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PenCHORD Current Activity

Active Projects | Recently Completed and Closed Projects

This section outlines the current PenCHORD project portfolio, including completed projects and those that are being scoped but have not yet formally been adopted.

If you have any queries regarding these projects or would like further information, please contact the Project Lead listed against each entry.  Alternatively, for general enquiries or if you have a research question that you feel our analysis and modelling could assist with please contact us.

Active Projects

Last updated 07/06/17

Project Title Streamlining pre-operative assessments at RCHT
Project Summary

NICE recently issued guidelines on pre-operative assessment which outline different tests for different types of surgeries in association with ASA scores indicating a patient’s fitness for surgery.

Based on these guidelines, the anaesthetics department wanted to know how streamlining pre-operative assessments (POAs) would possibly affect the time until the final outcome and the number of assessments. This project aimed to find out if advance knowledge of ASA grades helps to streamline the POA process.

Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Sebastian Rachuba
 
Project Title NeoNet: Providing a national demand/capacity model for neonatal care in England
Project Summary A NIHR HS& DR funded project to understand the current and potential future national patterns of neonatal care in England, by studying location of demand and care, acuity of care and cost of care to service providers and parents.
Collaborating Organisation RD&E Royal Devon & Exeter NHS Foundation Trust
Project Lead Prof Martin Pitt
 
Project Title Review of Operational Research in Emergency and Unscheduled care
Project Summary To review existing literature and information relating to the application of operational research methods in emergency and unscheduled care. To provide a structured account of the quantity, scope, research questions, modelling approaches, data requirement and sources, and impact. To create an on-going resource base for PenCHORD work.
Collaborating Organisation N/A
Project Lead Dr Andy Salmon
 
Project Title Optimising Resource Allocation for GP Urgent Care at Three Spires Medical Practice in Truro
Project Summary

This project will analyse daily telephone demand for urgent care appointments in one large Truro medical practice, and assess the impacts of additional non-clinical staff at stages of the queue to reduce waiting times and inform an optimal resourcing model.

Each practice tends to operate its own processes for the management of urgent patients. Within the 3 Spires Truro Practice, a new and evidenced based model is operating where all urgent requests are telephone triaged by a GP to assess requirements for urgent same day GP appointments.

The GP team are keen to understand whether changing the non-clinical resource allocation (different numbers, skills and by time of day) to the queue would influence total waits and the ultimate levels of demand, rather than pilot differing resourcing approaches to see what seems to work best.
Collaborating Organisation Three Spires Medical Practice
Project Lead Dr Daniel Chalk
 
Project Title Optimising plastic surgery clinic scheduling at Derriford Hospital
Project Summary Currently, plastic surgery clinics at Derriford Hospital are typically developing significant patient waits within 2 hours of start of service. The collaborators would like us to use modelling to see how clinics could be more optimally scheduled to meet incoming activity.
Collaborating Organisation Plymouth Hospitals NHS Trust (PHNT)
Project Lead Dr Daniel Chalk
 
Project Title HepFree: Chronic viral hepatitis in ethnic minorities - strategies to prevent the predicted increase in mortality
Project Summary NIHR Programme Grant project hosted at Queen Mary University of London (P.I. Professor Graham Foster), looking at  screening ethnic minority populations for Hepatitis. PenCHORD leads on the cost-effectiveness modelling work package.
Collaborating Organisation Queen Mary's University London
Project Lead Prof Martin Pitt
 
Project Title HepB: Optimising the management of chronic hepatitis B in children and young people
Project Summary Cost Effectiveness component of an NIHR grant led by Barts/Queen Mary University London (P.I. Dr Patrick Kennedy). Full title - Optimising the management of chronic hepatitis B (CHB) in children and young adults:  A cohort study to evaluate the use of quantitative Hepatitis B surface Antigen as a marker to risk stratify patients.
Collaborating Organisation Queen Mary's University London
Project Lead Prof Martin Pitt
 
Project Title DECODE phase 2: Devon-wide impact of triage on waiting times
Project Summary This project follows on from the first DECODE modelling project. The model will be applied to the South Devon and North Devon memory clinics in addition to the Exeter memory clinic. This project will seek to understand the generalised trends of the DECODE triage process on memory clinic waiting times.
Collaborating Organisation N/A
Project Lead Dr Sean Manzi

 

Recently Completed and Closed Projects

Last updated 07/06/17

Project Title DECODE: Dementia Diagnostic Pathway
Project Summary

A large proportion of memory clinic referrals are cognitively healthy which places considerable strain on stretched services locally, nationally and internationally. We have developed a computerized clinical decision support system (DECODE) which has the potential to provide an effective triage tool for memory clinics.

By ruling out inappropriate referrals (false positive cases of dementia) the system has the potential to reduce waiting lists, reduce the cost of diagnosing genuine cases of dementia, and prevent unnecessary distress in cognitively healthy patients who can be reassured at a much earlier stage. In order to strengthen the rationale for a definitive evaluation of the DECODE system as a memory clinic triage tool we need to model the anticipated impact on patient outcomes and financially.

