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Role of networks in supporting emergency medicine research: Findings from the Wessex emergency care research network (WECReN)

Article in Emergency Medicine Journal · March 2005 DOI: 10.1136/emj.2003.008268 · Source: PubMed

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Networks research as being less developed than ...... that of other disciplines.2 Ethical difficulties associated with emergency care research also limit the Role of networks in supporting potential for conducting research. Given the nature of emergency department emergency medicine research: findings setting, many patients are not in a position to give consent in the tradi- from the Wessex emergency care tional way.10 In particular, where emergencies occur, they require rapid research network (WECReN) decision making and interventions that do not permit time for explanation and D Wright, R Crouch, M Clancy deliberation on taking part in research.11 These factors cumulatively serve to ...... restrict the potential for conducting research in emergency care. This paper reports on the activities and experiences of the network and makes recommendations for the role of such networks in ROLE OF NETWORKS IN emergency medicine research. EMERGENCY MEDICINE RESEARCH It has been suggested that conducting 8 he importance of evidence based USA, it is still in its infancy in the UK. research as part of a collaborative team medicine in improving clinical care Funding is increasingly being awarded rather than as a sole researcher can has been emphasised significantly to emergency care research, but it is still effectively overcome many of these T 1 in recent years. Opportunities to con- some way from being a research disci- practical difficulties.12 In particular, net- duct research within emergency care, pline in its own right. This is attribu- works can generate a sufficient ‘‘critical however, have been restricted by time table not only to a lack of research mass’’ to permit high quality research. and financial constraints as well as a tradition, but also to a series of con- 2 The concept of ‘‘networking’’ is inherent lack of a research tradition. Research straints and obstacles to emergency care in clinical governance, necessitating networks in primary care have enabled research in the UK. the sharing of professional experiences healthcare professionals to conduct and the dissemination of knowledge.7 research despite similar difficulties.3 LIMITATIONS FOR RESEARCH IN Similarly, networking is also integral to Recognising this as a possible approach emergency care reforms: to developing and providing support for EMERGENCY MEDICINE research in emergency care, funding As commentators have highlighted, the was sought to develop a local emergency nature of emergency medicine presents ‘Each Emergency Care lead will care network. With funding from the certain challenges that restrict the form part of an Emergency Care Southampton University Hospitals’ potential for engaging in research. Network. This will help co-ordinate Trust Strategic Research Fund, the Many of these difficulties are generic all aspects of the local emergency Wessex Emergency Care Research and to health research (such as time and care system. Emergency care colla- Development Network (WECReN) was education), while others are specific to boratives will be introduced to launched in October 2001. This paper emergency care. From a US perspective, cascade knowledge and to spread reports on the activities and experiences Aghababian et al cited limited funding, a best practice throughout the service’ of the network in its first year. lack of institutional support, and little (D0H, 2001:6) Reflections and recommendations on experience or training in research meth- the role of networks in the support of ods as being significant barriers to Networks encouraging and support- 9 research in emergency medicine are emergency medicine research. Similar ing health research are familiar in 28 provided. issues have been noted within the UK, primary care. Presently, over 40 primary particularly with the ‘‘high pressured, care research networks (PCRNs) exist THE NEED FOR RESEARCH IN immediate, emotional, and often over- in the UK, which vary considerably in burdened’’ environment of emergency terms of organisation, location, specified EMERGENCY MEDICINE 2 The organisation and delivery of emer- medicine. aims, and membership (unpublished gency services has been the subject of Research in emergency medicine in report Evans D, et al, 1997). Some much scrutiny and change in recent the UK has also been affected by a networks are uni-professional and are years. Reports such as the Audit centralisation of research expertise. based in one specified region (such as Commission’s review on accident Opportunities to obtain research advice EyeNet for optometrists practising in and emergency departments4 and the and support in academic centres are London) while others seek to engage Department of Health’s publications on comparatively high while emergency with members across disciplines and Reforming Emergency Care56 further departments not in academic centres across broader geographical areas (such emphasise the need for high quality are unable to utilise the same level of as the Wessex Primary Care Research research on current service provision expertise.2 Despite this, a pressure still Network that supports all forms of and mechanisms for service develop- exists to have research publications to primary care research in Hampshire, ment and improvement. In addition, gain a ‘‘right of passage’’ for promotion , , and the Isle of clinical governance necessitates effective to clinical posts. This often results in a Wight). These networks represent a dissemination of evidence to ensure that ‘‘quick and dirty’’ style of research that shift in the production of knowledge clinicians access the most up to date is lower in quality and proffers fewer away from the ‘‘natural science evidence from research.7 opportunities for learning from the research’’ typified by a loan researcher While emergency medicine research research experience. It also perpetuates undertaking research in a linear manner has been successfully developed in the an image of emergency medicine (that is, from generation of hypothesis

