Making care safer for adults with complex health needs

Partnership identifies top questions for research to improve care safety.

A project led by the NIHR Imperial Patient Safety Translational Research Centre is helping set the research agenda for adults with more than one health condition, identifying the top 10 priorities for research to improve the safety of their care.

"Researchers and research funders can now prioritise these areas to make a real difference to patient safety" Professor Bryony Dean Franklin

Hundreds of patients, carers, health and social care professionals were involved in the James Lind Alliance Safe Care priority setting partnership, which aimed to identify those areas where research could make the greatest difference for adults with complex health needs. The resulting questions include how to improve communication among healthcare professionals, and how to address all the needs of each individual. These have been highlighted in an opinion piece published today in the British Medical Journal. 

“Using this rigorous priority setting process means that we have been able to identify research questions that are most important to those concerned – patients with complex health needs, and those who care for them,” said Professor Bryony Dean Franklin, one of the academic leads for this priority setting partnership, and a theme lead within the NIHR Imperial Patient Safety Translational Research Centre (NIHR Imperial PSTRC).

“This means that researchers and research funders can now prioritise these areas to make a real difference to patient safety.”

The burden of care

Millions of adults across the globe have complex health needs, meaning they have more than one health condition. This could include having both heart disease and cancer, or diabetes and depression, or mobility problems and dementia, for example. People with such complex health needs often require treatment and care from a range of specialists and services, such as from hospitals, care homes and social care as well as their GPs. This care and support can also come from family members and friends, and take place at home.

This can mean that planning and managing the healthcare of people with complex health needs can be challenging, and must be tailored to their individual needs which may change over time.

“The burden of managing my care is often greater than the burden of the diseases themselves” patient voice

“The burden of managing my care is often greater than the burden of the diseases themselves,” said one patient involved in the work.

This complicated situation raises concerns over how to ensure that care is safe.

The project, led by the NIHR Imperial PSTRC in partnership with the James Lind Alliance (JLA), set out to identify the most pressing questions for research which, if addressed, could improve the safety of care for adults with complex health needs.

Patients, carers and health and social care professionals were involved at all stages of the process, overseen by a Steering Group made up of people representing these groups and chaired by an independent JLA Advisor. Key questions for research were identified through a UK wide survey; experts were consulted to identify questions already answered by research. The remaining questions were then ranked through a second survey and finally prioritised at a multidisciplinary workshop attended by patients, health professionals and other relevant people, leading to the top 10 questions that are most important to those concerned. 

Watch this video to find out the top 10:

Setting the priorities

The top 10, outlined below, fell into four major themes that emphasise the need for greater collaboration, communication and coordination. These were: addressing the needs of the “whole person”, recognising the expertise of patients and their carers, improving communication between professionals, and improving the use of patients’ medical records.

1. When patients require care from more than one specialist or department, how can their needs be addressed in a way that considers the whole person through better organisation and team-working?
2. How can communication be improved among professionals working in different organisations who are involved in a patient’s care?
3. How can health professionals be encouraged to listen to and value the expertise of patients, in relation to treatment and management of their health conditions?
4. How can we ensure that patients are discharged safely from hospital, in a way that ensures their individual treatment, support and care needs will be met? How can we ensure that all of the services involved are committed to this?
5. How can communication be improved among the health professionals within a single organisation who are all involved in a patient’s care?
6. When patients receive care from different specialists, should one health professional oversee that person's treatment and care to improve safety?
7. How can important information about a patient be recorded in a way so that health professionals can access the key facts quickly?
8. How can health and social care be better joined up, more flexible and responsive, so that patients can be regularly reviewed and their care plans changed as necessary?
9. How can carers’ knowledge of a patient and their specific healthcare needs be recognised and used to improve and inform the care provided by professionals?
10. To what extent do health professionals read patients' medical records before providing care? How can this be improved?

Translation to patient benefit

Now that the questions have been identified and agreed by the people who they affect the most, the NIHR Imperial PSTRC will disseminate them widely to encourage research groups and funding bodies to recognise, prioritise and address them. 

As one of the leading centres for patient safety research in the UK, the NIHR Imperial PSTRC will review its research strategy and begin drawing up plans for research that will start answering these important questions, ultimately making a difference to patients and the people who care for them.