A view from the UK: How NHS hospitals are adapting to treat COVID-19 patients
In these unprecedented times, I’m in awe at what healthcare professionals and organisations are dealing with daily.
The speed at which plans in the National Health Service (NHS) here in the UK are being made, updated and actioned upon is extraordinary. Large hospitals are ramping up critical care beds between five- and eight-fold to prepare for the projected wave of ill patients.
In parallel, we have seen hospital IT teams working around the clock to deliver infrastructure support to facilitate new ways of working, as more individuals work remotely and more clinics adopt telehealth. Even more demanding for these teams, though, is ensuring the necessary bandwidth, and hardware to support an expansion of high-acuity beds.
Despite these challenges, we have been awe-struck by two of our UK clients choosing to continue their implementations of new functionality to their teams during the week of 23 March.
At Bolton NHS Foundation Trust, the planned activation of new mobile functionality for community paediatric services went ahead as scheduled. Many of the staff who would be benefiting from this functionality — which includes offline working for home visits — have been redeployed to help prepare for and treat acute admissions.
Still, the system is live, and that means that once this crisis has passed, they can start using this new software right away.
At Gloucestershire Hospitals NHS Foundation Trust, the recent activation of Sunrise EPR nursing documentation at both Gloucester and Cheltenham hospitals has now been augmented using electronic observation recording, including National Early Warning Score2 (NEWS2) scoring.
This, too, was an impressive decision as the trust was receiving COVID-19-positive patients. The new functionality facilitates visibility of serial observation trending across the trust to monitor all inpatients for iterative signs of deterioration and intervene earlier, if required.
Meanwhile, other Allscripts clients in the UK have also made significant, rapid changes that will help their staff manage those suspected of having COVID-19 and those who have been confirmed.
The flexibility of configuration within Sunrise EPR has ensured that no matter how digitally mature a hospital is, each trust has enabled new changes to meet the needs of their staff and complement their existing workflows.
At Gloucestershire Hospitals and Wrightington, Wigan and Leigh NHS Foundation Trust, the recording of a suspect COVID-19 or actual COVID-19 diagnosis means these patients can be identified and managed at ward level and across the hospital.
This enables a specific icon on the ward tracking board to be displayed for easy identification as well as specific patient lists to be generated for managing patients requiring isolation.
At The Dudley Group NHS Foundation Trust, patients with suspected or confirmed COVID-19 are identified by an icon on the patient header in their electronic record.
Salford Royal NHS Foundation Trust updated Emergency Department clerking documentation to record salient COVID-19 features, enabling a streamlined clerking process and a direct link to a pre-defined battery of pathology and radiology investigations that can be requested quickly.
Again, the ED tracking board displays all patients in the various ED areas and provides staff with at-a-glance information. This ensures they put on the appropriate level of protective clothing — prior to entering the patient cubicle.
Updates to Sunrise critical care documents have also been made to ensure appropriate structured data is recorded consistently. In parallel, their reporting team are providing reports to allow overview of current inpatients and use of high-acuity beds.
Liverpool Heart and Chest Hospital NHS Foundation Trust also updated documentation templates. In particular, Liverpool updated critical care documentation to record symptom onset as well as standard respiratory support requirements.
Currently, the trust is looking to convey this data for automatic upload to the Public Health England COVID-19 Hospitalisation in England Surveillance System (CHESS) database to minimise reporting effort and reduce transcription errors.
Looking to the future
The speed of these changes has been remarkable and further changes will be required once all hospitals are assaying their own COVID-19 diagnostic tests rather than sending them to external Public Health England labs. This will reduce the need to import external results and improve turnaround time of results.
We are working with our clients to share their newly configured content together with COVID-19-specific content and decision support rules built by Allscripts so that all sites have access to these tools.
At present, many NHS sites are building a new prescription order set to provide the complex protocols required for the new COVID-19 drug trials. The order set will ensure timely, accurate and consistent prescribing so these drugs can be administered quickly.
In parallel, specific documentation templates are in the pipeline to record the iterative response to the various treatment arms. Unlike many clinical trials, this will ensure the data is collected as a by-product of normal clinical documentation, rather than requiring re-keying of clinical data to support this research.
Not only will the COVID-19 drug trials be amongst the fastest mobilised, but the ability to review and report iterative, consistent outcome data from the EPR in near real time will be a key benefit to the global fight to stem this pandemic.