www.emjonline.com COMMENTARY 81 through to dissemination) within a N The carousel model (having a defined projects. In addition, the network aimed single discipline.3 Rather, networks sig- centralunitaswellascomplex to determine members’ research priorities nify a move towards a multi-profes- interactive relationships) and use this to guide future funding sional form of research characterised by N The orbital model (including a centre applications. The network would there- a combination of heterogeneous skills with coordinated satellite units) fore promote multi-centre research pro- and experience. Evaluations of networks jects as well as supporting and assisting N The bicycle wheel model (being more have illustrated that they are successful members’ own individual projects. The centralised with little collaboration at in increasing research capacity and network would also serve as a means of the periphery). promoting evidence based learning, disseminating current knowledge and particularly where there is a low base The two emergency medicine research best practice to members as well as 13 of research experience. networks currently based in the UK providing one to one advice to members As emergency medicine is defined (the Emergency Medicine Research on appropriate funding sources and by acuity and time rather than specific Group (EMeRG) based in Birmingham where to access educational support. disease type, the research questions and the Leeds Emergency Medicine Advertising for the network was generated are often complex and relate Research Group) operate as centralised undertaken by writing and distributing more to service delivery, organisational, networks, representing the research leaflets to all emergency departments in social, and economic issues. These ques- expertise located within a few academic the former Wessex region and by estab- tions pose particular challenges necessi- centres. In October 2001, a team from lishing a WECReN web site. tating a variety of research methods and the emergency department in disciplines within emergency medicine Southampton received £35 000 funding 14 FINDINGS FROM THE FIRST YEAR research : a requirement that may be to establish a research network. An effectively facilitated by a network Membership ‘‘orbital’’ model was adopted as it was Within 12 months of establishing the approach to research. While the concept felt that such a model would be the network, WECReN had been able to of networks in emergency care have most effective in decentralising research involve representatives from nine hospi- been welcomed, Foe¨x et al have warned activity and resources and in promoting tals in the former Wessex region. that collaborative working necessi- relevant research in each of the ‘‘out- Involving a variety of departments tates significant organisation and lier’’ centres (unpublished report, Evans meant that the network consisted of a may be undermined by varying degrees et al, 1997). The desire to decentralise diverse range of emergency departments of enthusiasm of those involved.8 was to encourage local ownership and in terms of size, structure, and experi- Similarly, networks can become overly participation in research activity. ence. In addition, representatives from dependent on key people confident in The funding was used to employ a full local emergency departments would undertaking research such that were time research assistant for one year to potentially provide an effective means they to leave, the network would be at develop and manage the network and for recruiting participants in research risk from folding. facilitate grant applications for funding. projects. Some of the funding was also used to The network recruited in excess of 60 ESTABLISHING A RESEARCH establish a network web site. members, 42 of whom work within an NETWORK The boundary of the network emergency setting as nurses, consul- Evans et al identified four models of reflected the former NHS region, includ- tants, registrars, etc. Other members research networks in a review of net- ing Hampshire, Wiltshire, Dorset, and included primary care health profes- working strategies conducted in 1997 the Isle of Wight. This included A&E sionals and related professions, such (unpublished report Evans D, et al, departments situated in Southampton, as paramedics and ambulance staff. 1997) (fig 1): Portsmouth, Basingstoke, Winchester, However, the degree to which people Swindon, Bournemouth, Poole, have actively participated in the net- N The crystal model (lacking a defined Salisbury and Newport, Isle of Wight. work has varied considerably. It became centre, but characterised by multiple Although the network was funded by apparent that only certain core members informal relationships) the Southampton University Hospital with an active interest in research and Trust and was managed and coordi- development consistently participated nated through Southampton General with the network. Hospital, it was deemed optimal to Three grant applications were com- establish ‘‘outlier centres’’ to encourage pleted over the first 12 months, none of research activity throughout the region. which were successful. However, these The principles of the network were to funding applications would not have encourage and support research beyond occurred without the network. Several Orbital model Bicycle wheel academic centres and to ensure that a A&E departments collaborated with model wide range of experience was repre- these projects by agreeing to recruit sented in the network. It was felt that participants from their department an inclusive membership, extending upon a successful outcome to the fund- to primary care providers and other ing application. The success of one of secondary care departments, would these applications may have focused the increase the collaborative component activities of the network and help bind of the network and the diversity of skills it together. All the lead investigators and expertise represented. on the proposals were based in The network aimed to identify mem- Southampton, thus undermining the bers from different multi-professional ‘‘orbital’’ approach that was desired. Crystal model Carousel model backgrounds based in the former More successful were the local network Wessex region who were interested in projects, including an assessment on Figure 1 Four models of research networks emergency care research. This would the research priorities of professionals (reproduced with permission Evans et al, facilitate research by assisting collabora- working within six emergency care 1997). tion and recruitment in research departments and a pilot study into user

