Managing clinical trials when every second counts

Through research, scientists and healthcare professionals seek new ways of making faster, better diagnoses and decisions for patients. The new neuro, emergencies and trauma (NET) research team at Imperial College Healthcare NHS Trust aims to bring research into highly pressurised clinical settings to help bring exciting new medical innovations to patients more quickly. Emily Ashworth, senior divisional research nurse and co-leader of the NET research team alongside senior research nurse Abby Harper-Payne, explains how her team is helping to see improved treatment methods and innovative diagnostic tools made available to patients.

Our Trust is one of only six academic health science centres (AHSCs) in the UK, so it’s really important that we have a major focus on research — not just undertaking research, but making sure research is used in a way that ensures our patients see the benefits of clinical studies and scientific breakthroughs as quickly as possible.

That’s why leading clinicians at our Trust helped create the neuro, emergencies and trauma (NET) research team to run studies in the emergency and acute environment and make innovative tools and treatment methods available to our patients. We started off with just myself and one other nurse, and over the past year have grown in size to six research nurses working with consultants, researchers and private companies.

Increasingly, organisations are working to develop tools and techniques to help improve diagnoses and treatments we offer our patients. When an organisation’s product has been deemed safe for use in a clinical environment, the organisation will need help to submit the product to a point-of-care trial — this means the product will need to be tested for efficiency and efficacy within a clinical environment to prove that it really can help clinicians improve patient care. At that point, the organisation will approach a team like ours to discuss how we might be able to use the product in a clinical environment and what we’ll require to make the trial possible. In some cases, the organisation will cover the costs of training or additional staff to enable the trial to proceed; in others, the organisation will pay the department outright for the trial to go ahead. In these cases, the funds are re-invested into the department.

The CoaguScan trial — which recently made media headlines — is an example of this type of trial. CoaguScan is a device that allows clinicians to know instantly whether or not a patient suffering from trauma requires a blood transfusion. CoaguScan also helps to determine the correct amount of blood products for each patient. Our team can already see how this technology has potential to change the way in which we treat rapidly bleeding trauma patients in the future. CoaguScan is one of 15 active studies our team is running right now.

Each of us in the team have different backgrounds and particular areas we focus on — neurological rehabilitation, major trauma or injuries and emergencies — but we all have experience of nursing in intensive care unit or emergency departments, and are passionate about research and patient care.

Our team attend nearly every trauma call in the daytime — up to 20 a day — and follow patients throughout their pathway, in order to recruit and monitor them for a variety of research studies.

When we approach patients and ask them to take part in a research trial we explain that the goal is to help improve treatment for future patients suffering from the same or a similar condition. A good example of this is with the Halt-it trial that uses an infusion called tranexamic acid to treat patients with excessive bleeding. We find that most patients are more than happy to assist when they know that in addition to helping improve their care now, participating in a research trial offers the potential to help others in the future.

We carefully monitor the results of all our trials and feed them back to clinicians, scientists and researchers which allows them to produce new drugs and treatments. We also work closely with other NHS trusts in London to collaborate on research to avoid replication. Often, we find that in the course of our work we help clinicians working on similar projects within the Trust connect with each other.

As with most healthcare professionals there are parts of our job which are not always easy, for example seeing trauma patients come in with terrible injuries, or having sensitive conversations with the loved ones of a patient who has recently passed away. It’s important with research trials that we still include results from deceased patients to ensure the end results are balanced and provide clinicians with an accurate summary of the results of the trial and that we can ensure the trials we are conducting are safe.

I think our Trust is particularly good at getting patients involved in pioneering research trials quite early on in their care and following them throughout their pathway, which in some cases can be up to six months or even a year, by telephone or in outpatients departments and we are lucky to have so many world-leading specialists within the Trust.

I’m really proud of the work of our team over the past year. We’ve got a number of studies in the pipeline that are really exciting, including more point-of-care testing in the emergency department to make faster diagnoses, and new treatments and therapies for major trauma patients. We really enjoy our work and it is very rewarding seeing the research that we do shape the way in which we care for our patients.