Publications by authors named "C Vindrola-Padros"

49 Publications

Boundary work during COVID-19: The transformation of research review and set-up.

Future Healthc J 2021 Jul;8(2):e322-e325

research UCLH/UC, NIHR UCLH Biomedical Research Centre, London, UK.

Background And Aims: The rapid setting up of research during the COVID-19 pandemic led to changes in ways of working within research organisations. The aim of this study was to examine the experiences of staff involved in the research review and set-up system at a large NHS and university partnership in the UK through the lens of boundary theory.

Methods: We carried out a rapid qualitative appraisal based on telephone interviews (n=25) to explore how staff experienced the research review and set-up system during the pandemic.

Results: In light of the pressures created by the pandemic, the boundaries established to set up distinct groups and responsibilities were modified to allow for different ways of working. Some of the new structures and processes were seen positively and brought groups that previously worked at a distance closer together.

Conclusions: The reconceptualisation of relations within the research system during the pandemic added more fluidity to ways of working within the research office and contributed to closer working interactions and an expanded team ethos.
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http://dx.doi.org/10.7861/fhj.2020-0262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285158PMC
July 2021

NHS 'Learning from Deaths' reports: a qualitative and quantitative document analysis of the first year of a countrywide patient safety programme.

BMJ Open 2021 Jul 7;11(7):e046619. Epub 2021 Jul 7.

Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.

Objectives: To review how National Health Service (NHS) Secondary Care Trusts (NSCTs) are using the Learning from Deaths (LfDs) programme to learn from and prevent, potentially preventable deaths.

Introduction: Potentially preventable deaths occur worldwide within healthcare organisations. In England, inconsistencies in how NSCTs reviewed, investigated and shared LfDs, resulted in the introduction of national guidance on 'LfDs' in 2017. This guidance provides a 'framework for identifying, reporting, investigating and LfDs'. Amendments to NHS Quality Account regulations, legally require NSCTs in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended NSCTs would share this learning and take measurable action to prevent future deaths.

Method: We undertook qualitative and quantitative secondary data, document analysis of all NSCTs LfDs reports within their 2017/2018 Quality Accounts (n=222).

Results: All statutory elements of LfDs reporting were reported by 98 out of 222 (44%) NSCTs. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of NSCTs (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 NSCTs (48%) have shared or plan to share the learning within their own organisation. The majority of NSCTs (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 NSCTs (17%) mentioned involvement of bereaved families.

Conclusions: The wide variation in reporting demonstrates that some NSCTs have engaged fully with LfDs, while other NSCTs appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfDs reports have previously been identified by national and international reports and inquiries.
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http://dx.doi.org/10.1136/bmjopen-2020-046619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264864PMC
July 2021

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review.

EClinicalMedicine 2021 Jul 23;37:100965. Epub 2021 Jun 23.

Department of Applied Health Research, University College London, Gower Street London, WC1E 6BT, UK.

Background: the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt.

Methods: we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888).

Findings: the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored.

Interpretation: future research should focus on staff and patient experiences of care and inequalities in patients' access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.
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http://dx.doi.org/10.1016/j.eclinm.2021.100965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219406PMC
July 2021

How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.

Appl Health Econ Health Policy 2021 May 19. Epub 2021 May 19.

Research Department of Primary Care and Population Health, University College London, London, UK.

Background: Studies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study.

Methods: We outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed.

Results: Cost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million).

Conclusions: These principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC.

Trial Registration: Not applicable.
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http://dx.doi.org/10.1007/s40258-021-00660-6DOI Listing
May 2021

The impact of COVID-19 on anaesthesia and critical care services in the UK: a serial service evaluation.

Anaesthesia 2021 May 18. Epub 2021 May 18.

Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.

Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID-19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri-operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one-quarter of all surgical activity was lost, with paediatric and non-cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one-third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three-quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID-19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics.
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http://dx.doi.org/10.1111/anae.15512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222939PMC
May 2021
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