we call Zoom, with our first meeting the day after The University of Manchester closed its doors and two since. How the pharmacists are managing Covid-19 is a regular standing item on our agenda.

This is an insight into what it’s like to be one the Community Pharmacists in our collaborative.

Safety rightly comes first, and in addition to keeping themselves safe as well as staff they also have the safety of their patients to consider. All have followed guidelines and introduced social distancing, limiting the number of people in the store at any one time. There are now vinyl footprints telling people where to stand with direction arrows and 2m distance bars even appearing on dispensary floors. One member of our collaborative has chosen not to allow any patients inside as they recognise, given the limited space within their store, it is safer to utilise counter space inside to prepare prescriptions and to then dispense outside the shop.

Some PPE was donated from the local community, while some pharmacies that are part of a chain have been sent it by head office who had procured it on their behalf. Gloves, masks and hand sanitiser are commonplace. Only one member of our collaborative has aprons.   As time has gone on they’ve got visors and now clear plastic screens have been installed. Much of the PPE has made tasks pretty much impossible, glasses steamed up by masks and gloves getting in the way of labelling up medication.

Many of the Community Pharmacists have struggled with staffing.  Contingency plans have been put in place splitting teams in two to ensure they could continue to function if a member of one team fell ill and colleagues had to self-isolate. Some pharmacy staff were advised to shield themselves or a family member, some staff developed symptoms and had to self-isolate, but the pharmacy work continued with temporary drivers being employed and volunteers helping deliver medication.

In the same way as you or I, they’ve also had to navigate mountains of information from a variety of sources. The pharmacists who work at chains, were fortunate to have superintendents cascading what was important and in some cases circulating standard operating procedures of how to change their pharmacy systems. However, some have relied on Royal Pharmaceutical Society helplines. But, a pharmacy isn’t any normal shop or business as, for pharmacists, carelessness costs lives, so they’ve had to get it right. We are grateful that amidst the corona crisis pharmacists have been able to continue working with us helping to improve patient safety. My poem ‘Frontline Pharmacists’ is a tribute to their enduring hard work.

Patient Safety and COVID-19 – the importance of NIHR PSTRCs

4 Jun

Since 2012, the NIHR has supported research into patient safety through funding Patient Safety Translational Research Centres (PSTRCs). There are now three centres: Greater Manchester PSTRC, Imperial PSTRC and Yorkshire and Humber PSTRC. These centres operate as partnerships between a host NHS organisation and affiliated universities.  

COVID-19 has brought to the fore the significance of patient safety like never before. Behavioural science has underpinned many of the most challenging safety concerns that have emerged during this time. This includes the effort to encourage the general public to follow government guidelines on physical distancing, the importance of staff wellbeing along with infection control in hospital. Understanding why people do what they do and promoting changes in behaviour are prominent features across the PSTRCs’ work.  

The PSTRCs are dedicated to improving patient safety across specific areas of the NHS and social care. The centres are designed to be agile and responsive to emerging research priorities, focusing on applying novel approaches to unsolved questions. The PSTRCs proactively involve patients, gathering their experiences before creating interventions to improve specific patient safety concerns. New safety initiatives developed by PSTRCs are then tested or piloted in the appropriate healthcare setting such as a hospital, GP practice, care home or pharmacy.   

The centres’ role in responding to the COVID-19 pandemic focuses on adapting existing work and building upon it to address some of the challenges facing the NHS. In addition, new research has been launched to understand and support the response to COVID-19.  

An example from the Greater Manchester PSTRC is the launch of a study that looks at the mental health of survivors of COVID-19 as well as the general population within Greater Manchester including those with lived experience of homelessness. Another example is the roll out nationally of a digital triage system for use by GPs which had been previously designed by researchers within the Safety Informatics team based at the Greater Manchester centre.    

Yorkshire and Humber PSTRC is exploring how healthcare organisations, such as hospitals and community pharmacies, have adapted operations to respond safely to the COVID-19 threat. It is also exploring the emotional support needs of healthcare staff and researching the impact of COVID-19 on people’s decisions to seek emergency healthcare.  

