Using Pillar 2 Testing data to improve Covid patient flow within hospitals
Covid has created an enormous set of challenges for the NHS. One particularly difficult example arises when a patient attends ED having had a recent Covid test. Confirming the test result and date quickly is not possible and we are reliant on the patient knowing and having proof of their result and date.
Even if we are able to qualify a Covid status, we then need to design a way of recording this information and then manually enter the data for every patient.
The national data is collected by Public Health England but then stored for NHS use through NHS Digital. NHS Digital, in turn, outsource the data warehousing of this information to a commissioning support unit (CSU). It is therefore very difficult to navigate all of the Information Governance and and IT flows to gain ready access to this data for use within an ED. Tackling the complex network of strangers that are requesting and receiving this data would entail is an unwelcome hurdle, particularly when working under pressure. The Covid COPI notice (see https://digital.nhs.uk/coronavirus/coronavirus-covid-19-response-information-governance-hub/control-of-patient-information-copi-notice) is meant to make it easier to share data safely and altruistically to tackle Covid but unfortunately systems, processes and politics can get in the way.
It's crucial to remember that this data is not for research or even for planning, it is for direct patient care – NOW. So, as patients present in our emergency departments with a recent test result for Covid we can stream them quickly into a Covid or non-Covid stream and thereby avoid putting more pressure on overstretched Pathology and Virology departments.
Building on good relations between East Kent Hospitals NHSFT with Kent County Council colleagues we have piloted the secure transfer of data between Public Health and the NHS.
With the support of IG colleagues, we have put in place a Data Privacy Impact Assessment (DPIA) and a Data Processing Agreement (DPA) promptly.
We now have an overnight flow of Pillar 2 testing data and have built a Patient Tracking List (PTL) that links the test result to the patient when they are entered on PAS upon attendance at ED or are a direct admission.
In terms of methodology, the diagram below illustrates the data flows and the IG that was necessary to put in place [and achieve quickly].
We are now identifying over 45% of patients arriving at our hospitals, compared to less than 25% prior to the intervention and are working to develop outcome measures to monitor the improvements.
We are also pursuing formal access to the data from NHS Digital direct to our organisation and into local care records and will happily support other organisations within Kent and Medway, and nationally, to achieve the same outcome.