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Identification of patient safety indicators spanning primary and secondary care, and development of a framework to guide safety monitoring

About This PhD Project

Project Description

Digital Integrated Care Records that span the health economy have the potential to benefit patients and clinicians by enabling safer, more joined up care through the sharing of comprehensive clinical information. There is an opportunity to use these data to improve patient safety. This approach fits well with the new models for monitoring and investigating safety issues that move away from single organisation incident collection and investigation to the more patient/ user-centric assessment of safety over time and across organisations.

There have been advances in the development of approaches to assessing patient safety in primary care (RCGP Patient Safety Toolkit) following the initial progress made in secondary care but the challenge remains as to how to join up approaches to get a better view of safety for individuals and specific groups of patients across the health and care system. Focusing on patients prescribed anti-coagulants, a family of medicines carrying a well-known risk of patient harm, this study aims to identify patient safety indicators that span community, primary and secondary care, which could be collected from a digital integrated care record. It will identify where gaps lie and some of the challenges to data collection. The findings will be used to develop a framework to guide the monitoring of the safety of patient care across organisations and time.

Patient safety indicators will be identified through a range of approaches along with identification of measurement gaps where new indicators could be applied. The literature will be reviewed to determine the nature of incidents associated with anticoagulants reported from different organisations (primary, secondary, care sector) across the health economy, particularly those that arise at organisational interfaces. This will be supplemented with a review of national patient safety incident data and national recommended quality measures for patients with conditions that require anticoagulant treatment.

A case study will be undertaken in one locality with a digital integrated (community, primary and secondary care) record to map measures of safety followed by a structured prospective risk analysis of patient care pathways e.g. Failure Mode and Effects Analysis to develop potential indicators for future risk (leading indicators) that complement indicators of actual harm or non-compliance (lagging indicators). In addition, case scenarios developed from the national incident data will be used to identify phases of care that are high risk for harm.

All candidates should hold a Master’s qualification (or complete their Master’s by September 2020) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.


For general enquiries, please email:
For project specific queries, please contact: Dr Helen Hogan:


Closing date: 05/01/2020;
Interviews: 22/01/2020
For applications and other information please visit our main NIHR ARC North Thames funded PhD studentships page:

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