NHS Innovation Awards 2008 Winners
The Medipex NHS Innovation Competition 2008 Award Ceremony was held on Thursday 14th May at the Royal Armouries in Leeds. Staff from across the regions’ NHS organisations were awarded prize money totalling £8000, and gained the recognition they deserved for developing new ways to better treat patients.
Medical Devices & Diagnostics Category
There were five finalists in this category:
- Adam Tucker from Leeds Teaching Hospitals NHS Trust with ‘The PATMit Patient Avoidance of Treatment interference Mitten’.
- David Brettle from Leeds Teaching Hospitals NHS Trust with the ‘Litebox’.
- Steve Sharp and Ian Barlow from North Lincolnshire and Goole Hospitals NHS Foundation Trust with ‘A wide area web-based glucose meter QA program’.
- Giles Morrison from Sheffield Teaching Hospitals NHS Foundation Trust with ‘Dynamic Cardiac CT Phantom'.
- David Brettle from Leeds Teaching Hospitals NHS Trust with the ‘Litebox’.
The winner was Giles Morrison with ‘Dynamic Cardiac CT Phantom’. This is a dynamic CT phantom representing the beating heart and descending Aorta. The phantom would provide regular heartbeat-like pulses, with realistic systolic and diastolic pressures, from 30 to 150 BPM and for a range of irregular heart conditions including aneurisms.
Cardiac CT is a rapidly expanding service with government commitment to improve diagnosis for cardiac conditions and there is significant capital investment within the NHS for new higher resolution CT scanners.
After visiting several centres performing Cardiac CT, it became apparent that different CT scanners were optimised for different types of patient presentation, dependant upon heart rate and regularity. However, when patients present with sub-optimal heart rate, or with heartbeat irregularities, then the range of doses required to perform successful CT imaging can increase rapidly beyond the minimum level published by the manufacturer. Cardiac CT can be performed at, or below, the dose of conventional fluoroscopic angiography, if patients fall within the scanners optimum range, with or without beta blocking. Outside of this range, without extensive optimisation, the dose can easily increase tenfold without user intervention, simply by allowing the scanner to follow its protocol to allow vessel imaging and analysis.
At present there are no commercial phantoms which allow the routine testing of the ability of CT scanner software to quantify the extent of Aortic disease under dynamic conditions. Since critical patient management decisions are made on the information provided by such scans it is critical to ensure that baseline and ongoing testing are performed to ensure that the system performs accurately, repeatably and reproducibly.
Imaging the phantom would allow the assessment of the efficacy of Cardiac CT software to image and subsequently analyse and measure the extent of vessel occlusion under clinical (pulsatile) conditions, rather than using a less representative stationary phantom. It would also ensure that the radiologists can determine whether fluoroscopic angiography is more appropriate for some patients.
Production of such a phantom has a potentially global impact, providing a method for the routine assessment and optimisation of Cardiac CT scanning under dynamic conditions at the local level. Every CT scanner used for Cardiac Applications in the requires optimisation which presently cannot be performed under pulsatile conditions, and hence does not represent a true test of the scanner’s performance under clinical conditions.
Software and ICT Category
There were four finalists in this category:
- Gill Brook from Bradford Teaching Hospitals NHS Foundation Trust with ‘Caesarean section advice DVD’.
- Prashant Verma from Sheffield Teaching Hospitals NHS Foundation Trust with ‘Development of a software package for photo-therapy treatment planning’.
- Richard Sykes from Humber Mental Health Teaching NHS Trust with ‘PDA based clinical pharmacy intervention tracker’.
- Richard Jones from Leeds Teaching Hospitals NHS Trust with ‘Antenatal Ultrasound QA System’.
The winner in this category was Prashant Verma with ‘Development of a software package for photo-therapy treatment planning’. The innovation relates to a software package for calculating non-ionising radiation treatment plans for patients undergoing narrow-band ultraviolet light therapy for treatment of skin complaints such as psoriasis and dermatitis. Patients undergoing phototherapy treatment generally have a course of treatments over several weeks. The radiation dose at each visit can be escalated depending on the skin's response to the previous treatment dose. The dermatology nurse uses the software, in conjunction with their visual assessment of the previous treatment, to calculate the next treatment time. The software package enables nurses to accurately calculate patient treatment times based on results of an MED (minimal erythemal dose) test that the patient undergoes.
Previously, patients had no MED test and were initially given a very low starting dose and subsequent increases in dose were reliant on un-calibrated detectors within the treatment machine. Photo-therapy treatment cabins use un-calibrated internal detectors that give inaccurate readings on light output. Dermatology nurses often rely on these readings because manual calculations are time consuming and prone to error. The Dermatology department requested the Medical Physics department to produce a software package that would overcome these issues
The software takes into account changes in the light output of treatment machines between patient visits. In this way there is a much greater confidence in the actual level of dose the patient receives.
