Critical Care and Peri-operative Medicine Research Group

Implementation Science

Globally, healthcare systems struggle to deliver the benefits of research to their populations. To change practice and ultimately patient outcomes, the results of high-quality trials need to be effectively implemented within local healthcare systems.

 

This acknowledges that the ‘bench to bedside model’ includes a 2nd translational gap –and implementation science has emerged as an important discipline for developing the evidence base on how to translate research findings into routine care. Within our group we use mixed-methods research approaches to understand the results of major trials that we run in peri-operative care and how to translate results that indicate changes to patient care into routine practice. Recent / current research include mixed-methods process evaluations of the EPOCH trial and of the PRISM and OPTIMISE II trials.

 

Watch: Implementation Science by Tim Stephens (Researcher)

 

Tim Stephens talks about his role as a QI specialist within the Group and the importance of implementation science in improving patient outcomes.

 

EPOCH - Mixed Methods Research

  • Martin, G. P., Kocman, D. , Stephens, T. , Peden, C. J., Pearse, R. M. and , (2017), Pathways to professionalism? Quality improvement, care pathways, and the interplay of standardisation and clinical autonomy. Sociol Health Illn, 39: 1314-1329. doi:10.1111/1467-9566.12585
  • Stephens, T. J., Peden, C. J., Pearse, R. M., Shaw, S. E., Abbott, T., Jones, E. L., … EPOCH trial group (2018). Improving care at scale: process evaluation of a multi-component quality improvement intervention to reduce mortality after emergency abdominal surgery (EPOCH trial). Implementation science : IS, 13(1), 142. doi:10.1186/s13012-018-0823-9

Example: Mixed Methods Evaluation

 

Selected figures from the mixed methods evaluation of the Royal College of Surgeons of England CholeQuIC project, which was designed to support surgeons in leading system change to reduce time to urgent laparoscopic cholecystectomy. The time-series chart demonstrates the overall reduction in variation in time to surgery that occurred in the patient cohort over time.

 

 

The grid shows the difference between the 4 most improved sites in the project (those that at least doubled their numbers of patients having surgery within 8 days; the project goal) and the 4 challenged sites that did not show any significant change in relation to the influences hypothesised to be most important for success during the improvement project.