This appeared last week:
IT issues highlighted in home isolation deaths
Sunday, 28 November 2021
NEWS - eHealthNews.nz editor Rebecca McBeth
Lack of integration and IT systems that are not fit for purpose are highlighted in a report into the “potentially preventable” deaths of two people in home isolation after contracting Covid-19.
The Northern Region Health Coordination Centre (NRHCC) commissioned the report into the Community Supported Isolation and Quarantine (CIQ) system in consultation with the Ministry of Health after a man died at home in Auckland on November 3. A second person died on November 5.
An independent review panel found there were “missed opportunities” that contributed to the deaths and the IT systems supporting the home isolation of Covid-19 patients , “have suffered from being unable to be either linked or effectively reconfigured to meet the priority needs”.
Also, “escalation pathways did not occur or function as planned, either for unclear reasons or due to software design issues”, the report says.
It recommends considering a “virtual ward round” model for the highest risk patients isolating at home and the NRHCC says it has since launched a Hospital in the Home initiative across all three DHBs, for cases needing a lot of health support.
The report says connectivity between all parts of the system is essential and clinical, welfare and other information that informs risk should be visible by the whole system from a common source.
“Supporting IT systems must be rapidly made fit for purpose with a focus on assessing and meeting clinical and welfare risks and needs,” the report says, adding that IT systems must ensure Māori particularly are not further disadvantaged.
"There is an absence of connectivity between the organisations providing different care and assessment functions," it says, describing each agency as 'blind' to the information in the other agencies systems.
It recommends that health information held in the Northern Region’s Clinical Portal and in general practice clinical records should be accessible to the clinicians and other teams doing an initial assessment of Covid-19 patients and ongoing health checks when they are isolating at home.
“Clinical support decision making tools should be embedded in the systems being used for screening of both inbound and outbound calls,” the review panel recommends.
A clinical acuity assessment tool has been reviewed and endorsed by the regional Clinical Technical Advisory Group and the panel says it should be urgently implemented.
The report says the re-emergence of Covid-19 in Auckland in August 2021 made community self-isolation “imperative and urgent” and the rapid increase in patients needing the service far exceeded planning and expectations, leading to the service being overwhelmed.
The report says the emphasis on technologies such as SMS, home oximetry, video conferencing and website-based information links is challenging for some patients who may struggle to access it due to low health literacy and lack of data or connectivity.
More here:
https://www.hinz.org.nz/news/588283/IT-issues-highlighted-in-home-isolation-deaths.htm
There is also excellent coverage here:
Review findings released following two deaths in home isolation
Media release from the Northern Region Health Coordination Centre
Monday 29 November 2021, 11:31 AM
The Northern Region Health Coordination Centre (NRHCC) has committed to learn from an independent review into the deaths of two people who had tested positive for COVID-19 and were self-isolating at home.
The independent review panel released its findings today on two separate cases, the first is a person who was living in Manukau. and another in Mount Eden. Both were living alone at the time of their passing.
The review findings have been released following consultation with the whānau of the deceased, who have provided feedback that has been included in the report. This considers each case as well as the Community Supported Isolation and Quarantine (CIQ) system. The NRHCC has already made important changes.
The
Chair of the Review Panel, Dr Jonathan Christiansen, Chief Medical Officer,
Waitematā DHB, has summarised key findings of the report and its
recommendations including:
• The need for earlier assessment of clinical safety, welfare needs and mental
wellbeing of COVID-19 patients in Community Supported Isolation and Quarantine
(CIQ)
• Better connectivity between all parts of the system to ensure clinical
oversight
• Heightened focus on equity and cultural safety, specifically Māori and
Pasifika
• The need for stronger clinical governance for adequate reporting systems and
rapid informed review of adverse events
It also identified significant opportunities to rapidly strengthen the capability, safety, equity and patient focus of the CIQ system.
The panel also considered both deaths were potentially preventable and there were missed opportunities contributing to the outcome.
The report was initiated by the Northern Region Health Coordination Centre (NRHCC) in consultation with the Ministry of Health following the first death on 3 November 2021. The second death followed two days after.