Imperial PSTRC is assisting the WHO with guidance on medication safety during the pandemic and has launched a study looking at the impact of COVID-19 on digital technology in primary care. In addition, the centre is supporting the REal-time Assessment of Community Transmission (REACT) study, a national, Imperial-led programme investigating COVID-19 prevalence and the use of home testing.    

The centres also recognise that this is a critical time for increasing the amount of research undertaken to support the NHS. Examples of this are developing online learning opportunities for those working in healthcare, online support communities and resources, and creating virtual research communities to allow work to continue even when face to face research isn’t possible.  

The centres each focus work across specific themes* which span behavioural science, mental health, patients and carers, medication safety, transitions of care between healthcare settings, and digital interventions including designing dashboards and Artificial Intelligence. These themes are well placed to address the impact of COVID-19 on the wellbeing of the workforce, the resilience of specific areas of healthcare, the role patients and carers are playing in patient safety at this time, and access to healthcare by specific groups of patients, such as those with lived experience of homelessness.  

Read more about the work of Yorkshire and Humber PSTRC in this blog from the Centre Director, Professor Rebecca Lawton and Centre Manager Dr Beth Fylan.  

Find out how the Imperial PSTRC involves people in its research, and how the Centre is adapting its involvement and engagement activities during COVID-19 in this blog.  

To learn more about the work of the Greater Manchester PSTRC during the COVID-19 pandemic, read Centre Director Professor Stephen Campbell’s thoughts in his latest blog.

For more information on the PSTRCs please visit:

Research themes:  

Greater Manchester PSTRC – Safety Informatics, Medication Safety, Marginalised Groups (including two sub themes, Mental Health, and Patients and Carers) and Safer Care Systems and Transitions (including the Behavioural Science sub theme).

Yorkshire & Humber PSTRC – Patient Involvement in Patient Safety, Workforce Engagement and Wellbeing, Safe Use of Medicines, and Digital Innovations

Imperial PSTRC – Safer Systems across the Continuum of Care, Partnering with Patients for Safer Care, Avoiding Deterioration in Complex Needs Patients, Enhancing the Safety of Medication and Technology, Improving Diagnostic Accuracy and Decision Making and Improving Diagnostic Accuracy and Decision Making.

The role of translational patient safety research during and after the Covid-19 crisis

3 Jun

by Prof Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

Health and social care research and capacity building in this country are embedded and integral to local and national policy and decision making, including in the area I work in, early transitional exploratory work related to patient safety.  

It has been both noteworthy and impressive, but unsurprising, how quickly the academic and clinical research communities have responded to Covid-19. It is admirable also and helpful that national bodies, and our funders at the National Institute for Health Research (NIHR), as well as The University of Manchester, have been supportive to the need to adapt our working practices (from home). While in some instances there has been a delay in some ongoing research, it has also enabled us to adapt some existing projects and set-up new studies relevant to the pandemic.  

The three Patient Safety Translational Research Centres (PSTRCs) at Greater Manchester, Imperial, and Yorkshire & Humber use an applied approach for developing and testing new methodologies. They also share learning, on improving the safety of services and care, before any wider roll-out.  Any new approach or intervention can have unintended consequences or do unintended harm to patients or staff. That is why it is better to test things and ask people about their experiences of the early innovation, which is what the PSTRCs are designed to do.  

Our four main research themes at Greater Manchester PSTRC focus on medication safety, safer care systems and transitions, safety informatics and marginalised groups, which includes two sub-themes on mental health, and patients & carers.*  

The Greater Manchester PSTRC has two other key aims. In addition to developing and testing new ideas in relation to patient safety, it aims to build capacity in patient safety of people, patients/carers, families, health & social care staff, organisations and systems. This will help to anticipate, prevent and address patient safety issues in workplaces and organisations while ensuring research is co-designed and led by lived experience.  

