Case study: HaemSTAR
The HaemSTAR initiative is supported through the NIHR Clinical Research Network Haematology specialty group.Find out more
Haematology Specialty Trainee Audit and Research (HaemSTAR)
HaemSTAR (Haematology Specialty Trainee Audit and Research) is a network of trainee haematologists supported by the NIHR Clinical Research Network. The organisation came about through a drive to encourage more registrars to get involved in research and now comprises a network of haematology registrars leading in each NIHR region, coordinating projects and recruiting junior doctors and nurses. It allows registrars to engage in clinical research without the need to be clinical academics.
HaemSTAR aims to promote clinical research into non-malignant haematology through opening new studies, increasing participant recruitment into studies, and facilitating staff development to establish the Chief Investigators (CIs) of the future. Developing and embedding investigative skills in registrars as part of their training will hopefully lead to research becoming a natural part of practice for future consultants, ultimately increasing research activity and improving treatment and outcomes for patients.
A new approach to research
Health research practice is often ‘top down’, relying on a Chief Investigator to identify a research area and complete the relevant paperwork to set up the study, which can be onerous. HaemSTAR aims to reduce the amount of time and money required to set up a study by using existing data to answer questions. Successful processing and interpretation of this data requires the collaboration of more junior staff, such as trainee haematologists, and overseeing an audit is more economical and quicker than setting up a clinical trial. HaemSTAR aims to demonstrate to staff that getting involved in health research can be flexible, does not necessarily require a large commitment of time, and will enable them to develop research skills in a supportive environment.
HaemSTAR has succeeding in raising the profile of haematology research in the UK and in supporting relevant studies. The following are some examples of HaemSTAR’s work:
Dr Pip Nicolson, national HaemSTAR lead, recently directed the network’s first audit. He aimed to demonstrate that through HaemSTAR it could be possible to run a coordinated, rapid research audit across the country, which could then be used to gain knowledge and improve treatments.
The first ‘flash-mob’ audit utilised 134 trainee doctors and nurses as collaborators across 39 hospital sites and recruited 978 patients in just 10 weeks, at zero cost to the NHS.
The audit aimed to examine the prescriptions of intravenous immunoglobulin (IVIg) for patients with immune thrombocytopenia (ITP) in the UK. A data collection tool was set up and the collaborators input data on IVIg treatment. This was analysed and the results suggest that more IVIg than the recommended dose is being prescribed, increasing risk to patients and increasing treatment costs. The results also demonstrated the possibility of using minimal resources to facilitate rapid data collection across the country.
Following the project, HaemSTAR looks to develop a generalisable methodology for future mass participation audits in non-malignant haematology. Audit outcome data can then be used to inform research hypotheses for future studies. Disease areas which HaemSTAR aims to further study within the flash mob concept include pre-surgical routine clotting screens, Gaucher’s Disease and Thrombotic Thrombocytopenic Purpura (TTP).
HaemSTAR aims to increase the number of participants taking part in non-malignant haematology research and supported the TRAIT study, which was a retrospective study struggling to recruit after the first six months. To help overcome this, five HaemSTAR sites opened, enabling ongoing, above-target recruitment. This success led to further funding for five more sites, the study was extended by four months and the target increased to 250 patients. Overall, 104 of the 268 recruited patients were through eight haemSTAR supported sites and the study closed after successfully recruiting ahead of time and target.
The HaemSTAR support for TRAIT was a great test of the network, and there is potential to expand this further in the future. In the next few years, HaemSTAR aims to support more studies at a national level and eventually set up and run its own clinical trials.
NIHR Clinical Research Network support
HaemSTAR acknowledges that it couldn’t exist without the support of the NIHR Clinical Research Network (CRN). Early on, the Haematology National Specialty Group (NSG) meetings provided a platform where the pioneer HaemSTARs could meet and discuss ideas. Following this, the clinical specialty lead from each NIHR local CRN has provided ongoing mentorship for their regional HaemSTARs. Even more recently LCRN West Midlands provided non-financial support in the form of dedicated time from a trials team and data manager in order to complete the FLASH-MOB project. The CRN also provides reimbursement for expenses payments to allow HaemSTARs to attend national meetings, network and share ideas.