Recipient organisationNHS Blood and TransplantSource-published name: NHS Blood and Transplant
Funding£2.0M
PeriodSept 2013 — Oct 2019
In plain English
AI plain-English summary
Every year, NHS hospitals transfuse hundreds of thousands of units of blood, yet many of these transfusions are unnecessary, wasting a costly and limited resource. This research programme aims to stop that waste by redesigning how hospitals receive feedback on their own transfusion practices. Current audit-and-feedback systems—where hospitals are told how well they follow guidelines—produce only modest and inconsistent improvements. The problem is not a lack of data, but how that data is delivered and acted upon. This project will develop two enhanced feedback interventions: one that improves the content of the feedback itself, and another that changes how it is delivered to the right people in the hospital. These interventions will be tested in a cluster-randomised trial across NHS Trusts, with a parallel economic analysis to assess cost-effectiveness. If successful, the research could reduce unnecessary transfusions across the NHS, saving millions of pounds annually and preserving blood supplies for patients who genuinely need them. It would also provide a generalisable model for improving audit-and-feedback systems in other areas of medicine, from antibiotic prescribing to surgical safety.
View original technical description
Aim. To design and evaluate enhanced feedback interventions within a national blood transfusion audit programme, promote the uptake of evidence-based guidelines and reduce the unnecessary use of blood components. Background. Audit and feedback (A&F) is widely used and embedded within the NHS, and represents the most common means of quality improvement, used locally, regionally and nationally. It is widely accepted that current A&F delivers variable and modest, but worthwhile, effects in a range of clinical areas. There is considerable scope to compare different ways of providing feedback and to understand their mechanisms of change to enhance the effects of A&F. Blood components for transfusion are produced from donations of blood by donors and are costly resources that support many areas of hospital practice. National audits of transfusion provide baseline information on compliance with standards. Despite evidence supporting restrictive use of blood components and recommendations in national guidelines, unnecessary over-transfusion practices persist, with wide variation between hospitals. Our preliminary work has identified consistent patterns of influences on transfusion practice, supporting the rationale for the development, application and evaluation of enhanced feedback interventions within A&F, as proposed in this research programme. Workstreams. The programme of research is divided into a sequence of four core workstreams (WSs), as follows: WS1. Development, piloting and refinement of two enhanced feedback interventions: enhanced content and enhanced delivery WS2. Cluster-randomised trial to evaluate effectiveness of enhanced feedback interventions compared with usual feedback, with a decision analytic modelling analysis for cost-effectiveness WS3. A parallel process evaluation to investigate fidelity of the interventions as delivered, received and enacted WS4. Development of general recommendations and tools. Research Environment: The existing National Audit programme of blood transfusion, which is undertaken through collaboration between NHS Blood & Transplant and the Royal College of Physicians, is very well supported by NHS Trusts with high rates of participation. The academic groups are based in institutions with excellent track records of applied health research, including the Clinical Trials Research Unit, with expertise in complex interventions, RCTs, intervention fidelity, health economics. Research Plans. WS1: Three subprojects: A) A structured analysis, based on current theories for understanding behaviour change, of the key components of existing usual feedback documents. This will inform: the development of a guidance document and training materials to describe the principles for analysing and writing up enhanced content of feedback interventions; and a protocol for writing an intervention with optimised content. B) Semi-structured interviews to identify the processes of feedback and the organisational levels and types of healthcare professionals who currently receive feedback. This will inform a protocol for an intervention to enhance delivery of feedback to all relevant staff, as well as practical guidance for clinical teams on how to ensure a systematic and evidence-based team-level response to the enhanced feedback delivery. C) A series of interview, observational and questionnaire studies will assess the acceptability and refine the delivery of the enhanced interventions in pilot sites. WS2: A cluster randomised controlled trial (RCT) and allied decision analytic model to test effectiveness and cost-effectiveness, respectively, of enhanced content and/or enhanced feedback, compared to usual processes of national audits. The enhanced interventions will be specifically designed from the framework developed in WS1 and evaluated for two separate targeted transfusion audit topics in sequence. Testing the interventions for two different topics will allow us to produce more robust evidence
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