Our third key aim is to build and share learning across health and social care systems locally and nationally, so there is an innovation pipeline that ensures rapid uptake of new ideas. It is imperative that those who are going to use the innovations are involved in development and testing.  Covid-19 shows clearly the importance and value of teamwork and communication with individuals, organisations and systems learning from each other and together; with a parity of focus on health and social care.  

Covid-19 is, rightly, the predominant issue at the moment. However, the essentials of patient safety remain the same as does the need to address existing known patient safety priorities that have affected, and continue to affect, so many people daily. Some of these issues, and the health, economic and social inequalities that often accompany them, have been, or are at risk of being, exacerbated by Covid-19. Most are not a direct result of it. Below are some examples of how the Greater Manchester PSTRC has responded so far to the Covid-19 context.  

Covid-19, mental health and the GM PSTRC  

The Greater Manchester PSTRC has a research theme looking at suicide and self-harm prevention, led by Prof Nav Kapur and Prof Roger Webb. During Covid-19, alongside the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), we are part of a national academic response to suicide prevention.**  This work is expanding on the NHS England’s national suicide prevention quality improvement programme. Nav and Roger are also members of the Expert Rapid Reviewing of the Emerging Scientific Evidence for Links between Covid-19 and Suicide Risk.

There will need to be a focus on a wider set of issues relating to mental health for people who have survived severe-critical levels of Covid-19, as well staff working in social care and NHS agencies. In addition, research will need to look at the effect on wellbeing and health of lockdown, shielding and social distancing.  

Covid-19 has affected, and will continue to affect, people in many ways. People who contract it are first victims. Those who care for patients with Covid-19, as well as the families of both patients and staff, can be second victims due to the personal harm that can be caused.  In addition, there may be those who become third victims – people who are responsible for investigating the outcomes of the pandemic and for safety improvement activities at a local and systems level***.              

Covid-19 and digital/informatics interventions at the GM PSTRC

Interventions developed by our Safety Informatics researchers, led by Prof Niels Peek, such as SMASH (The Salford Medication Safety Dashboard) and PINGR (Performance Improvement plaN GeneratoR) focus on using digital platforms to see if people are receiving appropriate care. Such examples develop and test computer software to analyse patient Electronic Health Records within GP practices, and increasingly across the health system, to suggest what steps could be taken to make a patient’s care safer. In essence, #DataSavesLives. It emphasises the importance of learning health systems, with universities and the NHS/health and social care, working together in partnership.  

Greater Manchester PSTRC staff, led by Richard Williams and Prof Niels Peek, are examining the indirect health impact of Covid-19 in our local populations by exploring patient presentation rates to services before, during after the pandemic for conditions such as cancer, cardiovascular disease, and mid-moderate and severe mental illnesses, as well as mortality rates in the longer term. Looking at data from the Office for National Statistics, the age-standardised Covid-19 mortality rate was 93 per 100,000 in Salford during the 1st March 2020 to 17th April 2020 observation period.  Whereas in neighbouring Trafford it was 31 per 100,000. During March and April 2020 Salford experienced the highest Covid-19 mortality rate outside Greater London and the South East region.  

People from a BAME**** background have been found to be at higher risk.  Understanding and addressing such existing inequality is fundamental to a societal and national response to improving patient safety and outcomes. For example, 1 in 4 people who have died of Covid-19 have a pre-existing diagnosis of diabetes. Ongoing management of people with long-standing conditions and those who have a number of underlying health conditions remains crucial to enable people to be as healthy, and therefore as safe as possible.    

Covid-19, behavioural science and the GM PSTRC  

Behavioural science is crucial at all times but vital during the Covid-19 pandemic. It underpins much of our work and the  research of  all 3 PSTRCs. Prof Chris Armitage of the  Greater Manchester PSTRC has been part of the British Psychological Society’s Covid-19 Research Priorities Group as well as the British Psychological Society’s Covid-19 Behavioural Science and Disease Prevention taskforce.*****  Behavioural approaches reinforce the importance of #COMBATCOVID19TOGETHER.  

