Critical Care Health Informatics Collaborative
Research type
Research Database
IRAS ID
148894
Contact name
Mervyn Singer
Contact email
Research summary
Critical Care Health Informatics Collaborative
REC name
London - South East Research Ethics Committee
REC reference
14/LO/1031
Date of REC Opinion
25 Jun 2014
REC opinion
Favourable Opinion
Data collection arrangements
This project aims to create an information technology capability, enabling researchers to investigate the course and
outcome of the critically ill. The study aims to automatically collect and store routine clinical, demographic and longterm
outcome data of all patients admitted to participating critical care units. The data, which will be rich both
longitudinally and in depth, will enable researchers to answer questions that have been impossible. Up to this point
most outcomes research looks at a single cohort of patients over a defined (and relatively short) period of time. These
cohorts may not be relevant to the UK population and are unable to take in to account either secular changes or the
impact of new interventions. The database will be of interest to Health Services Researchers and Clinical Trial
Researchers amongst others. The research interest can broadly be envisaged as:
1) Examining long term clinical outcomes. Do survivors of critical illness have significantly reduced life span or
increased resource utilisation, compared to the healthy or general hospital population? This knowledge would allow
clinicians and patients alike to make informed care decisions. Ongoing healthcare needs could be predicted and
resources appropriately allocated.
2) Look at predictors of outcome. Researchers have previously found a number of variables that may predict patient
outcome, however the datasets are frequently limited by the inability to continually reanalyse
or examine trends over
time. This constantly updating database will enable researchers to analyse how multiple predictive variables interact
with each other and over time. The numbers of patients within the database will grow rapidly (The 5 participating NHS
trusts admit approximately 10,000 critically ill patients a year) allowing researchers to investigate these predictors in a
large population of UK patients.
3) The impact of secular or process changes (e.g. High Impact Interventions in the Saving Lives campaign) could be
measured and quantified. This would not just be in the short term (length of stay in Critical Care or hospital survival),
but also in more meaningful long term survival.
4) Clinical Trials: Over the years, approximately 70 drug trials have been performed within critical care, not one has
demonstrated a reproducible benefit to the patient, despite large leaps forward in our understanding of the different
disease states involved. The reason for this is multifactorial,
however trial design has often been called into question.
This database will enable:
a) Appropriate powering of studies by examining the properties of the control subjects and how this may change as
inclusion/exclusion criteria are altered. This is important, as the nature of the control group appears highly variable
between different trials (mortality rate ranging from 1540%
within the same therapeutic area). This database will
enable trialists to investigate how altering inclusion/exclusion criteria may alter the outcome of their control group and
allow appropriate powering of their study
b) Predict more accurate recruitment rates. All large NIHR sponsored trials have failed to recruit to target, many believe
the targets to be unrealistically set. This database will enable accurate modelling of trial recruitment
c) Critical Care research, unlike cancer research, usually focuses on short term goals such as 28 day mortality or
hospital length of stay. This database would enable researchers to examine the impact of interventions on long term
outcomes (mortality and health care utilisation).Research programme
The Chief Med Officer (Dame Sally Davies) and the NIHR asked the five Comprehensive Biomedical Research Centres to form a National Health Informatics Collaborative with the specific aim to work with their partner NHS Trusts to develop methods to provide greater access to NHS patient data to improve both clinical and research outcomes. Five clinical themes were chosen, this application relates to the Critical Care Theme This project aims to capture clinical, laboratory and demographic data from all patients admitted to the adult general Critical Care Units (CCU) partaking in this study. All data will have been routinely collected as part of clinical care, no further data will be requested. The project aims to collect routinely collected electronic data from five NHS trusts. The NHS trusts involved are: University College London Hospital NHS Foundation Trust Guys and St Thomas' NHS Foundation Trust Imperial Healthcare NHS Trust Cambridge University Hospitals NHS Trust Oxford University Hospitals NHS Trust A large amount of this data (e.g. blood pressure, heart rate and oxygen levels) are automatically collected and stored in the hospital Patient Information Systems. Data, such as drug prescriptions are entered directly by the physician or nurse. The information systems also obtain routine demographic data (e.g age, sex, NHS number, postcode) from the Trust's Patient Administration System and laboratory data (e.g. blood test results). This aggregated data enables critical care clinicians to assimilate large amounts of information on which to make clinical judgements. This project aims to automatically acquire this data. Hospital based integration engines will ensure the data from all sites can be compared, for example, ensuring the units of measurement are the same (one trust may measure height in metres another in centimetres). At daily intervals this data is encrypted and exported (point to point AS256 transfer protocol) into a database within the University College London Data Safe Haven. The encryption and transfer protocol meet with NHS Information Governance standards and the Safe Haven meets NHS Information Governance Toolkit Level 2 and is requesting accreditation to ISO27001. The Safe Haven is already holding sensitive and identifiable NHS data. Once the patient leaves the critical care unit the data flow from the clinical information systems will cease. Providing the patient has survived an automated request will be made, using identifiable data within the Safe Haven, to link their data to the Hospital Episode Statistics database, to establish longer term outcomes. This request will be repeated monthly until the patient has died. At this point the data will be deidentified Researchers interested in mining this database will make a request to the Critical Care HIC Management Team, providing their application is accepted they will be given the requested data, however at no point will they be able to access identifiable data or be able to access the Safe Haven database directly.
Research database title
Critical Care Health Informatics Collaborative
Establishment organisation
Homerton University Hospital
Establishment organisation address
Accident and Emergency Dept
Homerton Hospital
Homerton Row
E9 6SR