Restarting research: How transparency and buy-in from research teams in Bristol is supporting prioritisation of studies
In May the NIHR announced that as we were entering a new phase of the COVID-19 pandemic, where the number of new cases is declining, it was the right time to work towards the restoration of research which was paused at the start of the pandemic.
Since this announcement, positive progress has been made to assess the portfolio of studies across the region. We spoke with David Wynick, Joint Director for Research at North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust, to find out more about the progress they are making.
At the beginning of the pandemic 70% of the portfolio was suspended, across both Trusts that is close to 800 studies. About 30% of studies on the portfolio were not paused because they were critical for patient's ongoing care, such as studies for cancer, some rarer paediatric treatments and cystic fibrosis.
For the 800 suspended studies, one can’t turn them all back on immediately. Reasons for that include a range of factors that include: staff are still busy, either on the front line or delivering urgent public health studies, there are fewer patients attending the hospitals and some studies need amendments to allow data and recruitment to be done remotely.
When it comes to implementing the Restart Framework, it is important to do it in an open, transparent and equitable way. It cannot be top-down, and it would be wrong for the R&I team to make unilateral decisions about so many studies. It has to be the research teams who make these prioritisation decisions. At our two hospitals we have large research units, where we have senior PIs, senior research nurses and then a whole team under them. We pushed the decisions on which studies to reopen and in which order out to them and said ‘you tell us which you think are the most important studies that you have the resources right now to deliver’. Everyone was very sensible and pragmatic and said ‘ok we’ve got 50 suspended studies, and these are the 8-10 that we think are the most important, that we want to restart, and we’ve got the resources to do it’. That was a much better way of prioritisation because then you have full transparency and buy-in, the experts are making the decision rather than a centralised R&I team. It was a very successful process at both Trusts.
There were also some studies that were not part of a research unit and we said to the PIs ‘tell us why you think it’s an important study and where you are going to get the resource from to deliver it’. We didn’t receive a response from the majority of those PIs and the ones who did reply said in most cases that they were not ready to restart their studies yet.
All of the above has meant we have thus far only been able to reopen about 25% of all suspended studies. We have also identified another 25% of studies that will likely be reopened in the next four to six weeks. The main limitations for the remainder are the availability of resources and especially those that require CT or MRI scanning.
We have also set up a restart dashboard, so we’ll be looking at that every week to track the progress of all our studies that have reopened and then are recruiting. This is very much ‘work in progress’ and we are mindful that as further COVID-19 peaks occur that may mean we will again have to suspend some studies.