Introduction
The COVID-19 pandemic is sweeping across the length and breadth of the UK. As a result, NHS England has issued guidelines for effective triaging[1] of urgent cancer ‘two-week wait’ referrals[2]. The intention of this guideline is to minimize the disruption to cancer services.
In order to fully understand the implications of this manual triage approach, this article will first explain the triage process during normal circumstances, and then highlight the additional impacts due to the coronavirus emergency. Finishing with a solution from YouDiagnose that will show how it can substantially improve the efficiency of the triaging process; a solution that could ultimately save lives during the pandemic.
What is the triage process under normal circumstances?
Triage is an involved exercise to prioritise the order or pathway of management from large numbers of referrals. This is done by assigning degrees of urgency to suspected cancer cases and prioritising accordingly
Triage aims to achieve a delicate yet complex balance between inappropriate referrals and missed/delayed diagnosis.
The incidence of delayed diagnosis in the UK are around 115,000 cancer patients out of 363,000 new cancer diagnosis every year [3] [4], while inappropriate GP referrals amount to at least 278,051; though the actual number can be as high as 750,000 in a year [5].
Triage itself is a resource-intense process involving the active participation of consultants, specialist doctors, secretaries, booking office, GP doctors, GP secretaries and booking office navigators.
The following is an example of the triage process for bowel cancer.
And a triaging workflow example from one of the NHS Trusts.
The triage process changes during the coronavirus emergency
The coronavirus emergency will only heighten the existing complexity of the manual triage process
As per the letter sent to the Cancer Alliances, the hospital consultants now have to be in agreement with the referring GP, if the patient is not going to be considered for the ‘two-week wait’ referral pathway.
The NHS England directive also puts an emphasis on greater communication between primary and secondary care to downgrade or reject the referrals. This, directly and indirectly, reflects how daunting the whole triage process will become. With the to and fro communications between the hospital and GP surgeries, there will certainly be an increase in overall workload.
The critical issues affecting triage during the coronavirus emergency
The reduced manpower and rising pressure on hospitals arising from backlogs, where there are already pre-existing capacity issues during periods of normalcy, will create severe strain.
If we put additional pressure on a strained system, the hurried triage process can result in over-investigations, inappropriate referrals, missed diagnosis and medical errors. Therefore, the question arises whether we should be allocating our scarce professional resources for triage when they are already thin on the ground.
The solution
A solution is desperately needed at this stage to remove as many manual processes as possible through triage automation
Speaking with Team YouDiagnose, their solution appears to have considered all aspects of the problem. They have taken the initiative to create an end to end solution for data-driven triage automation with clinician’s validation as the last step. This will not only reduce manual steps but also adds to safety through the hybrid model of decision making.
Data-driven triage automation brings seamless unification of all the steps, obviating the need for much of the laborious manual multi-stakeholder work. All of which provides the following benefits: –
- Increased accuracy of referrals by data-driven decision making.
- Improved patient safety arising out of the hybrid model of working.
- Greater system efficiency reducing patient wait time.
- Greater cost efficiency in the healthcare system
- Reduced carbon footprint due to the reduced number of printouts
- Improved physician and patient satisfaction
- Early detection of cancer
- Saving the vulnerable from potentially contracting coronavirus by augmenting the social distancing process
- Saved work hours from clinicians, secretaries, navigator, booking office and GP practices.
Conclusion
At a time when the country is struggling with the Coronavirus pandemic, a solution like data-driven triage automation could save thousands of lives and help in optimum utilization of the scarce resources we have at our disposal.
References
[1] Triage is the process of determining the priority of patients’ treatments based on the severity of their condition and the availability of resources [2] A ‘Two Week Wait’ referral is a request from a General Practitioner (GP) to ask the hospital for an urgent appointment for the patient, because the patient has symptoms that might indicate that they have cancer. https://www.hey.nhs.uk/patient-leaflet/urgent-two-week-wait-referral-hospital-information-patients/ [3] Cancer Statistics for the UK https://www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk [4] Lack of government action on NHS staffing undermines ambition to diagnose cancer early https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2019-09-02-lack-of-government-action-on-nhs-staffing-undermines-ambition-to-diagnose-cancer-early [5] GPs in England receive over 250,000 inappropriate NHS 111 referrals per month http://www.pulsetoday.co.uk/news/all-news/gps-in-england-receive-over-250000-inappropriate-nhs-111-referrals-per-month/20039017.article [6] To cancer alliance – NHS England https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/cancer-alliance-information-on-managing-cancer-referrals-19-march-2020.pdfTracey Swales
Tracey spent over 20 years in the global technology industry, creating global consulting businesses for companies such as Hewlett-Packard Enterprise with a focus on transformation services, with both proven and emerging technologies. Working with some of the largest companies in the world, in most countries in the world, as well as smaller enterprises, understanding their business needs, risk concerns and success inhibitors for implementation of technology transformation projects
In 2018 Tracey founded Portable Kingdom Limited in order to focus on supporting traditional businesses with AI adoption (including board advisory) and start-ups with global AI product go-to-market (including product strategy, product management, product liability and IP protection). With a focus on Health (plus Social Care and Wellbeing) and Retail.
Tracey has specific expertise in legal-ethical-strategy impacts, combo-tech solutions (AI, AR/VR, robotics, blockchain), corporate governance frameworks, organisational structures, processes and technology standardisation.
Tracey is a member of the Society for the Study of Artificial Intelligence and Simulation of Behaviour (AISB) and the All Party Parliamentary Group for AI (APPG AI).