Collaborating Organisation Devon Partnership Trust
Project Lead Dr Sean Manzi
 
Project Title Modelling the optimal size of Derriford ACU
Project Summary What would be the optimal size of the new Ambulatory Care Unit (ACU) at Derriford Hospital, such that the ACU is able to see all patients who could be seen and treated in an ambulatory capacity on the day they arrive and by close of service (8pm)?
Collaborating Organisation Plymouth Hospitals NHS Trust (PHNT)
Project Lead Dr Daniel Chalk
 
Project Title Optimising GP appointment policies at Ivybridge Health Centre
Project Summary This project is exploring the potential impact of three different GP appointment scheduling policies at Ivybridge Health Centre to determine which way of working is likely to promote reduced waits for GP appointments and more appointments with patients’ own GP.
Collaborating Organisation Beacon Medical Group
Project Lead Dr Daniel Chalk
 
Project Title Torbay and South Devon Stroke Patient system (acute and community)
Project Summary Torbay and South Devon stroke patient bed requirements and early supported discharge resource requirements (acute & community).
Collaborating Organisation Torbay and South Devon NHS Foundation Trust
Project Lead Dr Mike Allen
 
Project Title Pathway mapping of STEP 2-4 psychological therapies in the NEW Devon area
Project Summary Working with both commissioner and providers, this project mapped the flow of mental health patients between Devon Partnership trust, other providers and 3rd sector organisations.
Collaborating Organisation NEW Devon CCG
Project Lead Prof Martin Pitt
 
Project Title RCHT CPFT MSK therapy service integration
Project Summary This is a question about integrating the MSK outpatient physio and occupational therapy services. This team is already planning to integrate the pathway beginning in mid-August but have no idea what the impact is going to be on service use, activity, resources. They are incredibly keen for us to work on this project but the time in which is to do the project is very short. This project would involve creating a base case simulation and then looking at a pathway which has not been tested and there is no data for.
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Sean Manzi
 
Project Title SCN Urgent Care Review: Modelling provision for stroke and cardiac services in the South West region
Project Summary This modelling project, undertaken for the Strategic Clinical Network urgent care review, has examined the expected impact of centralising stroke and heart attack services in the mixed urban/rural communities of the South West region.
Collaborating Organisation SW Cardiac and Stroke Strategic Clinical Network 
Project Lead Dr Mike Allen
 
Project Title Streamlining the bladder cancer pathway at RCHT
Project Summary The pathway for muscle-invasive bladder cancer pathway patients at Royal Cornwall Hospital is relatively straightforward, but contains numerous delays. Some delays relate to waiting times for referrals to Derriford Hospital for surgery, but there are also significant delays before this stage, and the collaborators have aimed to reduce their own delays by looking at the potential benefits of pre-alerts and joint clinics within the pathway. The reduction of delays could potentially save lives for patients with this time-critical condition.
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk
 
Project Title Optimising polypharmacy using Agent-Based Simulation
Project Summary This project sought to optimise the prescription of multiple medications for those with diabetes and coronary heart disease, so as to reduce the treatment burden and maximise benefit for these patients. The project used Agent-Based Simulation and Reinforcement Learning to model the way in which patients amend their own medication in order to maximise their perceived benefit and minimise the number of different medications they take.
Collaborating Organisation University of Exeter: Medical School
Project Lead Dr Daniel Chalk
 
Project Title Modelling Radiographer-led discharge at Yeovil District Hospital
Project Summary

This project modelled the pathway for minor injuries at Yeovil District Hospital to visualise the workflow and to evaluate the impact of introducing radiographer-led discharge from A&E. Joint work was undertaken with the Medical Imaging Department (Prof Karen Knapp), who have analysed training needs for radiographers.

Collaborating Organisation Yeovil District Hospital NHS Foundation Trust
Project Lead Dr Sebastian Rachuba
 
Project Title Cornwall acute and community stroke bed capacity modelling
Project Summary Simple model looking at the rehabilitation options for RCHT patients who have suffered a stroke. Two modelling approaches have been used; (i) infinite bed capacity - patients always go to their acute and community closest hospital; and (ii) capacity-restrained model (for community rehab).
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Mike Allen
 
Project Title AHSN Cardiac Troponin
Project Summary

The aims of this project were to; (i) identify the current variation in the use of cardiac troponin tests across the South West region; (ii) predict the impact of using the high sensitivity troponin; and (iii) identify the barriers and facilitators for the efficient use of high sensitivity troponin.