Digital technology and behavioural science go hand-in-hand. This is why much of what we do is based on the lived experience of patients and the public.  We are extremely conscious that every item of data is about a person and every new approach or intervention has the ability to have an impact on the lives of patients.  

Behavioural science is about understanding and learning from peoples’ own lived experiences how best to support individuals to engage in behaviours that enhance their own safety and the safety of others. This involves a focus on the benefits and trade-offs or sacrifices of the individual as well as their families and families for the wider benefits of the wider population.  

An important component of patient safety is safeguarding, which is enhanced by appropriate, secure and confidential use of both clinical and behavioural information. Understanding behaviour is crucial to preventing infection and improving outcomes.  

It is crucial to understand the drivers of sustained public adherence to UK government Covid-19-related instructions. Evidence suggests there are currently high rates of public adherence. However, interventions to sustain adherence to government instructions in the long-term can only be developed if we know why people do or do not adhere to them. Prof Chris Armitage is part of a study to assess levels of public adherence to UK government Covid-19-related instructions; to gauge people’s perceptions of their capabilities, opportunities and motivations; and identify predictors of adherence. It is the first step in developing interventions to support continued public adherence to government instructions.  

Transitions of care during the pandemic  

Covid-19 has highlighted existing inequalities in health and safety and also those already at higher risk, such as residents in care homes and/or those with dementia. The Greater Manchester PSTRC’s Safer Care Systems and Transitions theme, led by Dr Maria Panagioti, focuses on the safer movement of patients between health and social care settings. Care pathways can involve many transitions, where the responsibility for patient care is transferred or handed over from one team, department or organisation to another. Patients and their carers and families can feel vulnerable and learning from their lived experiences is imperative.   Patient safety is about protecting the vulnerable and in care homes residents are elderly and often have multiple existing health conditions, which puts individuals at risk anyway. Recent figures show 25% of reported deaths from Covid-19 are in care homes, emphasising the underlying risks to residents and the unprecedented conditions that staff are working under.

Delivering primary care during Covid-19 has produced unparalleled changes to general practice as new ways of delivering GP services were set up in a matter of days. These include remote consultations via telephone, or ‘virtual’ consultations via video technology. This builds on the policy objective in the NHS Long Term Plan 2019 of implementing digital innovations to increase staff capacity and access to primary care services. In response to this rapidly changing shift in primary care consultations from face-to-face to remote consultations, Dr Ben Brown, Prof Niels Peek, Richard Williams and colleagues are supporting the Innovate UK-funded PATCHS feasibility study which assesses the opportunity and potential impact of applying Artificial Intelligence (AI) in online primary care triage. The system is currently being piloted by Salford Clinical Commissioning Group (CCG).  

It is imperative to understand the issues and problems faced by patients and carers when coming into contact with GPs and pharmacies. Our researchers, led by Dr Rebecca Morris, are involving patients and the public in the design of a Patient Safety Guide.  It is being used to help patients, GPs and pharmacists to identify key points where care can be made safer, including remote consultations.  

However, again, Covid-19 highlights existing inequalities with concerns about a ‘digital divide’, whereby some people or population groups may be excluded from digital approaches or technologies that could then exacerbate the pre-existing health inequalities. For example, of relevance is our work, led by Prof Caroline Sanders and Dr Kelly Howells, on access and experiences of primary care for people who are or have been homeless.

Last, but by no means least (indeed, most of all), is recognising and championing the exceptional commitment and work of all frontline NHS, social care and key workers during the Covid-19 crisis. The word “thank you” is not enough. It is to be hoped that Covid-19 produces a legacy of continuing to respond to and address existing health inequalities and safeguarding those most at risk and marginalised; as well as the value and importance of both key workers and the underlying health and social care infrastructure needed to enable rapid response to such events.  