www.emjonline.com 82 COMMENTARY perceptions and experiences of A&E DISCUSSION would the sharing of heterogeneous services, the results of which will be While the orbital model was the ideal of skills and experience that is described published in the near future. the network, in reality the network by Fenton et al as a hallmark of effective never effectively moved beyond a research networks, be possible.3 Administration ‘‘bicycle wheel’’ (see fig 1) approach Three steering meetings were estab- (unpublished report Evans D, et al, CONCLUSION lished involving representatives from 1997). In other words, while the inten- Networks provide an important means each of the member departments and tion was to maintain a centralised of promoting and supporting research in from primary care. Because of con- coordinating unit and to support satel- emergency care as well as facilitating straints of time and financial resources, lite units at each participating hospital, dissemination of evidence based prac- it was evident that regular face to members’ liaised with the Southampton tice, but by themselves do not deliver face meetings were not the most effec- team only and not with other health research. A network provides the poten- tive means of steering the group. professionals in their immediate area. tial benefit of dividing workload and Consequently, it was decided that a Active involvement in research, as Good multiplying opportunities and expertise. more ‘‘virtual’’ format for the network and Driscoll warned, remained focused However, this needs to be supported would be preferable, establishing two in those departments who were situated by sufficient enthusiasm, energy, and a web sites: one to advertise WECReN and in close proximity to academic centres.2 research agenda. Educational and finan- the other to provide online discussion. It was evident that the reasons for cial resources also need to be available The aim of the discussion site was limited involvement from other depart- to encourage research among health to discuss research problems, share ments were related to those factors professionals with little research experi- research ideas, and provide a means of discussed earlier: namely, a lack of ence. Two ways of developing research disseminating evidence to answer spe- finance, minimal education and training networks emerge from our experience. cific queries. opportunities, a lack of enthusiasm, Firstly, the establishment of a network and little available time to undertake on a needs basis—that is, around a specific research project—seeking out Challenges research restrict opportunities to get 289 interested clinicians and academics. In the network’s first year, certain involved in research. Secondly, establishing a network of challenges were experienced. Firstly, Networks, as Griffiths et al highlight, research interested people, who use research remained centralised to those offer a supportive framework in which it regularly to collaborate on research institutions and people with particular high quality research can be undertaken projects. Using discrete short projects, research experience and interests. There and disseminated, permitting a sharing with the latter approach, may be bene- was an expectation therefore among of experience and expertise, facilitating ficial in the research maturation pro- members that research active people recruitment, and making professionals 13 cess and help to build confidence in would lead the research, which was at more research aware. However, for participating departments, creating a a variance to the initial intentions of the networks to be as successful, there culture of independence from a central network to decentralise research activity needs to be a ‘‘critical mass’’ of enthu- department. and encourage research among those siasm, energy and research ideas ema- Our experience suggests that research with less experience. The support nating from network members. It was networks are more likely to get up and required to develop research questions, evident from WECReN, however, that running if there is a committed multi- formulate ideas, and develop proposals this critical mass was not attained and professional group who already have an had been underestimated and was not thus the network was too dependent on existing research agenda that a network realistic in the time frame available. a few research active people. This placed would help to achieve. Networks lacking Other groups seeking to establish net- the network in a vulnerable situation for such an agenda and hoping it will works should consider a two year time when these people were not present. emerge from within the network may frame for establishment and securing The ability of the network to support be less likely to succeed. sustainable funding. and encourage research was severely We would welcome communica- Insufficient time was also a consider- affected. tion from other groups about their able limiting factor that discouraged It was also evident that for networks experiences. involvement in research. Many health to be successful, sufficient funds have to professionals were unable to take the be made available to provide appropriate necessary time out of their work to educational events. Furthermore, the CONTRIBUTORS working practices of health profes- RC and MC conceived the idea, sought attend meetings or take a greater role funding for and worked with DW to develop in research projects. Similarly, certain sionals need to be restructured to enable WECReN. DW drafted the paper, both RC and health professionals could not commit staff to take ‘‘time out’’ to conduct MC critiqued and developed the paper. RC to attending research events because of research and to attend research events. and MC act as guarantors. This may usefully be incorporated into the possibility of last minute change of Emerg Med J 2005;22:80–83. clinical rotas. However, members were the development of emergency care doi: 10.1136/emj.2003.008268 happy to be involved in data collection networks6 ensuring that practice devel- as they could fit this within their usual opments and service redesigns are sub- ...... work routine. Finally, remuneration for jected to rigorous evaluation and testing Authors’ affiliations research activities was also important. and that we prevent the situation of re- D Wright, R Crouch, School of Nursing and For staff to get involved in research inventing wheels where some of the Midwifery, University of Southampton, and attend research related events, it answers lie in previously published Southampton, UK became apparent that funding had to be work. R Crouch, M Clancy, Emergency Department, available for their time and travelling More generally, for research networks Southampton University Hospitals NHS Trust, Southampton, UK expenses. When seeking funding for to run effectively, a ‘‘maturation’’ pro- research networks, consideration should cess is needed to allow members to be given to sessional release of network accrue sufficient confidence and experi- Correspondence to: Dr R Crouch, Emergency Department, Southampton University Hospital members to conduct research and parti- ence in research, and thus to contribute NHS Trust, Tremona Road, Southampton SO16 cipate in network opportunities. more actively in the network. Only then 6YD, UK; [email protected]

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