When COVID-19 changes the rules: Understanding the rapid implementation of a pathology result notification service – A case study (Preprint)

Abstract

The COVID-19 pandemic put enormous pressure on health systems around to world, including the New South Wales (NSW) Health system, it was also a significant driver of change. COVID-19 test data was, and remains, important to identify positive patients and monitor outbreaks and clusters [1]. This increased demand for NSW Health Pathology (NSWHP) testing and disrupted usual clinician pathology referral pathways, meaning that there was no simple way to rapidly deliver the large volume of negative patient results which was undertaken manually by staff. The NSWHP COVID-19 SMS Result Service (the Result Service) was introduced to alleviate pressure on frontline clinical staff due to surging demand for pathology testing and manual notification of results. At the start of the pandemic, negative results were taking up to ten days to be reported manually to patients. The introduction of automated result notification freed resources to focus on patients who tested positive including clinical management, support services and contact tracing. Successful implementation of the Result Service relied on partnering with Local Health Districts (LHDs).

Through a purposive sample of LHDs, this study explores contextual factors using the Practical, Robust, Implementation, and Sustainability Model[2] that influenced LHD adoption of the Result Service. The aim is to inform the planning and implementation of other technology resources for result notification and/or the delivery of pathology services to LHD customers and patients for other non-pandemic purposes.

We used a mixed methods approach. A semi-structured one-time survey was issued to a total of 239 staff from a representative sample of four metropolitan, regional and rural LHDs to elicit the views and experience of LHD staff, about the implementation of the Result Service. The survey was supplemented by analysis of retrospective NSWHP enterprise data related to COVID-19 testing and Result Service uptake rates.

Within a month of implementation of the Results Service, registration rates increased sharply from 10% to 75% in all four LHDs. Despite the low response rate 13% (31), several themes emerged from the survey. Most participants agreed that the Result Service benefitted the people of NSW and their LHD. The highest ranked factors that influenced the implementation were demand on frontline staff (4.57 out of 5), direction or support from the COVID-19 Lead (4.50 out of 5) and “patient demand” (4.48 out of 5).

This study explores the contextual factors that influenced successful implementation of the Result Service using the PRISM model. Based on staff feedback, the study found this included increasing demands on front-line staff, unfunded resource impacts and pressure from patients. This study will inform further research into the implementation of similar technology projects, specifically when they are dependent on partnering organisations.