*http://www.patientsafety.manchester.ac.uk/research/themes/

**https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltext

***https://journals.sagepub.com/doi/full/10.1177/2516043519850914

****Black, Asian and minority ethnic

***** https://www.bps.org.uk/news-and-policy/bps-launches-new-behaviour-change-guidance-help-reduce-spread-covid-19

******https://www.theguardian.com/world/2020/may/15/coronavirus-care-home-residents-deaths-england-wales

******* https://www.longtermplan.nhs.uk/

Communication is more important than ever in patient safety research

21 May

Work has been underway at the GM PSTRC to develop a Patient Safety Guide and researchers believe that it is more relevant than ever while keeping patients safe during the COVID-19 pandemic. Some small changes have been made to reflect the challenges being faced as a result of the pandemic. Fundamental to the guide is communication which has never been so important. Rebecca Morris, who leads the development of the Guide, explains its relevance at this time.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic has impacted us all in lots of ways and we are all incredibly grateful for the work that is being done by all health and social care workers in public and private settings as well as everyone on the frontline keeping us supplied. Thank you to you all.

The pandemic has also changed research. Many projects in clinical settings and health services research projects have been paused. Universities are in lockdown with staff working from home adapting to not being able conduct meetings in person and using Zoom instead. Yet the research that we at the GM PSTRC do on patient safety is more important than ever, and the project I’ve been leading is particularly relevant.  

This is because, for most patients not affected by COVID-19, the priorities of patient safety remain the same and delivering new approaches and interventions that make care and services safer are important. How we access care, what we ask and the role that patients and carers have in terms of patient safety has never been so visible. Importantly, how we can support our health and care services as they change to adapt is key.  

My project, the Patient Safety Guide for patients and carers aims to support patients and carers to address key patient safety questions and identify key points where they can make their care safer. The Guide remains the same but the context in which it is being developed and tested has changed with Covid-19. For example, most routine general practice consultations are taking place remotely via telephone or video, rather than face-to-face, often after a remote triage model using online consultations.

While the context has changed, the fundamentals of general practice and good quality of care have not. What remains the same are the fundamentals of communication and trust for involving people in their care and safety when treatment and care options change. What this will entail may evolve. How this develops over time as services and people adapt to the new ways of working, whether temporarily or permanently, must include such fundamentals at the heart of discussions. This includes issues around understanding the impact on equity of experience as not everyone can or do use remote modes of communication. Otherwise this may lead to upset and frustration by patients or carers trying to access care and by healthcare professionals delivering care in this new way, which may have longer term impacts. For example, being told that your ongoing treatment has been stopped indefinitely without any information about how to manage, what to do or who to contact if your condition worsens can leave patients feeling concerned and unclear what they should do. Our Guide aims to help support communication with prompts to support people and prepare them for their remote consultations.

It is as imperative to think about how people can be involved in their patient safety as the traditional forms of care have evolved and there have been delays or postponements in scheduled care. In addition, changes need to be considered in light of how the pandemic might affect people who are already marginalised. For example, a move to remote consultations may exclude or reinforce existing difficulties in accessing care for people who are deaf or have acquired hearing loss, or with dementia.

The services that have developed and adapted because of COVID-19 leave questions outstanding about care and patient safety to be answered. Changes to care have been communicated via letters with limited, or no direct discussion, with doctors or nurses and may leave patients feeling a sense of uncertainty and vulnerability. The context of being a patient or carer have changed overnight yet communication as always has been a key element of care and if people feel isolated or helpless this is more important than ever.

But how we can we support patients and carers with this? The GM PSTRC Patient Safety Guide has been co-developed with patients, carers, GPs, and pharmacists and is being adapted to reflect the new context. For example, the Guide focuses on where patients might go for health care (i.e. pharmacy or GP), how they can prepare for a consultation and the actions that are required as a result of it.

We are working to ensure the Guide evolves to reflect the changes currently taking place in care practices. For example, how people use remote consultations, what support they may need to do this effectively, and how people have adapted from different communities and what we can learn from them to help each other. We believe the Guide has a part to play in improving patient safety.

