Category: methodological innovation (light blue)

New research and short film highlights benefits to patient care of mobile APP

Posted on by CLAHRC

New CLAHRC research shows the impact of the “Streams-AKI” app

Detection of one of the biggest killers in the NHS – Acute Kidney Injury (AKI) –  has been cut from hours to minutes thanks to the introduction of a new mobile app.

Working in partnership with Deepmind and the Royal Free London NHS Foundation Trust, CLAHRC researchers based at UCL evaluated the impact of the digital intervention-  an App called Streams – and the clinical pathway it underpins – on safety and clinical outcomes for inpatients at risk of AKI.

The STREAMs app sends an instant alert to NHS staff if a patients test results show they are is at risk of Acute Kidney Injury

AKI is a sudden episode of kidney failure or kidney damage defined by changes in urine output or serum creatinine – a waste product filtered by our kidneys. AKI can affect other organs such as the brain, heart, and lungs. It is common in hospital inpatients, in intensive care units, and especially older adults. AKI is estimated to cause 40,000 deaths and cost the NHS over £1 billion every year.

We compared results between the hospital site using the app versus another site not using the app. The evaluation of Streams highlighted a significant improvement in the reliability of recognition, time to treatment and reduced costs.

A short film summarises the results of our evaluation which took place from May 2017 across the Trust.

Mary Emerson, lead nurse specialist for the patient at risk and resuscitation team, with patient Edgar Ferrante.

The short film accompanies three papers published today (July 31st)

The research generated a great deal of media coverage which included an appearance on BBC Breakfast by CLAHRC Director Professor Rosalind Raine

..and a news item on the BBC website

Read the papers below

Connell A, Raine R, Martin P, Barbosa EC, Morris S, Nightingale C, Sadeghi-Alavijeh O, King D, Karthikesalingam A, Hughes C, Back T, Ayoub K, Suleyman M, Jones G, Cross J, Stanley S, Emerson M, Merrick C, Rees G, Montgomery H, Laing C
Implementation of a Digitally Enabled Intervention to Detect and Treat Acute Kidney Injury Arising in Hospitalized Patients: Evaluation of Impact on Clinical Outcomes and Associated Health Care Costs
J Med Internet Res 2019;21(7):e13147
http://www.jmir.org/2019/7/e13147

Connell A, Black G, Montgomery H, Martin P, Nightingale C, King D, Karthikesalingam A, Hughes C, Back T, Ayoub K, Suleyman M, Jones G, Cross J, Stanley S, Emerson M, Merrick C, Rees G, Laing C, Raine R
A Qualitative Evaluation of User Experiences of a Digitally Enabled Care Pathway in Secondary Care
J Med Internet Res 2019;21(7):e13143
http://www.jmir.org/2019/7/e13143/

Alistair Connell  Hugh Montgomery, Peter Martin Claire Nightingale Omid Sadeghi-Alavijeh, Dominic KingAlan Karthikesalingam, Cian Hughes, Trevor Back, Kareem Ayoub, Mustafa Suleyman, Gareth Jones, Jennifer Cross,
Sarah Stanley, Mary Emerson, Charles Merrick, Geraint Rees, Chris Laing and Rosalind Raine
Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions
npj Digital Medicine (2019) 2:67
https://www.nature.com/articles/s41746-019-0100-6

 

 

 

 

Breaking down the barriers to research

Posted on by CLAHRC

What is preventing research with children and young people (CYP) with life-limiting conditions and life-threatening illnesses (LLC/LTI)?

Barriers to Research Access: Voices, Experiences and Solutions, or BRAVES is a programme of research aiming to explore the barriers to conducting research and some possible solutions

The team recently presented two posters at the 17th World Congress of the European Association for Palliative Care (EAPC)

 

 

The first gives an overview of the whole project

This poster was recognised as 1 of 3 best/highest scoring poster abstracts in the Palliative care in Children and Adolescents category

 

 

The second focuses on work with research ethics committees who provide approval for work to take place with this vulnerable group of patients

Dr Antonio Rojas-Garcia

Posted on by CLAHRC

Antonio holds a BSc in Psychology and an MSc in Research Methods and Implementation in Psychology and Health, both from the University of Granada, Spain. He has also been awarded a Ph.D. from the University of Granada, for his work in the Andalusian School of Public Health. During this time, he was part of several research projects, mostly focused on health inequalities and health systems, prior to joining UCL.  Antonio has particular interest in research methods in health, mostly systematic reviews and meta-analysis.

The impact of comorbidities on referral to and outcomes of hip and knee replacement surgery

Posted on by CLAHRC

New CLAHRC research looks at how comorbidities – multiple conditions experienced by patients –  influence referrals to, and outcomes of hip and knee replacement surgery.

Taking a 360-degree view of the referral and treatment process our researchers, led by Bélène Podmore, investigated current evidence in this area for patients with multiple conditions undergoing surgery. We examined;

  • the short-term outcomes relating to the safety of the hip or knee replacement surgery
  • long-term outcomes relating to the benefits of undergoing hip and knee replacement surgery.

We found comorbidities predominantly impact the safety of hip and knee replacement surgery but have little impact on its effectiveness.

Bélène also interviewed a variety of health professionals and therapists for their take on referring and selecting patients with comorbidities for joint replacement surgery.  We found some disagreement among professionals – ranging from GPs to surgeons – on roles and responsibilities in the management of these patients.

The two pieces of research are presented in handy new “BITE-sized” summaries with links to full papers and further reading –

How do comorbidities impact on the referral pathway to access joint replacement surgery in the NHS? An interview study with healthcare professionals in the NHS

What is the impact of comorbidities on outcomes of hip and knee replacement surgery? A review of the evidence

From theoretically informed to theoretically informative improvement research

Posted on by CLAHRC

A new BMJ Quality and Safety editorial by Dr Roman Kislov, Senior Research Fellow at the Alliance Manchester Business School, has highlighted CLAHRC work as an example of successful engagement with management theory by researchers.

Dr Kislov’s research focus is the processes and practices of knowledge mobilisation, and his editorial highlights our recent paper on how different NHS Boards implement a quality improvement intervention – the QUASER guide.

He cites the paper as “an example of successfully deployed theoretically informative approach, highlighting some practical tips for researchers who aspire to move from merely applying theory towards entering into dialogue with it and, through doing so, refining its assumptions.”

Read the editorial

Engaging with theory: from theoretically informed to theoretically informative improvement research

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of

Read the iQUASER paper

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Read our BITE sized summary of the iQUASER paper

Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile

Posted on by CLAHRC

The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.

Joint replacement benefits and harms for people with other illness

Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.

Read the paper

Podmore B, Hutchings A, van der Meulen J, et al
Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis
BMJ Open 2018;8:e021784. doi: 10.1136/bmjopen-2018-021784