Anticipated benefits of this software include:
- MED test for every photo-therapy patient
- Anticipated reduction in the number of treatments required (An audit is underway to confirm this)
- Reduced patient waiting
- more accurate dosimetry for all NHS patients
- Patients moving from one centre to another would have a better likelihood of receiving consistent doses
Assistive Technology and Rehabilitation
There were 3 finalists in this category and they were:
- Kim Gostolo and Sharon Greensil from Rotherham Doncaster and South Humber Mental Health NHS Trust with ‘DVD Seated Exercise’.
- Bipin Bhakta from Leeds Teaching Hospitals NHS Trust with ‘A robotic system to aid recovery after stroke’.
- Helena Miles from Bradford Teaching Hospitals NHS Foundation Trust with ‘Bradford Smart Walker’.
The winner was Bipin Bhakta with ‘A robotic system to aid recovery after stroke’. The innovation is a novel robotic system (iPAM) to assist patients in undertaking additional therapeutic exercise with minimal input from the therapist. It supplements, but does not replace, the therapists’ work. iPAM addresses the shortage of hands-on therapy available to most stroke patients in the UK. By enabling patients to undertake extra exercise, it has the potential to accelerate recovery and improve final arm function; not only would this benefit patients themselves, it may also reduce health and social care costs.
The motivation for this innovation arose because of the limited clinical rehabilitation therapy resource for people with neurological conditions such as stroke. The amount of exercise therapy determines the speed and completeness of patients’ recovery. This is important because the upper limb (UL) function contributes to independence and self esteem. Conventional hands-on Physiotherapy and Occupational therapy is labour intensive, and therefore resource limited. There is a need for methods of increasing the amount of therapeutic exercise for patients, within existing staffing resources.
We have already built a first prototype and proved the concept with a clinical trial involving ten stroke patients. We now wish to refine the hardware design and enhance the control system. This work has been initiated by an established multidisciplinary research team, comprising NHS doctors and therapists, mechanical engineers, computer scientists and psychologists. We involve patients and their carers extensively in our work, via our Rehabilitation Technology User Group (RTUG). The extent of user representation in the development of iPAM is one of the features which distinguishes it from competing systems: patients and carers have been closely involved since its inception three years ago.
By providing greater quantities of rehabilitation, this project addresses specific issues identified in the NHS plan, the National Service Frameworks for Long Term Conditions and Older people (Standard 5) the Cooksey Report and other strategic publications.
If successful benefits of iPAM include:
- Savings of 3 to 4 hands-on therapy sessions per day i.e. up to £65 per day
- iPAM can be shared between hospitals and clinics to maximise the number of patients benefiting from its purchase
- Geographical inequalities may be addressed through remote and rural deployment
- High degree of user acceptance through continuous patient involvement
Publications and Training Materials
In the Publications and Training Materials category there were four finalists:
- Rachael Smith and Jayne Duffy from Calderdale and Huddersfield NHS Foundation Trust with ‘Functional Framework for Competency (FFC)’.
- Amanda Jackson from Barnsley PCT with ‘Parent information leaflet about newborn skincare’.
- Sonya Mills from North Yorkshire and York Primary Care Trust with ‘Preventing Healthcare Associated Infection Workbook’.
- Janet Hirst from Leeds Teaching Hospitals NHS Trust/University of Leeds with ‘Soft Simulated Labouring Cervices’.
The winner was Amanda Jackson with ‘Parent information leaflet about newborn skincare’. The idea is to produce a specific evidence-based parent information leaflet about safe and effective skincare for newborn babies. There is currently a lack of impartial information for parents which focuses on the need to treat newborn skin carefully and which identifies how essential it is to avoid baby toiletries for the first few weeks of life. There is a wealth of research-based literature relating to the potential dangers of using common baby toiletries in the newborn period, and it is essential that families are made aware of this information from an impartial source.
In addition it is planned to develop a non-biased, evidenced-based leaflet and disseminate copies of it to the multi-disciplinary team within all neonatal and midwifery units and health visitor centres in the network. The various teams will then ensure all families are provided with the information leaflet to allow them to make an informed choice about skincare routines for their baby.
The motivation for this has arisen from a strong commitment to providing safe, evidence-based care for all babies, and the current lack of specific information for parents about appropriate skincare and the need to avoid toiletries in the first weeks of life. Also research-based evidence suggests that use of baby toiletries in the neonatal period may render an infant more likely to experience skin conditions and allergies in later life. There has been the development of a skincare teaching package, and facilitation of information sessions and study days for the multi-disciplinary team in all nine neonatal units and their associated midwifery and health visitor departments. These sessions have evaluated very well and it is apparent that there is a need for specific parent information relating to this subject to be available.
The impact of the teaching package on the network has been huge:
- most units now removing baby toiletries from their clinical areas
- staff empowered to educate families about the potential health consequences of using baby toiletries on newborn skin
To be able to offer an information leaflet to parents in addition to educating staff, will have a positive impact on all babies in the network, and will hopefully result in a long term reduction of skin-associated morbidity and its associated cost to the NHS.
Medipex would like to acknowledge and thank the sponsors and supporters of our 2008 Innovation Competition: