We are naturally curious...Patterns of repeat referrals –when, from where, reason? Can we teach...
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We are naturally curious ….. … and not happy to accept the status quo
Transcript of We are naturally curious...Patterns of repeat referrals –when, from where, reason? Can we teach...
We are naturally curious …..
… and not happy to accept the status quo
Direction of travel …
• Some examples of clinical challenge
• How we can use data to influence service change
• How we can turn challenges into research questions
• Steps to take when designing a research study
Clinical challenges prompt us to consider change …
Examples of challenge:
1. Unmet need: is change in practice required e.g. family education sessions for long term patients
2. Organisational change: can we prove this makes a difference?
3. Compare practice in different settings
4. I wonder if…?
1. Unmet need: family education for long term patients
Building the case
Convincing colleagues
Preparing for change
Evaluating impact
Evidence that change is needed
Evidence that the change will
work
? Skill mixLearning needs
PatientsStaff
Process
1. Unmet need: family education
Building the case
Convincing colleagues
Preparing for change
Evaluating impact
Evidence that change is needed
Evidence that the change will
work
PatientsStaff
Process
Skill mixLearning needs
Audit:prevalenceResearch:evidencePatient:feedbackFuture: demand
Publications: evidencesimilar servicesmilestonesresources
Sources:Librarian!Conf abstracts
Evidence:Skillmix requiredTime required:
activitytrainingfollow up
Patient/carer:- SatisfactionNutrition service:- Uptake- Cost neutral?- Staff
satisfaction
2. Can we prove this makes a difference?
The impact of a nutrition education initiative for novice nurses
What to measure?
Staff:• Satisfaction, confidence, competence
The nutrition service:• Inappropriate call-outs, timely call-outs, ….
Patient • Better experience, improved nutrition, shorter LoS, shorter
intervention time
Sedation management in UK and Australia
● Sedation breaks often not achieved in ICU1, despite evidence that sedation stops are safe2
● We don’t know the impact of organisational factors…
● Responsibility for sedation hold decisions rests (mostly) with doctors in Australia and nurses in the UK
Aims1. To examine documentation of sedation and extubation plans in similar ICUs in England and Australia2. To explore factors associated with assessment and management of sedation in ICU patients.
3. Compare practice ….
4. I wonder if….
● we can tailor nutrition services to better meet the needs of parents of chronically sick children?
● we can measure how confident family members feel when the patient is discharged with HPN?
● delayed decisions about nutrition in stroke care affects staff satisfaction?
● family-centred care approaches, successfully implemented with children, are feasible to use in adult patients with long term nutrition needs?
● the way we confirm NGT placement is different from other Trusts?
Clinical Problem
Peer review &
Academic input
Develop Research Question
Design study
Other professions/sites?Regional/National/International
Costs
ApprovalsData collection
& analysisPRACTICE CHANGE
Publication &Conf Presentation
Track record:- Individual- Ward/Dept- Trust
What evidence is published?
Audit , QI or Research?
Requires funding -
Develop bid
Identify preliminary
work
Adjust study design as appropr.
STEPS IN DESIGNING
A STUDY
What data do we already have?Is it easy to access?Is it ‘clean’?How would we analyse it?
Problems with guideline implementation:
what (audit); who (clinicians or pts) why (ask…)
Patterns of repeat referrals – when, from
where, reason?
Can we teach family members to undertake
care?
What is the impact of early goal-directed protein-energy
nutrition on short-term clinical outcomes and long-
term physical quality of life in ICU patients?
EBP Audit
QIResearch
Different approaches ….
• Stay curious
• Share your curiosity
• Find out what data you already have
• Get advice!
• Know your local librarian
