Staff from the North East and North Cumbria draw learnings from research conducted during the COVID-19 pandemic
Today the “learning from the RECOVERY trial in Northern England” study was published in the international journal BMJ Leader, which focuses on leadership in health and care. The study, which was conducted by researchers at the NIHR Clinical Research Network North East and North Cumbria (CRN NENC), identified an “ideal recruitment situation”, which allowed participating sites to maximise recruitment to the RECOVERY trial.
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial was part of the United Kingdom’s response to the COVID-19 pandemic, which called for urgent research into tackling the new virus. The aim of the RECOVERY trial was to identify treatments for those hospitalised with suspected or confirmed COVID-19 and it was the first key “Urgent Public Health” study to be given fast-track approvals and additional support to facilitate the research. High recruitment rates were required for timely results; however, recruitment rates were inconsistent across different hospitals and places.
The study published today was set up in September 2020 in an effort to learn from earlier experiences of research recruitment during the pandemic and to positively influence recruitment in later waves.
All eight acute hospital trusts in the North East and North Cumbria collaborated on the study, sharing learning on what had worked well and where there was room for improvement. The research team contextualised each recruitment site by looking at their pre-pandemic operational status, prior research activity, COVID-19 admission rates and participation in other Urgent Public Health studies. The team also conducted one-to-one interviews with NHS staff involved in the RECOVERY trial. Situational analysis was used to identify the narratives that shaped recruitment activity.
The study team identified an ideal recruitment situation which was influenced by five elements: uncertainty, prioritisation, leadership, engagement and communication. The closer a site got to the ideal recruitment situation, the easier they found it to implement the most significant factor on recruitment: embedding research into standard care.
The study results meant that the CRN NENC was quickly able to identify where to put additional resource in order to have maximum impact on recruitment when the second wave of the pandemic hit. As a result, the North East and North Cumbria managed to recruit 15% of all regional COVID-19 hospitals admissions to the RECOVERY trial in 2020/21 (compared to a 9% national average recruitment rate).
Professor Caroline Wroe, Clinical Director of the NIHR CRN NENC, said: “The COVID-19 pandemic led to unprecedented challenges for our healthcare and research services and a national call to facilitate Urgent Public Health studies. In the first wave of the pandemic, we saw both the challenges and solutions local research and development teams worked through to facilitate the RECOVERY trial and wanted to understand the factors influencing recruitment.
“The results from this study demonstrate the importance of prioritising and resourcing research during a pandemic. This work allowed us to improve access to research for our local populations, which was particularly important in areas of health deprivation where COVID-19 death rates were higher. It also demonstrated that we can work together to deliver research where it is most needed.
“We are delighted that this work is being published in BMJ Leader and want to thank our regional research colleagues who contributed to this study and shared their experiences in an open and responsive manner.”
Sue Jacques, Chief Executive of the County Durham and Darlington NHS Foundation Trust and chair of the LCRN Partnership Group, said: “The COVID-19 pandemic highlighted the critical importance of research to find evidence-based treatments for care and I am delighted that so many patients were involved in the ground-breaking RECOVERY trial in our region. This work highlights the impact of embedding research into routine clinical care and we are proud to have collaborated on this study.”
Dr Deepak Dwarakanath, Deputy Chief Executive and Medical Director of the North Tees and Hartlepool NHS Foundation Trust, said: “COVID-19 was the biggest challenge the NHS has faced for many years. For the first time in generations, we were dealing with a condition for which, apart from basic supportive care of IV fluids, antibiotics, steroids and respiratory support, there were no other focused proven treatments. We rapidly realised that the only way forward was for the whole organisation to become research active to support the national and international efforts to identify treatments to control the impact of the virus.
“This paper illustrates how important it is to embed research into ‘business-as-usual’ and how it benefits recruitment. We are very proud to have supported this effort."
Dame Jackie Daniel, Chief Executive of The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “In March 2020, the COVID-19 pandemic thrust the NHS into unknown territory and we knew that research was essential to help us find treatments that worked. Our dedicated research teams in the North East worked together to identify the challenges of delivering research in a pandemic and describe the ideal situation where research opportunities are embedded into clinical care pathways so that all patients can benefit.
“The RECOVERY trial relied on many thousands of people with COVID-19 to get involved and it is a great achievement that 15% of patients admitted to hospital with the virus were able to participate in this world class study in our region. The treatments that were developed are ones which are now used as standard across the world and I’m very proud of the significant role that our clinicians in the North East played at this critical time in our history.”
Dr Salman Razvi, Director of Research and Development at Gateshead Health NHS Foundation Trust, said: “The COVID-19 pandemic has been a hugely challenging experience for the NHS, especially its staff members. Urgent Public Health studies such as the RECOVERY trial were key in finding therapies that were safe and effective in managing patients admitted with COVID-19. Gateshead Health NHS Foundation Trust, like most other trusts in the country, had to make difficult decisions between clinical needs and research requirements.
“After a slow start initially and having been given support from CRN NENC, Gateshead NHS Trust did extremely well in terms of recruiting patients into the RECOVERY trial and was one of the top five performing trusts in England. We were very happy to participate in this qualitative study that has shed light on the barriers and facilitating factors that can help promote research in a pandemic situation.”
Professor Richard Haynes, RECOVERY Trial Coordinator, MRC Population Health Research Unit, University of Oxford said: “The RECOVERY trial has answered many therapeutic questions for severe COVID-19 and has shown what high-quality research the NHS can deliver. As impressive as the recruitment rate was, there was substantial variation between participating hospitals. This paper provides very valuable insights into some of the drivers of this variation and what needs to be done to ensure that research can be embedded into NHS care to the benefit of all.”