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Imperial College researchers have developed methods and indicators for highlighting potential variations in healthcare performance and safety using routinely collected health data. Analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, and hospitals throughout the world. The results of our analyses helped detect problems at Mid Staffordshire NHS Foundation Trust and triggered the initial investigation and subsequent public inquiry with wide ranging recommendations based on the recognition of their value and their use in enhancing the safety of healthcare.
The Variable Life-Adjusted Display (VLAD) is a graphical tool for monitoring clinical outcomes. It has been widely adopted by UK cardiac surgery centres, and has helped a shift in culture towards more open outcome assessment in adult cardiac surgery, which has been credited with reduced mortality rates. VLAD is also being used for a broad range of other clinical outcomes by regulatory bodies worldwide. For example, Queensland Health uses VLAD as a major part of its Patient Safety and Quality Improvement Service to monitor 34 outcomes across 64 public hospitals, and NHS Blood and Transplant uses VLAD to monitor early outcomes of all UK transplants.
VisensiaTM is a bedside `early warning' system, deployed in many hospitals in the UK and US, which automatically analyses hospital patients' vital signs, produces simple-to-read scores, and alerts healthcare staff to any deterioration in a patient's condition. It resulted from research in this Department, commercialised by Oxford BioSignals Ltd (£1.5m sales to date, and 137 licences sold since 2010). VisensiaTM reduces the number of patients already in hospital who suffer an unexpected cardiac arrest or need an unplanned transfer to intensive care. The US Food and Drug Administration (FDA) approved the system's use after a 1000-patient clinical trial. There were no unexpected fatal cardiac arrests on the wards where the clinical trial took place in the three years after VisensiaTM. was deployed.
Patient records underpin the delivery of healthcare. When the recorded data are aggregated, they provide information to support service delivery, audit and research. Research conducted at Swansea University from 2000 to 2011 showed that variations in the structure and content of records across the NHS limit their quality and utility. To address this, the University collaborated with the Royal College of Physicians to develop evidence-based national standards for the structure and content of patient records. First launched in 2008, the standards have been endorsed by numerous statutory bodies and professional organisations, including the Department of Health, NHS England, NHS Litigation Authority, Mid-Staffordshire Inquiry, Care Quality Commission, General Medical Council, Academy of Medical Royal Colleges, and Academy of Medical Sciences.
Between 1996 and 2013 researchers at Swansea University evaluated service initiatives and changing professional roles associated with the management of patients with debilitating gastrointestinal disorders. This work showed the clinical and cost effectiveness of two main innovations: open access to hospital services for patients with inflammatory bowel disease; and increased responsibility for nurses, particularly as endoscopists. Our evidence has had a broad, significant impact on: national policy through incorporation in NHS strategies, professional service standards and commissioning guides; service delivery through the provision of increasing numbers of nurse endoscopists and the wide introduction of nurse-led open access to follow-up; and patient care, as documented in sequential national audits in 2006, 2008 and 2010.
Statistical analysis and methodological development carried out by Imperial College London on data from the Bristol Royal Infirmary Inquiry and the Shipman Inquiry have led to new monitoring systems in healthcare. Using routinely collected healthcare information, we have highlighted variations in performance and safety, impacting the NHS through direct interventions and/or policy change. For example: (i) findings and recommendations arising from our research for the Bristol Inquiry were reflected in the final inquiry outputs, which highlighted the importance of routinely collected hospital data to be used to undertake the monitoring of a range of healthcare outcomes, (ii) a range of monitoring recommendations have arisen as a direct result of the research on data from the Shipman Inquiry, (iii) analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, (iv) Imperial's monthly mortality alerts to the Care Quality Commission were major triggers leading to the Healthcare Commission investigation into the Mid Staffordshire NHS Trust.
Acute stroke services in the Belfast Health and Social Care Trust have been reorganised using research on modelling stroke patient pathways through hospital, social and community services carried out in CSRI at Ulster. By suitably administering thrombolysis (clot-busting drugs), a stroke patient's time in hospital, community rehabilitation and nursing homes can be reduced, so that although the treatment costs money up front, it saves in the long-term and also improves quality-of- life. The work has contributed to changing stroke patient policy in the Belfast Trust as well as enhancing patient quality-of-life. It is applicable throughout the UK and beyond.
A quiet technology revolution in the UK has been changing the way that police officers on the beat and hospital nurses access and record information, using handheld electronic notebooks that bring large time and cost savings. This revolution began as a University of Glasgow research programme and led to the creation of a successful spin-out company, Kelvin Connect. Acquired in 2011 by the UK's largest provider of communications for emergency services, Kelvin Connect has grown to 30 staff. Its Pronto systems are now in use by 10% of UK police forces and nursing staff in several UK hospitals.
Research carried out at the University of Southampton has led to the development of a new tool for detecting and managing malnutrition. The Malnutrition Universal Screening Tool (MUST) has been rolled out to more than 80% of hospitals and care homes in England and 98% in Scotland, is part of national health policy in Finland and the Netherlands, and has attracted interest internationally. The National Institute for Health and Clinical Excellence bases its current quality standard for nutritional support in adults on the MUST framework; only two NICE guidelines have saved the NHS more money. MUST has become an integral part of the UK's health policy framework, embedded in routine clinical care and supported by bodies responsible for clinical and care excellence. It is central to learning programmes on managing malnutrition.
This case study describes a significant new index used to monitor death rates in hospitals. The Summary Hospital Mortality Index (SHMI) was developed as a direct result of research carried out at the School of Health and Related Research (ScHARR). This was implemented nationally in October 2011 and the SHMI is now the main mortality indicator used by the NHS. Following publication of the high profile Francis Inquiry on Mid Staffordshire in February 2013, set up to investigate excess mortality in the Trust, the Government has used the SHMI to identify and target 8 further hospitals for investigation.