Work on studies already undertaken, to write up, submit for publication and use the time to turn the available evidence into high impact grant applications

End of project summary

Background

Time used to turn available evidence into high impact grant applications in four resulting areas:

1. Professional and non-professional networks of individuals have emerged as a possible mechanism to enhance safety in two of the studies. This replicates technological solutions where architecture that uses modular redundancy has been significantly superior in terms of reliability than the linear processes that underpin the majority of safety interventions in healthcare: It is however unclear whether this finding can be extrapolated to broader areas of care, what rule systems are required to ensure reliable functioning and what the optimum size of safety networks is.
   a. NIHR Programme grant in collaboration with health service researchers with a Health Foundation background in Cardiff and Swansea (Sharon Williams, Andrew Carson-Stevens) leading to feasibility studies and pragmatic trials.
2. The literature reviews have found little published evidence of safety outcomes of electronic health records despite the significant promise of the technology: It would seem opportune to examine the effects of recent installations in England on publicly available data sets as part of an observational study using publicly available outcome data sets supportive by qualitative work to contextualise the findings and identify necessary conditions for impactful implementation of these installations.
   a. RfPPB application; link with digital health researchers in Cambridge and at University College London. There is a potential to develop and test new trial methodology including randomization of features of electronic health records in pragmatic multi-centre studies with commercial providers.
3. The limited knowledge of cost of errors adverse events for patients, families, clinicians and organisations outside of litigation is a block to investment into better hospital safety. This requires a formal review of the literature which might require a subsequent full program grant that we have started to set-up.
   a. Initial research sponsored by Philips Healthcare and delivered by Bangor University’s health economics group (Centre for Health Economics and Medicines Evaluation). Potential for NIHR Programme grant depending on results of exploratory work.
4. The lack of suitable patient reported outcome measures (PROMs) in acute care has been one of the learning from the grant. A development of suitable metric is required both to improve services and to drive value based healthcare.
   a. NIHR Programme grant with Prof Dan Lasserson from the University of Birmingham and the Society for Acute Medicine with the option to test the resulting algorithm as part of the national audit infra-structure.

Main Messages 

1. Patients are able to support their own safety while in hospital through documentation of the ideas, concerns and expectations with a level of reliability that rivals that of healthcare professionals. 
2. Patients and those close to them are able to complete checklists for common side-effects of cancer treatments.  
3. Electronic health records in their current form might add little to the safety of patient care.