BANCC Making a difference: establishing a cardiology research team within a district general hospital

ardiovascular nurses sometimes find division. Six years ago this pivotal Acute coronary syndrome themselves tasked with starting a post did not exist, and within the cardiology Despite the general assumption that Cservice from scratch and developing division, no research or clinical trials were with acute coronary syndromes this into an essential part of delivering open to recruitment. (ACS) present themselves to the emergen- excellent care. Nicola Bowers, Funding provided by the National cy department with chest pain, epidemio- ordinary council member and senior Institute for Health Research (NIHR) paved logical data reveal that only about 50% of research nurse at Wycombe Hospital writes the way for a clinical research nurse post patients with chest pain suffer from coro- about her strategy and achievements in and collaborative working with my organi- nary heart disease and only 10% have a establishing a clinical research team at her sation, commercial partners and an innova- definitive diagnosis of acute myocardial district general hospital (DGH). tive consultant cardiologist. These collabo- infarction (MI) (Mockel et al, 2013). The rations have led to great achievements ben- rest are diagnosed with other cardiac or Building a cardiac efitting our cardiology patients. extra-cardiac conditions, e.g. gastro- research team As the only cardiac clinical research nurse oesophageal, musculoskeletal, pleuro-pul- As research evidence driving patient care is in the DGH, I realised I cannot do this monary, mediastinal or psychogenic. emphasised (Department of Health (DH), alone, and made the initiative to contact the Apart from troponin, a second biomark- 2006), there has been an increased demand Thames Valley Cardiovascular NIHR local er, copeptin, is already being used in for clinical research nurse posts. However, research network where I became a member Europe to diagnose and determine the findings by the DH (2000) concluded that of the steering group committee. The main severity of MIs. After a visit to a centre in most settings ‘failed to maximise the nurs- aim of the network is to improve and meet Germany, I wrote a UK research protocol ing contribution to research and develop- delivery targets for patient recruitment at a with Dr Clifford and gained successful ment’. To resolve this, the report, Best national level. Through my work with the ethical application to test this theory local- Research for Best Health, (DH, 2006) set group, we ran a successful international ly. In the 900 patients recruited, we aim to: goals for supporting the research infrastruc- annual research network meeting where we ◆◆ Compare the safety of the present stand- ture by offering appropriate training and also presented our research outputs. ard of care to the safety of an early rule- development for professionals within the Building on the achievements of the ini- out strategy using combined testing of NHS who are involved in research. tial clinical research nurse post that I held, a copeptin and troponin at admission in My masters dissertation in advanced research team has now been established. patients with signs and symptoms sug- nursing practice focused on the importance Within our division, we control our own gestive of ACS and a low-to-intermediate of the role and integration of the cardiology financial research budget and have opened risk profile (Grace Score <140). clinical research nurse within the cardiology over 30 cardiac clinical trials. It was recog- ◆◆ To compare length of stay (in hours) of nised that leadership for this team will also patients in both pathways. be a nurse role; hence a job description for a The primary endpoint of the interim CONTACT BANCC Agenda for Change (AfC) grade of analyses will be the 30-day mortality of Website www.bancc.org cardiac research was established. For his patients who were discharged from the efforts in supporting the development of the emergency department based upon the Twitter: @bancccouncil research team, Dr Piers Clifford, our DGH biomarker test result. The data analysis is Facebook: British Association for Consultant Cardiologist, was recognised by still ongoing and depending on the results, Nursing in Cardiovascular Care the NIHR as a Clinical Research Network this new biomarker may help refine the Tel: +44 (0)20 7380 1918 Leading Commercial Principal Investigator diagnosis of MIs more accurately. Email: [email protected] and by the Health Service Journal (HSJ) as one of the Top 50 Innovators in the NHS. Cardiac rehabilitation BANCC The cardiac research team was pivotal in c/o The British Cardiovascular Society Innovative projects the service redesign and implementation of 9 Fitzroy Square As our team grows in capacity and confi- an innovative, technology-based solution London dence in carrying out high-quality research, called Care4TodayTM for cardiac rehabili- W1T 5HW we have taken on innovative projects that tation involving patients with .

can have a huge impact on patient care. Their achievements included recruiting Ltd © 2017 MA Healthcare

226 British Journal of Cardiac Nursing June 2017 Vol 12 No 6 BANCC

>700 participants to this commercial ‘I want to say how good I have found Conclusion research portfolio project within a year. Care4Today, it has had a huge impact on From one nurse post, in collaboration with This was instrumental in receiving a my rehabilitation’ stakeholders, I was able to develop a highly Patient Experience Network (PEN) award, successful and productive cardiac clinical recognition as a finalist in the Value in ‘Despite my years as a GP in practice, I research nurse team and help with increas- Healthcare HSJ awards, and for needed Care4Today’s help and explana- ing the profile of the research network. As Buckinghamshire Healthcare inclusion in tion for a speedy recovery’. a result, the DGH receives over £250 K in the list of Top 100 Performing NHS Trusts income from commercial research which committed to delivering clinical research Heart failure (HF) helps support cardiovascular research and to time and target. The clinical research team is currently the research team. Most importantly, this Results from this study have shown that working on the development of an inte- gives patients the opportunity to receive referral to cardiac rehabilitation was grated pathway for the management of innovative care by participating in high- 27 days with Care4TodayTM compared patients with HF. This is a £1 million joint- quality clinical trials. with the national average of 55 days, more ly funded project with Janssen Healthcare I would like to use this model to improve patients were on the programme (82% vs. Innovation. We are developing a reactive, research practice and nurture other nurs- 53% before the programme and 43% responsive electronic patient record link- es to take up clinical research roles national average) and participated for a ing primary care physicians, secondary throughout the cardiovascular division longer period (38 more days than the care cardiologists, pathology, radiology and beyond, reaching out to other depart- national average). We are currently await- and the patient using novel digital technol- ments to establish teams within other ing data on hospital re-admission and ogy. specialties. BJCN patient mortality. The positive feedback Patients with HF will be able to take con- from participants is encouraging and indi- trol of their disease by setting up pre- References cates acceptability of the new programme: agreed automated alerts if their condition Department of Health (2000) Towards a strategy for and development: Proposals for is deteriorating symptomatically, biochem- Action. HMSO, London ‘All the education and exercise has ically or physiologically. The warning signs Department of Health (2006) Best Research for Best helped me to get to better than “nor- are automatically communicated to the Health: A New National Health Strategy. DH, London mal”’ patient, their carer and the HF service. The Mockel M, Searle J, Muller R et al (2013) Chief research team is involved in all aspects of complaints in medical emergencies: do they ‘Caring and informative. Good exercise the project from writing the protocol, com- relate to underlying disease and outcome? The Charité Emergency Medicine Study programme. Extensive information plying with all ethical and practice stand- (CHARITEM). Eur J Emerg Med 20(2): 103–8. available’ ards, to recruitment and evaluation. doi: 10.1097/MEJ.0b013e328351e609

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