Evaluating a digitally-enabled care pathway for Acute Kidney Injury

A new publication highlights our work in evaluating a new patient pathway with the potential to provide clinicians with real-time data on inpatients at risk of Acute Kidney Injury.

AKI is common (affecting up to 20% of UK acute hospital admissions);  associated with significant morbidity and mortality, and expensive – excess costs to the NHS in England alone may exceed £1 billion per year.

Researchers at the Royal Free Hospital (RFH), part of London’s Royal Free London NHS Foundation Trust (RFLFT) have developed a digitally-enabled care pathway for inpatients, incorporating  a mobile software application – the “Streams-AKI” app – that “reads” routinely collected serum creatinine data in hospital inpatients and alerts health professionals where a patient is at risk of AKI.

We have published our protocol for this evaluation, and a postcard-style “need to know” summary – or BITE – of our research plans. We’ll measure its success for patients (in terms of speed and effectiveness of their diagnosis and care), NHS staff and clinicians (to find out what they think of the pathway) and for the NHS in terms of patients’ length of stay and costs to the service.

The protocol and BITE will interest NHS staff and clinicians working in renal care, as well as those interested in the potential of technology to improve detection and diagnosis via routinely collected data

Beyond searching- supporting NHS colleagues to contribute to systematic reviews

We recently collaborated with colleagues at Peninsula CLAHRC to deliver a successful ‘Beyond Searching’ course.

Members of the PenCLAHRC Evidence Synthesis Team (EST) travelled to London to work with CLAHRC North Thames’ Dr Antonio Rojas–Garcia in delivering the workshop to 19 librarians from the NHS and various universities.

Beyond Searching was devised 5 years ago by members of the EST who have been running annual workshops ever since. The course is designed to show health information professionals that they already have the skills to effectively contribute to systematic reviews –  reviews aiming to find as much as possible of the research relevant to the particular research question, and to identify what can reliably be said on the basis of these studies. The training gives them the confidence to get involved in the process and to advise others.

Librarians and other information professionals are highly skilled and motivated individuals with a drive to learn about new technologies and ways of working. They already have the skills needed to contribute to systematic reviews so our course is more about how they apply those skills. ‘It is always a joy to teach this workshop – often we learn a lot ourselves in the process – and it was particularly good this time to get the chance to collaborate with colleagues from CLAHRC North Thames.’

Morwenna Rogers (EST member)

This was the second year that the course followed a flipped classroom model, which EST members learned about during their visit to the University of Michigan two years ago. The model frees up classroom time for discussions and active learning, by making some of the foundation lectures and reading material available to participants in advance.

Attendees were asked to complete a series of online tasks prior to the course, which introduced them to key concepts of systematic reviewing and comprehensive searching. This enabled attendees to focus on more detailed aspects of search techniques during the workshop.

Guest speaker Claire Stansfield from the EPPI-Centre was also invited to discuss the use of automation (employing machines, computers, or robots to help researchers identify relevant papers), and its implication for reviews in the future.

The beyond searching team were delighted with the positive feedback they received. One attendee said that it was:

The best training [they] have ever attended

Another attendee planned to use the knowledge she had gained to change practice in her own place of work, and another thought that the flipped classroom model was excellent preparation for the face to face teaching day.

Dr Rojas – Garcia (below) praised the cross CLAHRC co-operation behind the delivery of this workshop, remarking:

It was great to spend the day collaborating with colleagues from PenCLAHRC. I considered it a very positive experience, it has been really encouraging to see how other colleagues teach about systematic reviews.’

To read more about the Beyond Searching workshop  collaboration, visit the EST blog.

Evidence in public health decision-making – its creators and users need to come together

Decision-makers in public health can be confronted with a huge volume of data, evidence, reviews and summaries – from local and national sources. There is also an acknowledged gap between evidence and policy in public health.

In a recent blog on the EPPI centre website CLAHRC researchers Dylan Kneale and Antonio Rojas-García reflect on their work exploring the use of evidence in local public health decision-making – and raise the question – How much research is being wasted because it is not generalisable in local settings?

While reduced resources make judicious use of evidence more important than ever when deciding how and where to apply resources, researchers also need to understand, and better communicate, the generalisability of their research evidence to decision-makers working locally.

Read Evidence use in public health – make-do and mend?

 

Better data to improve health and wellbeing

We have been reaching out to colleagues in local authorities and public health departments to highlight the value of research evidence in improving health and well being among local populations. The CLAHRC is forging useful links with our partners in local councils, bridging the gap between research and the front line.

Local authorities are a key audience for the CLAHRC as they are responsible for public health in their area. Public health includes prevention of illness and disease, sexual health and smoking cessation.

CLAHRC partners Islington and Camden Councils run lunchtime learning sessions for staff as part of their Using Data Better initiative. They invite speakers from various sectors to present the potential for data to improve health and health services for local residents. The boroughs have joined forces to deliver public health, and have a team of data analysts at work –  identifying issues that have a negative effect on people’s health, and planning to deal with those issues.

In October Dr Chiara De Poli (below left) presented to public health staff and analysts in the two Councils.  Chiara was joined by the CLAHRC’s Professor Gwyn Bevan and health economist Dr Elena Pizzo, presenting evidence of the limited impact of current policy options on the projected diabetes ‘epidemic’ in Islington, which stimulated a lively discussion about what Islington might do to tackle this.

Chiara’s work is part of a wider CLAHRC study, led by Professor Bevan, investigating the design of research and decision support processes to ensure the utility of research outputs. We are making efforts to make our research more “user friendly” and accessible to colleagues in the NHS and local government so they can use it in decision-making around planning and commissioning services and interventions for the populations they serve.

There was learning on both sides – our researchers got an insight into the challenges faced by staff on the front line and an appreciation of the type of data local authorities collect and analyse to improve health and well-being. We offered projections on the likely impact on diabetes prevention of current policies adopted by local authorities.

Feedback from our audience was extremely positive and we hope this is the start of a fruitful collaboration between the CLAHRC and the Public health teams within Islington and Camden.

“Once again, thanks for delivering a wonderful presentation – many of us were fascinated by your progress, and it’s no surprise that our head of dept. is now keen to collaborate further”

Mustafa Kamara, Intelligence & Information Analyst, Camden and Islington Public Health