Over the past 10 years I have established a cardiovascular clinical research team within Buckinghamshire Healthcare NHS Trust, heightening national and international awareness of our cardiology clinical activity through the Thames Valley and South Midlands network. My post commenced as a part-funded National Institute for Health Research (NIHR) cardiology clinical research nurse and currently within my role I lead three services, integrating cardiac clinical research throughout the division.
This has involved the introduction of more than 60 cardiovascular clinical trials. We are often contacted by other centres to share best practice in recognition of our being the highest recruiting centre for several studies in the UK. Our division has been successful at implementing a cardiovascular clinical research team within a district general hospital using NIHR and commercial income, building on our profile locally and nationally (British Association for Nursing in Cardiovascular Care, 2017).
In 2014 and 2017, I was involved in setting up and writing the ethics outline for the Health Research Authority, gaining approval for two large NIHR portfolio adopted, commercial clinical trials. The trials recruited large cohorts of patients, which were in excess of 1000 participants. After some collaboration and negotiation, our local research and innovation department transferred responsibility and management of the cardiac clinical trial budget to our cardiovascular division.
Through the success of building the cardiac clinical trials service, increasing budgetary funding, demonstrating operational project and people management expertise and enhancing my leadership skills, my professional role expanded in May 2018. I am currently managing the cardiac rehabilitation and integrated acute and community heart failure services, which includes introducing a cardiovascular specialist nurse service integration. This will enhance the quality of care provided to patients, delivering up-to-date evidence-based practice, using resources and clinical research as the common thread throughout the patient treatment pathway (Bowers, 2020).
The UK still does not have a national framework for clinical research nursing, and the role is not perceived as integral to every service's multidisciplinary team (MDT) (Faulkner-Gurstein et al, 2019). This is unfortunate because the development of my role has been instrumental in digital programmes, providing project management operational strategies, working in collaboration with Trust management, local clinical commissioning groups, cardiac rehabilitation, heart failure inpatient services, industry, research and innovation, outpatient and community heart failure specialist nurses. In my view, the data derived from these projects will contribute to improving care throughout Europe.
Service redesign
My vision and motivation is for clinical research to be a common thread running through all allied health professionals' job descriptions and integrated through every MDT, avoiding the patient ‘postcode lottery’ across the UK, in terms of offering patients the opportunity to make an informed choice as to whether they would like to participate in any clinical trial (provided they meet the eligibility criteria).
The Trust carried out a cardiac rehabilitation service redesign aimed at optimising patient recruitment and retention and decreasing readmissions. The trial recruited 700 patients to an NIHR portfolio commercial clinical trial over a 12-month period. From this service redesign we have been able to achieve significant benefits for both patients and staff. The recruitment rate to cardiac rehabilitation has increased from 40% to over 80%, almost double the national average. Outstanding feedback was received from the patients through our Friends and Family Test: in December 2013, 40 out of 41 respondents stated that they were ‘extremely likely’ to recommend the programme. A few comments we have received from patients are:
- ‘The talks are post-event for me, but pre-event for my family. The information has affected us all’
- ‘The education was really interesting and learnt loads. As a consequence I have changed my eating habits’
- ‘This is my third heart attack and I feel so much more informed this time.’
Enhanced staff efficiency means that the cardiac rehabilitation team is able to manage nearly double the number of patients while increasing staff only by one whole-time-equivalent.
The results from this service (McCartan et al, 2017) show that we enhanced the quality of patient care and the results of the service redesign went on to win the Patient Experience Network (PENN) Award of 2014 and the service was shortlisted for the Health Service Journal award of 2015. The initiative involved collaborative working with an international pharmaceutical company, Janssen Healthcare Innovation. In 2019, this service retained accreditation from the British Association of Cardiac Prevention and Rehabilitation. This means that the programme has achieved excellence on certain criteria, which have included:
- Its multidisciplinary approach
- Collection of data
- Efficiency in getting clients into the programme
- Increasing uptake among those participating.
Within our integrated heart failure service, collaboratively working with industry and 12 local GP practices, a clinical dashboard was developed and introduced to support the monitoring of patients with heart failure in the community. The dashboard was available to clinicians via a web portal, and monitored patients' symptoms via a combination of self-reported questions and telehealth devices. This enabled health professionals to identify earlier patients who were deteriorating, and to support an intervention to avoid unnecessary hospital admissions and/or further deterioration.
Care pathway
An ongoing study is evaluating the impact of this novel heart failure care pathway on hospitalisation rates for patients, length of stay for patients with primary or secondary diagnosis of heart failure, patient and staff satisfaction and patient quality-of-life measures. This study recruited 200 heart failure patients; analyses of the results are currently work in progress. However, within the initial screening phase of introduction, the project highlighted that approximately one quarter of patients who were being treated for heart failure in the Community had not had an investigatory diagnostic test; this was rectified and will have increased the quality of care provided to the patients who participated.
Management of the cardiac clinic research budget highlighted that our participation in commercial research generated over £250 000 income, while benefiting the cardiology patient pathway, service design and quality of care. This funding was used to develop a cardiovascular clinical research department, research laboratory and team of nurses, research practitioners, coordinators and administrators. All local cardiovascular patients now have the opportunity to make an informed choice as to whether they would like to receive new treatments and take part in a cardiac clinical trial.
My cardiac clinical research position has provided me with an opportunity to gain funding grants, enhance international dissemination of innovative technical/digital treatment pathways, and to improve the quality and management of care for cardiac patients locally, nationally and internationally. With the use of digital technology we can provide innovative solutions that enable collaboration and data sharing between industry, primary care, secondary and tertiary care cardiac services, and community heart failure nursing care.
Recognition of the need for this collaborative working has been identified nationally and internally and, within my current position, I provide leadership, education and advice for several pharmaceutical industry companies, primary care, and all members of the MDT in relation to the current clinical research evidence and the implementation of these guidelines into standard of care cardiovascular clinical practice.
Enhanced approach
I endeavour to use the award to promote the importance of clinical research and to highlight the International Conference on Harmonisation/Good Clinical Practice as mandatory training for all allied health professionals. I want to highlight the need to implement an enhanced interdisciplinary approach to all patient care, to see integration of services, and for clinical research to become a common thread in all job descriptions. This would establish the NHS as an internationally recognised centre of research excellence, provide national and global patient equality, improve patient safety and enhance quality of care.
It was a real honour to be shortlisted for this award, which felt especially poignant in 2020, the Year of the Nurse and Midwife, while also working through the COVID-19 pandemic. I would like to take this opportunity to congratulate fellow nominees Charlie Bloe and Susanne Christie on winning first and second place for this award