May 2020

Ciarán McInerney In Digital Innovation, Patient safety, view all PSTRC blogs

Modelling winter pressures at the NHS-R conference

A conference report by Tom Lawton

Simulating the processes of a hospital can help us foresee challenges to which we can proactively respond. The Digital Innovation theme is working on simulations of how patients flow through the hospital to improve foresight relating to increased patient pressures, like what might be expected from the current COVID-19 virus. Our colleague, Tom Lawton, presented his work at a conference of analysts and statisticians associated with the National Health Service (NHS).

Who are the NHS-R community?

The NHS-R community is a network of NHS staff that use the R programming language to do healthcare analysis. The second NHS-R conference was a sell-out event, twice as large as 2018’s inaugural event, and represents an excellent opportunity for the community to come together and share ideas.

What is the ‘Winter Pressures’ project about?

The Winter Pressures project, supported by the Health Foundation, presents a novel data-driven modelling technique to simulate a virtual hospital. As patient-safety specialists, we are using state-of-the-art simulation techniques to improve our understanding of what might contribute to winter pressures, and hopefully uncover potential mitigations. What we learn from this work has implications for how we model patient flow in general, which could help us make informed preparations for events such as the COVID-19 outbreak.

How can simulation contribute to patient safety?

The more we know about what might happen, the better we can plan the best care. Simulation modelling can be used to safely test out scenarios/decisions and ideas to help alleviate unwanted circumstances, like the pressures caused by spikes in admissions. Modelling allows us to test even the strangest ideas without ever putting a patient at risk by making changes in a virtual hospital rather than a real one.

You can try something similar by playing the 1997 computer game Theme Hospital (or more recently, Two Point hospital, which I beta tested!). The game simulates a hospital in which your task is to treat patients against the clock. Our Winter Pressures project created a more complicated and specific simulation to understand how patient flow is affected by a variety of interventions.

For example, what happens if we run a “hotel” to assist patients who were clinically well but had stayed for social reasons? What is the effect of expanding the use of the diagnostic virtual ward, whereby patients are able to wait at home but have their investigations prioritised as if they were in the hospital?

– Image sourced from https://i.ytimg.com/vi/KvgifLGujDU/maxresdefault.jpg

How is the Digital Innovation theme making use of simulation for safety?

Our hospital simulation can be scaled up from a single ward to model an entire hospital at once. We have released the computer code in the hope that we can drive further use of this powerful technique in the NHS.

As part of the NHS-R conference, I led two workshops on simulation modelling using r-simmer. These sold out quickly, demonstrating how much interest there is in doing this kind of work in the NHS. We started with a basic model of an Intensive-Care Unit using more traditional techniques and built it up until it was fully data-driven.

It was difficult for those not already versed in R programming and what is known as Discrete Event Simulation. This showed the need for further training in simulation modelling and we are already in discussions about setting up training so more people can learn how to use these powerful techniques.

The importance of sharing for safety

These kinds of conferences are extremely important to allow projects like this to “touch base” with others, and ensure that the outputs are useful both in terms of what is needed in the NHS, and what can drive the state-of-the-art without being too complex to use. They also serve as a great opportunity to promote the benefits of this kind of improvement work, so it can be used across the NHS for patient benefit. Safety is a property of our healthcare systems so it can only be ensured through healthy and effective connection and communication between us all.

How can I get involved?

We in the Digital Innovation theme would like to know what healthcare project ideas you might have that could benefit from event simulation. Let us know in the comment section below.

And don’t forget to tell us how you get on running your own Theme Hospital.

