I was reading a clinical update published by the ANF titled “Strategies to Enhance Teamwork in the Acute Care Setting”. While clinical trials are hardly acute care, there were several take away messages that can be applied to clinical research to improve patient safety, protocol compliance and overall outcomes for patients and the study.
Critical information transmitted via handwritten note, email or text message had a potential to lead to fatal errors due to miscommunication
I can’t count the number of times I have left notes in the patient’s chart to come back and find that they have been ignored completely. My favourite was an Investigator that wrote neatly around the sticky note I had put in the patient’s chart while ignoring the instruction written on the note.
Nothing beats face-to-face communication if you want something done. Non-verbal cues during face-to-face communication help stress when something is important. I also find talking directly to someone makes them more accountable.
Even non-patient related communication is improved when a face-to-face meeting is held. Think about a web-based Investigator Meeting or SIV versus a face-to-face meeting. It is always easier to retain information provided by a person as opposed to a power point presentation.
The most successful collaborations were those that were non-hierarchical but with leadership that encouraged a cooperative approach to patient care.
A problem I encountered often in my early research career was that I would give the acute care staff (including investigators) instructions and the staff would then promptly ignore what I had told them and do what they thought was best. This lead to patients having to repeat procedures unnecessarily in order to comply with the protocol requirements. It also lead to a lot of frustration and resentment on both sides, creating a “me versus them” scenario.
It took me a while to realise that it was my job to communicate not only what had to be done but why. I needed to be a leader not a boss. When I approached the staff with the attitude of “we are both on the same team”, things started changing for the better.
This applies to CRAs as well. The more successful trials I have been involved in have been working with CRAs who viewed sites as part of the team rather than the enemy. Risk Based Monitoring acknowledges the need for non-hierarchical leadership and is based of the premise working with sites to improve their processes as opposed to finding and pointing out errors.
Including the patients and their families in the handover process promoted a collaborative approach.
Patients have a vested interest in what happens to them. The patient will not let anyone do anything to them if they know it affect their ability to stay on a trial (particularly if the treatment is having a positive effect).
As a junior nurse, I was taught to always let the patient know what was going to happen as it reduces anxiety about the unknown. I have carried this over into my research career and found it has an added bonus. More than once I have received a phone call from the acute care ward that started “We want to do <xyz> but the patient said we can’t because of the trial. Is that right?” or “The patient is due for discharge but she says that she has to have a <insert procedure here> “.
Handing Over to Other Research Staff
Handing over a trial to other staff to cover a period of leave has been something I notice many research staff struggle with. Staff with a clinical background tend to focus on the patients and ignore the admin, while the reverse is true is staff with a non-clinical background.
It has taken ten years and the input of all of the research coordinators I have ever worked with but I have finally developed an effective template for trial handover. This template is designed to be given to any coordinator at your institution and they should be able to pick up the trial and run with in within 15 minutes.
This template is designed to be a “living” document. It works best if completed at the beginning of the trial and updated as needed.
If you have any feedback on the document, I would be glad to hear it: email@example.com