06 May COVID-19 – the implications for investigating
COVID-19, as the disease is known, has created a formidable workload for our healthcare system over the last couple of months, whether it is building the NHS Nightingale Hospitals, re-organising acute hospitals or building new apps to track the spread of the disease. Many healthcare organisations have been on a ‘war’ footing. Almost all healthcare professionals will have experienced nothing like this pandemic in their working lives.
As the first wave of the coronavirus outbreak subsides, a ‘new’ normal will return to healthcare. And some aspects of the ‘old’ working world will re-assert themselves. This will include having to sort through the many patient safety incidents reported over the period. As the head of quality compliance at a major London teaching hospital told a Verita colleague recently, ‘we are logging them but, come the day, we will need to sort them out and we need your help’. We are standing by to do just that as they are an early adopter of the Eva patient safety incident investigation technology built by Microsoft and Verita.
What exactly might face us as we look through COVID-19 generated incidents? Well, here is an informed guess:
- Concerns expressed by families about indirect deaths/deterioration arising from delayed diagnosis and/or treatment.
- Issues arising from healthcare professionals having had to take critical clinical decisions ‘on the hoof’
- Care incidents arising from staff having to work outside their area of competence during the emergency
- Safeguarding concerns
- Disputes about the care and treatment of vulnerable elderly patients e.g. should they have been ventilated? Why didn’t they receive that type of medication?
The task facing every healthcare organisation will be deciding what to investigate and how. And that is where NHS Improvement’s recent announcement comes into play.
In the drama and turbulence of the last few months, you will be forgiven if the publication of NHS Improvement’s Patient Safety Incident Response Framework (PSIRF) has passed by you unnoticed. The framework was published on 10 March and is described as a ‘key part of the NHS Patient Safety Strategy’. The main points from the framework can be summarised as follows:
- ‘Patient safety incident investigation’ replaces the term ‘root cause analysis’
- Serious incidents should be investigated using a systems-based approach by using the amended contributory factors framework
- Less serious incidents can be subject to audits & reviews
- Investigators should be ‘properly trained’
- Trusts should establish an effective and compassionate patient safety reporting learning and improvement system
Perhaps the most significant point for organisations to bear in mind is the second one requiring that ‘serious incidents should be investigated using a systems-based approach’. As we sort through the COVID-19 incidents we will need to separate the ‘serious’ from the ‘less serious’. And having decided what to investigate we will be using the analytical tools – including the new contributory factors framework – embedded in the Eva patient safety incident investigation tech to get to the heart of the concerns.
The world has experienced ten pandemics in the last 300 years. As Dr Stephen Davies, economic historian, says in his Going Viral video briefing for the Institute of Economics Affairs, they are a recurring feature of human history. He also makes another important observation which is highly relevant to healthcare in the early 21st century. Pandemics ‘accelerate previous trends but also lead to striking innovations’. In the last two months, Microsoft Teams has accumulated 12 million new users. Many of those, no doubt, are in healthcare. If this pandemic provides an impetus for the rapid adoption of technology in healthcare, then all to the good. Especially if that technology serves an everyday purpose and integrates with the working life and routines of healthcare staff. And Eva does just that.