Acknowledgements

The Winter Pressures project is part of the Health Foundation’s Applied Analytics programme. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

PSTRC In Patient safety, view all PSTRC blogs

The role of translational patient safety research during the COVID-19 crisis

By Dr Beth Fylan and Professor Rebecca Lawton

Over the past weeks we have witnessed the raised profile of health research and the fundamental role it is has in addressing the international crisis caused by COVID-19. Health research organisations around the world have rallied to focus on identifying treatments and vaccines to aid prevention, recovery, save lives and enable societies to return to near-normal functioning. The hugely important role of behavioural science in understanding how best to persuade and support the general population to play their part has also been evident throughout. In the UK, the Government has placed its financial clout behind vaccine development and clinical trial centres are galvanised in establishing an evidence base to help clinical decision making. The RECOVERY trial established by the University of Oxford, for example, is currently testing a range of potential treatments for COVID-19 in 170 sites, including our own Bradford Teaching Hospitals NHS Foundation Trust.

Beyond this crucial, clinically focused work, applied research groups such as ours have been considering how their disciplinary expertise can contribute to benefit the healthcare system at this time. NIHR Patient Safety Translational Research Centres occupy a unique space in national healthcare research. Our role is to explore concepts, theories and methods that may have a role in increasing the safety of care but have not yet been developed or fully exploited. In short, we ‘aim to turn patient safety discoveries into practice’.¹ We translate through developing new knowledge and understanding, or skills and tools which can be used or tested further.²The commitment to funding such exploratory research is one of the reasons why the UK is at the forefront of health research internationally, recognising that innovation is key to enhancing the benefits gained from decades of work improving the safety of care.

We have come a long way in the UK since the publication of the report An Organisation with a Memory in 2000 ³ in understanding the extent and nature of unintended harm to patients. Whilst the NHS has made great strides to eradicate many major of causes of harm to patients, such as wrong-site surgery and retained foreign object post-surgery (often called the ‘biggies’ of patient safety), harm is still prevalent (estimated to affect one in 20 patients).⁴ We have recognised the need in tandem to explore different ways of improving care.

Early translational research offers a route into these improvements and PSTRCs are a crucible for ideas yet untried and untested. Like others during this time of crisis, we find we have a role to play in the ongoing effort and the opportunity to adapt our work to address some of the challenges the NHS – and the public as a whole – faces. This means that, while some of our studies have been paused to reduce staff and patient burden, we can adapt quickly to the COVID-19 challenge by refocussing our early translational research where it can potentially bring benefits.

For example, our ongoing portfolio of work using resilient healthcare theory has given us the building blocks of a study to monitor and understand organisational response to the crisis. Similarly, our work to understand the impact of healthcare staff wellbeing and emotions in teams on care quality has enabled us to launch resources to support them given the unprecedented conditions that staff are working under. We are also adapting current studies in order to understand how patients and the public are supporting the health system by staying safe or why, in some instances, they may be staying at home, rather than seeking care if their health is deteriorating.

Having opened up new areas of enquiry based on our learning from previous work, we hope the findings from these studies will contribute to the growing knowledge of how we work together to respond to a patient safety crisis on a grand scale as well as how safety can be maintained when the norms and rules for delivering the service no longer work.

All us who have worked in health research for many years are deeply impressed, not only by the speed of the response of the academic and clinical research community to understanding this disease, but also to national bodies – such as the National Institute for Health Research (NIHR) and the Health Research Authority – which have swiftly adapted processes to agree funding for research studies, give due oversight to their protocols and approve them. We hope that collectively we can generate an organisational memory for working in a crisis that will help us think differently about safety in the future.

And, finally, we remain grateful for the extraordinary work of our frontline NHS, social care and key worker colleagues in tackling the COVID-19 crisis.

National Institute for Health Research. £17 million invested in NIHR Patient Safety Translational Research Centres. 13 February 2017. https://www.nihr.ac.uk/news/17-million-invested-in-nihr-patient-safety-translational-research-centres/12278
Aronson J. When I use a word . . . Defining translational research. BMJ Opinion 2017. https://blogs.bmj.com/bmj/2017/04/21/jeffrey-aronson-when-i-use-a-word-defining-translational-research/
Department of Health. An organisation with a memory: report of an expert group on learning from adverse events in the NHS. London: The Stationery Office, 2000.
Panagioti M, Khan K, Keers RN et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ 2019; 366 :l4185