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Researcher Case Studies

 

expert consensus policy for airway extubation in patients with acute brain injury - arun joseph

Can you tell us about your policy engagement project?

Patients with acute brain injury often require ventilator support in intensive care units. Timely liberation from ventilators can significantly reduce morbidity, mortality, ICU stay, and hospital costs. However, approximately 20% of patients struggle with ventilator liberation. Our project aims to set the groundwork for a longer term initiative to influence policy in relation to ventilator management in intensive care units for patients admitted with acute brain injury. The main aim of this project is to broaden the impact of this work by influencing policy around ventilator management in intensive care units for patients with acute brain injury. We will do this by leveraging our collective experience to enhance awareness and engage stakeholders proactively. In addition, we will develop an expert consensus document to standardise practices, reduce variation, and curb unnecessary ICU stays.  

How was your policy engagement project funded? 

We were awarded £5,000 by the Oxford Policy Engagement Network (OPEN) Seed Fund to support our project aimed at improving ventilator management for patients with acute brain injury. The project  focussed on creating a protocol for an expert consensus document, initially targeted at clinicians who manage these critically-ill patients. By establishing clear guidelines, and improving clinical decision-making, the project aims to boost confidence across various intensive care units. It will also help to establish strong collaboration between the Nuffield Department of Clinical Neurosciences (NDCN) at the University of Oxford, where I am a researcher, and the Neuroscience Intensive Care Section of European Society of Intensive Care Medicine (ESICM). In addition, i hope the project will foster more policy collaborations in the future. 

How were  your policy outcomes evaluated, and what were some of the main findings?

I presented the protocol to the OPEN funders at the Blavatnik School of Government.

The title of our project is “Expert consensus guidance for extubation of patients with acute brain injury: an international, multi-disciplinary and multi-professional expert panel e-Delphi study” and the study involves the following stages:

1. Conduct a comprehensive scoping review to identify and evaluate key clinical criteria that determine ‘readiness to extubate’ in patients with acute brain injury, including measures of upper airway integrity.  

2. Conduct a descriptive qualitative study using semi-structured interviews of clinicians and researchers from various disciplines and professions with expertise in airway management and research to explore measures of upper airway integrity and extubation predictors to inform understanding of the risk of  extubation failure. 

3. Conduct an e-Delphi consensus-study to identify those criteria most important to assess prior to extubation, recruiting an international multi-disciplinary/professional panel of experts involved in the ventilator management of patients with acute brain injury.  

4. Hold a series of online consensus meetings to finalise the “readiness to extubate” criteria and establish expert consensus guidance for extubation in patients with acute brain injury. 

5. Identify knowledge gaps and develop a list of research priorities for future research areas in this field.  

 

How did you and your research benefit from policy engagement? 

My current research focusses on lung and upper airway function in ventilated patients with acute brain injury. The expert consensus policy project will complement the physiological research and I am also getting exposed to qualitative research methodologies for my future post-doctoral work in this area. 

What's next for your future policy engagement plans? 

I am hoping to secure additional funding to execute the protocol in several stages within a 48 month timeline. I am looking into resources and funding opportunities to complete the guidance. I have been very  successful in setting up an international ventilator weaning and extubation in Neurocritical care network and also have received endorsement from Headway, a UK-wide charity that works to improve life after brain injury. Through Headway, we have an opportunity to involve patients and families in every component of our project.  

What are your top tips for other researchers planning policy projects?

Put Patients first! What do patients want?. What do patient’s carers want?. Find a way to alleviate their suffering through rigorous research. Be a voice for their pain and that is what a policy project all about! Rest follows automatically.  

 

 

 

 

 

Mel's Policy workshop

SLEEP AFTER STROKE POLICY WORKSHOP - DR MELANIE FLEMING

CAN YOU TELL US ABOUT YOUR POLICY ENGAGEMENT EVENT?

Sleep is very important for function and repair of the body. Good sleep quality is likely to be important in giving the best chance of recovery of movement for patients who have had a stroke. Sleep problems are often reported by people after stroke, however sleep problems are not screened for or treated in the stroke care pathway. In this project, we brought together stroke survivors alongside key stakeholders with influence across healthcare, charities, academia, and policy organisations, in a workshop to discuss practical barriers and solutions to screening and treating sleep in the stroke care pathway, and to develop a strategy to influence policy and change in the future.

HOW WAS YOUR POLICY ENGAGEMENT EVENT FUNDED? WHAT WAS THE FUNDING APPLICATION PROCESS/TIMELINE LIKE?

The project was funded by an Oxford Policy Engagement Network (OPEN) seed fund award. The funding offers awards of up to £5,000 to enable researchers at the University of Oxford, and public policy professionals anywhere in the world to kick- start or deepen collaboration, working together to design, deliver and evaluate projects. Applications must include a policy partner so the main barrier to this funding is whether you can find a policy partner that meets OPEN’s requirements who is willing to collaborate on the project. 

HOW WAS YOUR POLICY EVENT EVALUATED, AND WHAT WERE SOME OF THE MAIN FINDINGS?

The policy workshop was evaluated by complete an end of project report. The main findings that were established as a result of the workshop were: 

  • Greater awareness is required about the importance of sleep after stroke.
  • Training is needed for clinicians, family members and stroke survivors.
  • Resources are necessary for clinical staff and the volunteer sector to share with stroke survivors.  

HOW DID YOU AND YOUR RESEARCH BENEFIT FROM POLICY ENGAGEMENT?

It brought our research to the attention of key stakeholders relevant to the stroke rehabilitation clinical care pathway throughout Oxfordshire. We have built great connections with stakeholders and increased the awareness of the importance of sleep after stroke. Our policy partners were instrumental to achieving the project goals and will be key to any future policy engagement work.

WHAT'S NEXT FOR YOUR FUTURE POLICY ENGAGEMENT PLANS?

We will continue to work with our policy partners and stakeholders to increase the awareness about the importance of sleep after stroke and provide informative resources for stroke survivors. We will be prepared to engage with future policy guideline reviews. 

WHAT ARE YOUR TOP TIPS FOR OTHER RESEARCHERS PLANNING POLICY EVENT?

  • Get as much core staff team support costed into the funding application as possible.
  • Including people with lived experience of stroke into the policy workshop helped put discussion points into perspective.
  • Partnering with a charity made patient involvement easily achievable.
  • Walk before you can run – the steps to impact might be smaller than you think!
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