Derriford Hospital Critical Care Team Devise New Research Delivery Model Which Proves Effective in Responding to the Covid-19 Challenge

The Critical Care Team at Derriford Hospital has been at the forefront of caring for patients with Covid-19. The research trials they deliver offer hope to patients and an opportunity for staff to work together to further knowledge, along with, building an evidence base that, it is hoped, will be used to find treatments and care for those with Covid-19.

The approach embeds research into the clinical environment and this requires innovative ways of working. One solution is having Research Nurses that split their time between clinical work and research delivery. Liana Lankester, ITU Research Nurse, does exactly this. She describes how the team put together all the information needed to recruit a patient to a trial in one handy pack:

“The ‘grab packs’ contain the inclusion-exclusion criteria, the patient information sheet, the patient consent form and how to randomise out of hours. This enables us to run trials at all times.”

A changing service

The team have utilised the skills of ITU Registrar’s and Advanced Critical Care Practitioner’s (ACCP), incorporating them into the unit’s research model has allowed an increase in the capacity to deliver research around the clock. During most shifts, a member of the multi-disciplinary team can be found in the Critical Care Unit allowing recruitment to happen ‘out of hours’. They deliver important roles such as screening for eligibility, having discussions with patients around giving consent, randomising participants to specific arms of trials and ensuring patients are informed and supported throughout the recruitment process.

Helen McMillan is an ACCP, she describes the impact this new way of working has had:

“Since we adopted this approach we have found that our recruitment to studies has considerably increased.”

Delivering as a team

In addition to reconfiguring how the team operates the role of Principle Investigator (PI) has been pivotal in communicating the importance of research to the wider clinical teams. Dr Nikitas the Chief Investigator (CI) of one and PI of three of the studies currently conducted in our department comments on the new research delivery model on ICU:

“The new research delivery model of our department has been focused on the development of a multi-disciplinary ICU Research Team which will facilitate the conduction of clinical [commercial and non-commercial] and translational research studies in our department 24 hours a day, 7 days a week. The main pillars for the research conduction in ICU are our ICU Research Nurses, supported by all members of the ICU Team, the CIs and PIs as well as the R&D Department of our institution.

“Development of effective clinical and translational research in Intensive Care Medicine, aiming to identify factors that affect survival and recovery of critically ill patients and develop new treatments for critical illness, is one of the greatest challenges for the specialty. Taking into consideration the demand for continuous delivery of high-quality clinical research in the current challenging times for the Intensive Care Medicine, the research delivery model that is developed in our department can maximise the potential for our department’s contribution towards that goal”.

During the Covid-19 pandemic the Intensive Care Unit has commenced the Recovery – RS, the REMAP – CAP and the ISARIC trials. They have also been able to start the GenOMICC trial which can recruit both Covid-19 and non Covid-19 participants. They also continue recruiting to BLING III, and to the our own single-centre Novel Somatosensory Evoked Potentials Study in comatose survivors of Out of Hospital Cardiac Arrest.

Learning from change

A collective effort, reconfiguration of services and a commitment to continue delivering research wherever possible has resulted in the new model of research delivery that gives benefits to both patients and staff. The hope is the lessons learnt responding the Covid-19 pandemic and the creative solutions generated will continue to inform practice for years into the future.