Live alerting tool streamlines recruitment in ICU research

A new tool developed at UCLH and UCL streamlined recruitment to a clinical trial in intensive care by automatically spotting when a patient met the eligibility criteria for the trial and then alerting the research team.

The technology meant the research team could recruit patients to the trial they would otherwise have missed – and meant the team did not have to manually check each day which patients were eligible.

The tool – called TrialsAssistant – was developed by Rory Maclean (UCL Institute of Health Informatics research fellow and UCLH internal medicine trainee) and Dan Hanlon (honorary research fellow at UCLH) working with the team delivering the MOSAICC trial. MOSAICC aims to improve care for critically ill patients with acute kidney injury.

In the future similar tools could be used in other clinical trials in intensive care.

Recruitment to clinical trials in intensive care is always a challenge.

In the ICU, a patient’s condition is often changing quickly. The rapidly changing nature of their condition means it can be difficult to ‘catch’ a patient at the right time to recruit them to a particular trial.

TrialsAssistant is a dashboard which monitors the electronic health records of intensive care patients in real time. It sends an instant alert to the research team’s iPhone when a patient meets the recruitment criteria for MOSAICC. This alert does not contain patient information, but prompts the research team to look at the dashboard.

The research team can then verify the patient’s eligibility and consider approaching the patient or their family about the trial.

The tool makes use of EMAP – the Experimental Medicine Application Platform – which was developed at UCLH. EMAP is linked up to Epic – the electronic health record system at UCLH. EMAP makes health care data available for research in real time.

TrialsAssistant is an example of how technology can be used to improve research efficiency. It means the research team no longer needs to manually check each day which patients are eligible for the trial.

This manual process had involved copying and pasting information from Epic into an Excel spreadsheet – and having to repeat this process every day.

TrialsAssistant provides live updating spreadsheets with details of all relevant information on the condition of ICU patients. It sends an alert to the research team when a patient meets trial criteria.

The research nurses for the trial said TrialsAssistant has enabled them to recruit participants they definitely would have missed if not for the dashboard, and saved them a lot of time. The team believe the tool has saved them between 30 minutes to 2 hours every day.

Dan said: “The feedback we have had from the research team has been incredible – it has saved them a huge amount of time, especially when compounded over time, and the tool has removed a lot of the manual work the team was having to do in Excel each day.”

At the moment, TrialsAssistant is set up for use in the MOSAICC trial alone.

Rory said: “Our next step would be to enable use of TrialsAssistant at other hospitals where the MOSAICC trial is being run, and also in other trials in intensive and critical care. We’d like to work with software experts to build a platform where other research teams can create bespoke versions of the tool for whatever trials they are running, and which will work alongside whichever electronic record system their hospital is using.”

The MOSAICC trial – which is funded by the National Institute of Health and Care Research – is looking at use of sodium bicarbonate in patients with acute kidney injury. AKI can lead to build up of acid in the blood (known as acidosis) which is very dangerous.

It is thought that sodium bicarbonate given to patients with acidosis due to AKI may significantly reduce mortality rates.