Collaborating Organisation SW Academic Health Network (SW AHSN)
Project Lead Prof Martin Pitt
 
Project Title Achieving step change in the emergency stroke pathway across the South West peninsula
Project Summary A project looking to reduce stroke-related disability in the South West by accelerating the real-world implementation of clinical evidence for thrombolysis treatment after acute ischaemic stroke.
Collaborating Organisation SW Academic Health Network (SW AHSN)
Project Lead Dr Mike Allen
 
Project Title Which Factors Influence Demand for Community Nursing?
Project Summary This was a capacity building project, in which we helped the collaborators to build a simple qualitative System Dynamics model of the factors that influence demand for community nursing services in Cornwall, in order to identify potential problem areas. This enabled Peninsula Community Health (PCH) to be more pro-active in planning resources to meet demand, and identified areas for further investigation.
Collaborating Organisation Peninsula Community Health C.I.C
Project Lead Dr Daniel Chalk
 
Project Title Reducing A&E Four Hour Breaches in Cornwall 
Project Summary Royal Cornwall Hospitals NHS Trust A & E have seen worsening performance and a significant growth in attendances since October 2015. In the majority of cases, the official reason for a breach is lack of beds, but the truth is often more complex, with increased demand from various A & E streams reducing capacity to deal with other streams. RCHT and NHS Kernow wanted to redesign RCHT A & E resources to better reflect the activity generated from each incoming stream. Therefore, we developed a model to help them make a decision about the resources they actually need to cope with demand (and variability in demand) from each stream.
Collaborating Organisation Kernow Commissioning Group
Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk
 
Project Title Optimising the location of Outpatient Services in Cornwall - Phase One
Project Summary This project aimed to answer two questions; (i) Based on current activity, which outpatient clinics should be held at which sites in Cornwall in order to minimise travel times for patients?; and (ii) Is this configuration likely to change based on forecasts of activity in five years time?
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk
 
Project Title Optimising the location of Outpatient Services in Cornwall - Phase Two
Project Summary Phase 1 of this project demonstrated the potential for centralisation of outpatient clinics to significantly reduce clinician travel costs to outpatient clinics whilst having only minimal negative impact on patient travel times. In Phase 2, we explored a number of specific reconfiguration scenarios in order that a case could be put to the RCHT Outpatient Improvement Group to reconfigure outpatient services across Cornwall.
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk
 
Project Title Optimising the Geographic Configuration of Urgent Care Centres in Cornwall
Project Summary This project aimed to establish the optimal location and number of Urgent Care Centres in Cornwall, to form a key component of a redesign decision within the Cornwall Sustainability and Transformation Plan.
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk
 
Project Title Urgent Care in Cornwall PHASE 2: Enhancing the Evidence Base
Project Summary

How would the findings of the previous urgent care centre geographic modelling in Cornwall be affected if we were to:

a) consider urgent care sites in Devon as viable sites for those near the border

b) include travel times for those travelling by public transport

c) consider forecasted urgent care activity levels up to 2021?
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk 
 
Project Title Mapping and reconfiguration of hyperacute stroke services in Wales
Project Summary The Royal College of Physicians (London) and PenCHORD were tasked by the Stroke Implementation Group (SIG) of the Welsh Assembly Government to coordinate the development of service maps and profiles for hyperacute and acute stroke services across Wales. The aim was to provide robust evidence to support discussions regarding service reconfigurations.
Collaborating Organisation Royal College of Physicians
Project Lead Dr Mike Allen
 
Project Title Cornwall mental health service pathways
Project Summary The aim of this project was to understand how Cornwall Partnership Trust can change the process of inpatient mental health care to make more effective use of facilities and avoid out of county referrals. The project sought to identify any current bottlenecks in the system by using discrete event simulation to understand the current situation and how it might be altered. The outcomes from this project included a set of suggested changes based on the inpatient care pathway, to improve patient flow and reduce pressure on the system.
Collaborating Organisation Cornwall Partnership NHS Foundation Trust
Project Lead Dr Sean Manzi
 
Project Title Modelling the potential impact of the Health ePass app at RCHT
Project Summary A simulation model of the A & E department at RCHT was built in order to assess the potential impact of the Health ePass app being used by patients to reduce medical history collection times.
Collaborating Organisation Royal Cornwall Hospitals NHS Trust
Project Lead Dr Daniel Chalk

 

Upcoming Events

Sep
27

Making sense of health research...

Plymouth - John Bull Building - SR4

An introduction to making sense of evidence   Introduction to Making Sense of Evidence During this talk a...
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Sep
28

Searching and Review Clinic

The University of Exeter, St Luke's campus, South Cloisters (Room 2.35)

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News

Professor Rob Anderson wins prestigious book prize

15 September 2017

  Rob Anderson, Associate Professor of Health Economics and Evaluation, was one of the authors to...
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Job opportunity: Graduate Communications Assistant

04 September 2017

We are looking to recruit a Communications Assistant to support the Engagement, Research Information and...
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Stroke Association awards funding for stroke thrombectomy collaboration

16 August 2017

A study into a new and more effective treatment for acute stroke in England, carried...
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News

Research Projects

Improving the mental health of children and young people with long term conditions

Theme: Mental Health & Dementia

Systematic review evaluating the effectiveness and cost-effectiveness of interventions aimed at improving the mental health...
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Cognitive Monitoring in Planned Arthroplasty Surgery Study (CoMPASS)

Theme: Evidence for Policy and Practice

SWARM are developing a study looking at post-operative cognitive dysfunction (POCD). In an initial...
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Research Projects