Welsh Ambulance Services NHS Trust Research and Innovation Annual
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Welsh Ambulance Services NHS Trust Research and Innovation Annual Report 2015-2017 'To build a culture where research can flourish, influencing practice for patient benefit' TABLE OF CONTENTS Executive Summary .............................................................................. 3 Introduction ........................................................................................... 4 The research and innovation environment ......................................... 4 Skilled staff and building capacity ...................................................... 5 Collaborations ....................................................................................... 5 Grants and funding secured ................................................................ 6 Current research ................................................................................... 6 Innovation ............................................................................................. 8 Case study of innovative research ...................................................... 9 Knowledge transfer, dissemination and impact ................................. 9 Improving Quality Together ............................................................... 10 How do we know we are succeeding? .............................................. 10 CPD Events……………………………………………………………………… 11 Conclusion ........................................................................................ 112 Research and Innovation in the Trust ............................................ 133 Appendix A ........................................................................................ 166 References ......................................................................................................... 166 Recent relevant publications ............................................................................... 167 Note: Other versions of this document, including Welsh, can be made available upon request. 2 Executive Summary Research and innovation are core activities for the Welsh Ambulance Services NHS Trust (the Trust) in order to enable us to develop and deliver effective and efficient care. The Trust has a long and well established reputation in delivering high quality research through its Pre-Hospital Emergency Research Unit (PERU). This annual report presents the progress made against the Trust’s 2015-2019 Research and Development (R&D) Strategy. The activities outlined in the report reflect the major advances which have been made in recent years, and the growing confidence in the organisation. Likewise, the Trust has seen significant increases in the scale, complexity and breadth of research and innovation in recent years. Research and innovation can be considered a journey, from the development of ideas through to large scale evaluation and dissemination, and activities within this report are at different stages in this journey. With our partners we have developed ideas such as paramedic initiated FICB for hip fracture, pre-hospital antibiotic in SEPSIS and TIA referral by paramedics to specialist clinics which, following rigorous research, may become core practices in the pre-hospital environment. We are also exploring the effectiveness of treatments which may have been adopted in the absence of robust evidence, such as the PARAMEDIC-2 study which is evaluating the role of adrenaline in Out-of-Hospital Cardiac Arrest (OHCA) and is now the largest resuscitation drug trial in Europe. Wales has made a significant contribution to the PARAMEDIC-2 study and, through delivering this and other research mentioned within this report, the Trust continues to build its capacity and reputation for conducting large scale complex research trials. The findings and knowledge gained from research and innovation must be translated into practice if they are to positively impact on patient care. This report presents activities which demonstrate the transfer of knowledge through publications, presentations, and most notably the National Institute of Health Research (NIHR) themed review of Research for Ambulance Services which presents the breadth of ambulance service research funded by the NIHR over recent years, and to which we significantly contributed. Finally, a key message in this report is one of collaboration, where a wide range of individuals including clinicians, Clinical Contact Centre staff, leaders, administrators, research and academic partners have worked together to develop and deliver the aspirations contained within our strategy. Dr Brendan Lloyd Medical Director 3 Introduction The research and innovation functions for the Welsh Ambulance Services NHS Trust (the Trust) are facilitated by the Pre-Hospital Emergency Research Unit (PERU). PERU is responsible for developing and implementing strategies and related plans for the Trust’s research and innovation function. PERU is funded by Health and Care Research Wales (HCRW), which is the R&D arm of Welsh Government. The NHS in Wales has long supported the influence of research and innovation to improve the health and wealth of the nation. This was laid out in the report Together for Research and Innovation: A Health and Social Care Research and Development Strategy 2012-2015 (WG 2012), which sought to stimulate and reward excellence and innovation, improve the research environment and invest in the future. It is therefore recognised that research and innovation are core activities of the Trust and this is reflected in our 2015-2019 Research & Development (R&D) Strategy, with a vision to: Build a culture where research can flourish influencing practice for patient benefit. This report presents the activities that PERU and the Trust has engaged in between 2015-2017, and considers progress made against the 2015-2019 R&D Strategy. The Research and Innovation Environment Within the R&D Strategy it was recognised that before embarking on significant change there was need to understand the current situation, critical factors which may affect the change and what success would look like. The first step in this process was reflected in the 2015-2019 R&D Strategy which states: “We will measure this success by developing and administering a research capacity assessment tool. This tool will be informed by the literature and grounded in the research and development environment within the Trust” It was established early that such an R&D capacity building audit tool existed, and in 2015, along with all other UK Ambulance Trusts, the Trust engaged in a research capacity building audit through the National Ambulance Research Steering Group (NARSG). This audit provided the information needed to ensure resilience and capacity to continue to attract and deliver high quality research and innovation. The audit covered areas of finance, governance, collaboration, policy, education and skills development. In order to develop and deliver high quality R&D an organisation needs an efficient and effective R&D office, which is based at PERU. In recent years, the PERU has undergone a transition with staff movement, which posed a potential threat to the integrity of the research environment. In order to sustain the R&D office function and retain resilience throughout this transition, a restructure within the department and renegotiation of finances allowed for key appointments and longer term sustainability. PERU has emerged from this transition with a skilled and efficient core of staff, including: a Head of Research and Innovation, Research Officer, Research Assistant and Finance Support. The research team is supported on a study by study basis with seconded Research Support Officers, who are funded through application of the AcoRD framework. 4 Skilled Staff and Building Capacity Within the R&D Strategy a commitment was made to: “Support and develop our clinical leaders in being active participants in research and development processes. We will also support the development of a range of skills, and understandings and tools to integrate research, and the evidence gained in to their daily practice, and activities such as clinical supervision, leadership and education.” In order to achieve this and create an inclusive and sustainable R&D future, we have made progress in the following areas: We aimed to develop the number of principal and chief investigators within the Trust and PERU. We now have two Chief Investigators (CIs) leading collaborative studies. We are also expanding our number of Principal Investigators (PIs) to include areas such as the Clinical Contact Centre, Workforce and Organisational Development. We recognised that research and innovation is an integral component in clinical leadership and we continue to support and influence this through clinical structures within the Trust. Research is a significant element of roles such as Advanced Practitioners, Clinical Team Leaders, Nursing and Medical Staff, and we continue to influence this acknowledgement in job plans and annual appraisals. We sought to support the development of critical appraisal skills, supporting education and increased knowledge mobilisation. Staff within the Trust have now been trained to deliver research, and we have a range of staff contributing to Research Trial Management Groups. Staff are also are encouraged to undertake the Good Clinical Practice course (GCP), face-to-face or online. GCP covers international standards of governance, ethics and clinical practice in research. Working collaboratively with Learning and Development, PERU has made available an