Dr Jay Naisbitt, a Consultant in Intensive Care medicine, has found that integrating research into routine practice has facilitated patient recruitment into urgent public health studies and has boosted morale across his team. This blog was originally published by the NIHR as part of the COVID-19 Research Voices series.
I am fortunate to work alongside an established acute research nursing team across all our Northern Care Alliance sites as well as the NIHR lead for critical care, Professor Paul Dark.
Evidence shows that critical care units which undertake research can improve mortality rates across all of their patients. For us, research is normal practice and a central pillar in the process of improving NHS care.
In early March, with sight of the approaching Covid pandemic, it was apparent that one of our Care Organisations needed additional clinical support and leadership of the critical care response. As a result, I transferred my clinical activity to Fairfield General Hospital in Bury.
We were able to rapidly build a cohesive multidisciplinary team drawn from respiratory medicine, anaesthesia and critical care to meet the challenge of our NHS “moonshot”.
Breaking down boundaries
Working in a smaller hospital has had its advantages, one of which has been the ability to rapidly design and deliver new pathways of care with an enthusiastic multidisciplinary team, working together and breaking down traditional departmental boundaries. This has enabled us, from the outset, to integrate research into our standard operating procedures.
At the beginning of our Covid response, we intubated and ventilated the majority of our patients. But from the second week onwards, we saw that some patients would survive with conventional oxygen therapy or non-invasive CPAP (Continuous Positive Airway Pressure) support, often in combination with awake prone positioning (whereby a patient lies with their chest facing downwards). This meant avoiding the risks of invasive ventilation altogether.
It was clear to us that the evidence base supported a position of equipoise (where it is unknown which treatment is likely to be better). We subsequently adopted the RECOVERY-RS protocol into our routine practice and were able to randomise the first patient within an hour of site approval. Our anxiety about obtaining informed consent from a critically ill patient, who may be hypoxic with respiratory failure, was addressed by the consent model used by the trial, which allows for retrospective or consultee consent.
Providing real evidence
In addition to this, what’s been interesting to note is that when we first started taking part in this research I had thought CPAP would be the way forward, but now I’m not sure which treatment will prove to have the best outcome for patients. Research is how we can overcome our innate bias and provide the real evidence we need.
Playing an active part in research through the first phase of the pandemic has improved morale across our Covid critical care unit and has helped to shape our team identity and focus. It led to media interest and has enabled us to emphasise the public health messages to our local population with school age children producing artwork for our patients and team. This has felt particularly important given the high prevalence of Covid-19 in our locality, presumably reflecting the high degree of deprivation across the northeast sector of Greater Manchester.
It was easy to become disheartened in the face of the challenge of Covid-19, but it is our privilege to be able to help others in their time of need and to deliver research that will define best practices, whilst hopefully saving and improving the lives of our patients.