The NIHR GM PSTRC – COVID-19

3 Apr

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As COVID-19 continues to affect the country the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC) will play a role both now and in the near future to help the NHS strengthen its armoury in the fight against the virus.

The GM PSTRC is one of three national patient safety centres which are working together, along with their partners and the wider research community.

The NIHR GM PSTRC is dedicated to making care safer for patients and turns research into practice across four main themes, Transitions of Care (including Behavioural Science), Safety Informatics, Marginalised Groups (including Mental health and homelessness and the role of patients and carers) and Medication Safety.

This blog post will be updated with relevant news on how NIHR GM PSTRC studies are having an impact in the weeks and months ahead.

All face to face research has been paused and many of the centre’s researchers are working to adapt existing studies and interventions to ensure these can deliver maximum value and impact during the fast-paced pandemic. These studies will play an important part in the fight against COVID-19.

The Safety Informatics theme has developed a number of interventions which have the potential to improve safety at this time, such as an intervention that supports remote consultations via text and video and can be utilised by GP practices. In addition the centre’s new sub theme, Behavioural Science, will be well positioned to play an important role.

Updates will be available when there is news to share on any of this work.

The centre is connected to other research centres and NHS trusts across Greater Manchester. Working together, these organisations aim to improve outcomes for everyone during the COVID-19 pandemic.

PSTRCs PhD Network event 2020

13 Mar

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For the second year PhD students funded by the three NIHR patient safety centres gathered to present their work, display posters and hear from expert speakers on Monday 24th February 2020.

This year the event was hosted by the centre based at The University of Manchester, the Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), which is a partnership between the University of Manchester, and Salford Royal NHS Foundation Trust, in collaboration with the University of Nottingham. PhD students travelled from the other two centres, Yorkshire and Humber and Imperial to take part in the event.

The PhD students were joined by experienced researchers from the three centres, and Dr Jane Brooks, Director of Postgraduate Research, School of Health Science, at The University of Manchester. The day was chaired by the GM PSTRC postgraduate & training lead Prof Roger Webb.

Dr Jane Brooks highlighted the value of studying for a PhD while giving the visiting students and researchers some background on The University of Manchester’s credentials and achievements.

Jane said: “It is clear that a great value of the PSTRCs is the diversity of work that’s undertaken and the commitment shown to the patient’s voice and needs. I was particularly impressed to hear the PhD students themselves presenting their work. Their enthusiasm for study and making a difference to the patient population is worthy of high commendation.”

NIHR Doctoral Research Fellow, Rebecca Hays spoke to attendees sharing her insight and experience in her presentation ‘Reflections on an NIHR Doctoral Research Fellowship’.

Rebecca said: “I think it is important to take advantage of the opportunities available to you, and Fellowships offer an unrivalled opportunity for development. Through my Doctoral Research Fellowship, I have been able to devise and work on my own project for the first time. I learned a lot just from the process of developing the application, and am really enjoying collaborating with a wide range of people, including members of the public, NHS staff and experts from other Universities.”

Salina Tsui, a PhD student from the Greater Manchester PSTRC who attended the event, said: “The network event provided an opportunity for me to get to know the research that’s underway by other PhD students and was also a great way for me to learn how their research has developed. Their excellent presentations made me think of how my research could benefit from the involvement of patients and the public along with how to go about it. Importantly, the day got me thinking about how my research can be presented to different audiences.”

Professor Stephen Campbell, Director of the GM PSTRC, said: “We’re immensely proud of all the PhD students who are part of the 3-PSTRC PhD network. For some it was their first time presenting their work. The day was a reminder of the huge breadth of work and methods underway across all the centres and the potential difference it can make to patient safety.  The three PSTRCs are fortunate that the calibre of PhD students is so high and their work is undoubtedly enhancing the impact of the centres. I look forward to following their progress.”