Today (24 October 2022) the learning from the RECOVERY trial in Northern England study was published in international journal BMJ Leader, which focuses on leadership in health and care. The study, which was conducted by researchers at the NIHR Clinical Research Network North East and North Cumbria (CRN NENC), identified an “ideal recruitment situation”, which allowed participating sites to maximise recruitment to the RECOVERY trial.
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial was part of the UK’s response to the Covid-19 pandemic, which called for urgent research into tackling the new virus. The aim of the RECOVERY trial was to identify treatments for those hospitalised with suspected or confirmed Covid and it the first key urgent public health study to be given fast-track approvals and additional support to facilitate the research. High recruitment rates were required for timely results; however, recruitment rates were inconsistent across different hospitals and places.
The study published today was set up in September 2020 in an effort to learn from earlier experiences of research recruitment during the pandemic and to positively influence recruitment in later waves.
All eight acute hospital trusts in the North East and North Cumbria collaborated on the study, sharing learning on what had worked well and where there was room for improvement. The research team contextualised each recruitment site by looking at their pre-pandemic operational status, prior research activity, Covid-19admission rates and participation in other urgent public health studies. The team also conducted one-to-one interviews with NHS staff involved in the RECOVERY trial. Situational analysis was used to identify the narratives that shaped recruitment activity.
The study team identified an ideal recruitment situation which was influenced by five elements: uncertainty, prioritisation, leadership, engagement and communication. The closer a site got to the ideal recruitment situation, the easier they found it to implement the most significant factor on recruitment: embedding research into standard care.
The study results meant that the CRN NENC was quickly able to identify where to put additional resource in order to have maximum impact on recruitment when the second wave of the pandemic hit. As a result, the North East and North Cumbria managed to recruit 15% of all regional COVID-19 hospitals admissions to the RECOVERY trial in 2020/21 (compared to a 9% national average recruitment rate).
Dame Jackie Daniel, Chief Executive of The Newcastle upon Tyne Hospitals NHS Foundation Trust, said: “In March 2020, the COVID-19 pandemic thrust the NHS into unknown territory and we knew that research was essential to help us find treatments that worked. Our dedicated research teams in the North East worked together to identify the challenges of delivering research in a pandemic and describe the ideal situation where research opportunities are embedded into clinical care pathways so that all patients can benefit.
“The RECOVERY trial relied on many thousands of people with COVID-19 to get involved and it is a great achievement that 15% of patients admitted to hospital with the virus were able to participate in this world class study in our region. The treatments that were developed are ones which are now used as standard across the world and I’m very proud of the significant role that our clinicians in the North East played at this critical time in our history.”
Caroline Wroe, Clinical Director of the NIHR CRN NENC, said: “The COVID-19 pandemic led to unprecedented challenges for our healthcare and research services and a national call to facilitate Urgent Public Health studies. In the first wave of the pandemic, we saw both the challenges and solutions local research and development teams worked through to facilitate the RECOVERY trial and wanted to understand the factors influencing recruitment.
“The results from this study demonstrate the importance of prioritising and resourcing research during a pandemic and identified the ideal recruitment situation where research is embedded into routine clinical care. This work allowed us to improve access to research for our local populations. This was particularly important in areas of health deprivation where COVID-19 death rates were higher and demonstrated that we can work together to deliver research where it is most needed.
“We are delighted that this work is being published in BMJ Leader and want to thank our regional research colleagues who contributed to this study and shared their experiences in an open and responsive manner.”
Professor Richard Haynes, RECOVERY Trial Coordinator, MRC Population Health Research Unit, University of Oxford said: “The RECOVERY trial has answered many therapeutic questions for severe COVID-19 and has shown what high-quality research the NHS can deliver. As impressive as the recruitment rate was, there was substantial variation between participating hospitals. This paper provides very valuable insights into some of the drivers of this variation and what needs to be done to ensure that research can be embedded into NHS care to the benefit of all.”