Meet the methodologist: Tim Hicks
Tim joined the NIHR Newcastle In Vitro Diagnostics Co-operative (NIHR Newcastle MIC) in April 2020. He divides his time between working with ourselves and Northern Medical Physics and Clinical Engineering at Newcastle Hospitals. His role at the MIC has focused on care pathway analysis within the national partnership called CONDOR. This work is helping to match the most suitable new COVID-19 tests to situations where they could improve patient care.
How have you found your first year at the MIC?
I moved to a new country, started a new job, and started working from home all around the same time so it’s been challenging! But it’s been fun and enjoyable. The MIC are a great team to work with. That definitely helps.
Can you tell us a bit about your training and why you wanted to join the MIC?
During my Masters in Clinical Sciences we had a lecture about modelling an A&E department, and I was really interested in it. The Scientist Training Programme was an opportunity to focus on this. I modelled the wheelchair service in North Wales to find out where their bottlenecks were for providing wheelchairs. When this job came up, I thought it was brilliant, because it tied into everything I wanted to do to around improving patient flow. And it also lets me do some modelling, which I found really fun!
What does your work in Medical Physics involve and how does that link to the MIC?
I am involved in gait analysis, which involves sticking 3D markers on people – kind of how they make all the Marvel movies now! We track patients walking and from that we can see where limitations are in their movement to help inform surgeries, orthotics, and physiotherapy.
If there isn’t a device available, clinicians will also come to Medical Physics and say, “I want something to do this” and the department makes it basically! My work involves checking that the device is working and it is not dangerous to the patient. I am learning a lot around regulations in Medical Physics which can really help the companies I work with in the MIC including what evidence they need before they can get to the clinical trial stage.
What you have been doing at the MIC and why is it important?
Firstly, I looked at whether COVID-19 testing was being done in care homes and how the testing was happening. I also studied infection prevention and if they were splitting residents into COVID positive rooms and negative rooms.
Until you know how the system works you cannot develop it to the best of its potential. I have been mainly doing care pathway analysis which looks at the patient journey and how one individual interacts with the whole care system. This involves looking at guidelines and carrying out detailed interviews. We tend to map this out into a detailed flow diagram.
Next, I investigated how patients were admitted into hospitals. I also examined what happened when they got there including what symptoms the medics look at and the current tests they use. I also explored who was taking the tests, how long the test takes to come back, and where the patient is, while the tests are being taken.
The work has involved working directly with the MICs based in Oxford and London and doing interviews together. Working in such a broad team with different areas of expertise has really helped our work.
What have you enjoyed the most about this work?
It is like solving a puzzle and that is quite satisfying. When you have a care pathway and you show it to somebody and go “right after taking in everything you’ve said, everything the guidance has said, and past experience, how does this look?” and they say “Yeah, pretty spot on.” That feeling is amazing! The qualitative side is fun as well. Talking to different clinicians, people with different backgrounds and our public insight panel has been really enjoyable. When I spoke to the insight panel, they suggested putting COVID-19 testing in pharmacies which made us look more into that. So, to be honest I like every part of this job!
What have been the challenges with this piece of work?
Normally with care pathways there are national guidelines covering it and people tend to do the same thing or they have years of experience seeing patients with a particular condition. Whereas with COVID things have been changing very quickly. So, trying to design a pathway when there are so many unknowns is quite tricky. Fun from a pathway engineering side of it though!
What are you happiest about so far with this work?
The care pathway we designed for secondary care (hospitals and specialists). We had a very close relationship during the interviews with The National Institute for Health and Care Excellence (NICE) and spoke to them every two weeks. Our work revealed that hospitals without labs on site, really needed point of care tests. NICE went away and did their modelling independently from us and came to the same conclusion! So, it was validation of the work we had done. It also showed our work had an impact at a high level.
What are the three take home messages you would like the public to know from this work?
1. No test is perfect, and you can get false results. Therefore, a test should not be used in total isolation.
2. A so called “perfect test” could become ineffective and potentially harmful if you put it in the wrong place and it is not suitable for the end user.
3. An imperfect test can still be useful in the right environment and situation.
What is coming next with this work?
We are analysing what GPs think about COVID-19 testing. We are also outlining an alternative pathway to help GPs send patients for testing without them coming into their surgery. We hope this will inform planning so in a future pandemic this system could be set up very quickly. That way hospitals will not be overwhelmed, and your GP could still be open.
I enjoy research so at some point in the future, probably in the next five years, I want to do a PhD.
Outside of work, what are you looking forward to during 2021?
We are hoping to get a mortgage and start planning our wedding. I am looking forward to seeing my family again and having a barbecue over the summer. I also really want to go hiking and go back to the Lake District.