Using on-call research nurses to boost recruitment to clinical trials

Introduction

Patients who are acutely ill do not always present between the hours of 9am and 5pm, and it is well documented that patients who are admitted to hospital outside of normal working hours experience greater delays, have fewer treatment options and are more likely to die (de Cordova et al, 2012; Kim, 2010; Ehlers et al, 2008).

Clinical trials offer patients the opportunity to have access to innovative treatments and procedures – however, those who present in accident and emergency out of hours might not be able to access these treatments as clinical research teams might not be available. The ability to recruit patients into studies 24 hours a day helps to achieve trial recruitment targets that are used to dictate the future funding of studies.

In 2010, our research team extended our hours of working to 12-hour days, seven days a week, which resulted in a 25% increase in patient recruitment figures. However, this still left 12 hours each day without cover. As a result, in 2015 we became the first hospital in the country to develop a round-the-clock on-call research nurse service for hyperacute stroke and emergency research trials. Since the on-call rota has been implemented, we have improved the choice and opportunity for treatments that are provided to our local population.

Developing the service

Our overnight on-call rota uses research nurses from our team who are alerted when a suitable patient is admitted.

We initially sought funding from the local clinical research network (2015/16) to cover the overnight on-call rota for one member of staff. Nurses receive a minimum payment of £15 for a 12-hour on-call session, and they can claim an additional payment if and when they are called to see patients.

We anticipated that there would be one or two calls per month, but over the first 12 months of the service, calls increased to one or two per week, enabling us to include 55 patients in acute clinical trials during the night; these were people who previously may not have had the choice, or opportunity, to access the trial’s treatment options.

Outcomes

We have consistently exceeded recruitment targets on all acute trials, and we have maintained our position as the highest-performing hyperacute stroke research centre nationally.

Innovation has made the trust an appealing site to conduct research trials. The ability to maximise recruitment, offer 24-hour inclusion and provide around-the-clock research nurses has enabled the trust to open a number of highly competitive commercial trials (of which we are now the highest recruiting centre internationally). This has allowed us to offer cutting-edge treatment options to our local population, and helped us generate the income needed to fund the on-call rota. We can also provide essential equipment, such as drug fridges and computers, to the A&E department.

Future plans

The team is keen to further expand the service, which is offered locally, and we are becoming involved with A&E and trauma trials. We are opening trials that will require immediate recruitment following admission to A&E, as well as a move from an on-call service to a team that is available on-site throughout the night.