Northern Region Health Coordination Centre Lead (and Counties Manukau Health CEO) Fepulea’l Margie Apa, responded to the report saying:
“It is a very sad time for both the whānau and friends of these two people and our hearts and thoughts are with them as they come to terms with their loss. We are fully committed to providing any support we can.
“People in healthcare work tirelessly to provide the best care possible, however, it is clear that more could have been done and needs to be done. The main lesson is the need for improvement, which is what we are all committed to achieve.
“We unreservedly accept the findings of the review and apologise to the whānau for the shortfalls in the response provided. We are grateful to whānau for providing input at such a difficult time. I want to acknowledge the steps that have already been taken to strengthen the approach and address the recommendations made.
“This has been a thorough but swift process, undertaken by independent experts. This was absolutely essential to ensure transparency and for people to understand what happened.
“These two deaths resulted from a combination of situations and events, and we needed to analyse them quickly so we can improve our care in the future. The model for CIQ we have in place now is not the end point, it is an interim back up while we support primary and community based teams to build their capability to look after their enrolled patients.”
The review report points out the CIQ system was established to meet the needs of a rapidly growing number of patients with COVID-19 and their whānau in a short space of time. It says that, given the speed of change and the complexity of the system, it is remarkable that much has gone well.
It also says there are significant opportunities now to rapidly strengthen the capability, safety, equity and patient focus on the CIQ system and the care pathway overall.
Changes have been made to CIQ in the last three weeks with clinicians, administrators, public health teams and community organisations working to stabilise and improve the system. Improvements made to date include:
o
The piloting of new models with Māori and Pacific providers who are able to
provide holistic clinical, social, welfare and mental wellbeing support
o Immediate clinical assessment using information already available to quickly
identify those who are high risk and needing special clinical, social or mental
health support
o Reduction of the time taken between a positive test and the first clinical
assessment
o The launch of a Hospital in the Home initiative across all three DHBs for
cases needing a lot of health support
o Door knocking for those not able to be contacted, particularly those
isolating alone
o The establishment of a CIQ Clinical Governance Group with the purpose of
identifying emerging risks and trends, so that issues can be addressed. The
Group has already met.
Margie
Apa continues:
“The report highlights a number of areas where improvements to the whole system
were needed. As with the rest of the world, we’re moving in a fast-paced
environment where we have to change our response as things evolve.
“Importantly, one of the key areas of improvement relates to the assessment of individual welfare needs and wellbeing, and there is extensive work happening across the health and social sectors, and with our Māori and Pacific communities, to support a strengthened response.
“We are managing an increasing number of positive COVID-19 cases in the community. What is clear is the serious nature of Delta and how it can affect people very quickly, especially those who are unvaccinated with pre-existing conditions. When it strikes, it can be swiftly devastating.
“This report provides valuable lessons for all New Zealanders who need to take this illness very seriously. Everyone should get vaccinated to give them maximum protection when they are exposed to the virus, and no one should dismiss symptoms or wait and see how it develops.
“Act immediately, get tested and stay at home until you get your result. If you become unwell call healthcare services or your GP, and if you have difficulty breathing or are very unwell call 111. All these services are free when COVID-19 is involved.
“Treat COVID-19 seriously and get help. Listen to the advice you are given. Be aware of your whānau and friends, and help them if needed. Most importantly, get vaccinated to reduce the risk of serious consequences from COVID-19.
“The CIQ system has been analysed in detail in this report. As a health system, a community and a nation, we all have a responsibility to look after each other as we continue to battle this pandemic.”
More here:
It is well known that, because of the large numbers, during COVID19 outbreaks may COVID positive patients with various levels of clinical impairment have been sent home with various forms of home monitoring (e.g. a pulse oximeter and some vitals assessment technology) and told to:
1. Measure and report in regularly.
2. Come to hospital quickly if the feel they are detiorating.
We also know that despite these precautions that all over the world there have been a number of unexpected and problematic deaths.
What this report adds is that there are a range of integration and information issues which may not be ideally handled – as well as issues which would be best described as some problems with the individual’s “social determinants of health” that can add to risk. Clearly health and technical literacy is a big one here!
There were, in this case, also issues of the services that were offered being easily scalable to meet demand.
I found this report a useful reminder of both the need to plan carefully as well as to adjust services that need improvement. This has been especially important in the COVID response globally!
David.
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