Research (Ref 576)

Improving Wrist Injury Pathways (I-WIP)

The implementation of early MRI scans for patients with wrist injuries who have normal x-rays.  Around 70,000 patients a year in the UK go to hospitals with wrist pain after an injury with normal initial x-rays.

The main aims and objectives of the research study.

The project consists of two parts.  The first part aims to understand the problem better, the second part aims to then develop a way of tacking this implementation problem.

The aims of the first part of this project are to find out:

  • what helps staff to provide good treatment for patients with wrist injuries.
  • what makes it challenging to provide best quality care.
  • what is most important to patients who have wrist injury.

How this research is going to help address MSK health.

The research will develop a complex intervention to tackle this implementation gap, in doing so the researchers seek to improve care for patients with wrist injuries by helping NHS hospitals introduce early MRI more effectively.

The main research methods, or datasets being used.

This first part of the study shall consist of mixed methods, including case study focused ethnography, pathway mapping, and qualitative interviews.  This component shall also include the development and piloting of a data platform (including bespoke front end and dashboard) with our project partners PRO-MAPP. This shall enable local clinical teams to easily gather data and monitor their performance in real time.  Improved situational awareness provided by these data together with training and implementation components in our complex intervention will support frontline teams to improve time to MRI and definitive treatment for patients.

This study will then lead to a second project which will consist of an iterative series of 6 co-design workshops.  Firstly, the group will develop of a theory of change and driver diagrams as informed by the gathered data.  Secondly, the group will co-produce the complex intervention.  The complex intervention developed by this project will then enable us to apply for funding to firstly, test the feasibility of this intervention in the NHS and then secondly, to assess the effectiveness of our complex intervention compared to that of a robust comparator in a pragmatic randomised controlled trial.

Researcher: Ben Dean.

Supervisor: Prof Matt Costa.

University: University of Oxford.

Award stream: Inspiration Fund.

Award duration: 2 years.

Amount rewarded: £45,000.

Collaborations/ partners:

  • Researchers: Tim Stephens (Queen Mary University of London), Amy Grove (University of Warwick) and Ashley Scrimshire (University of York).
  • Industry collaboration with PRO-MAPP.
  • 10 NHS centres.
  • Expert group consisting of patient representative (Liz Baird), clinical triallists, clinicians, experienced qualitative researchers and experts in implementation science, quality improvement and complex intervention development.