The WHO definition of the phases of a pandemic have been previously established. Currently, we are in Phases 5 and 6 of COVID-19 (1). This makes specialty service delivery and planning challenging as human and financial resources are diverted into acute care for COVID-19 related disease.
The BSG has already published strategies for endoscopy service in the build-up or acceleration phase of the current epidemic (2) related to phase 5 and 6 of the WHO classification (phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region: phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6 indicates that a global pandemic is underway).
Purpose of this document
This document accompanies three grids: two related to service planning, in which priorities for planning and delivery across the specialty of GI medicine are proposed. The aim is to provide a pragmatic ‘toolkit’ for GI unit operations, during COVID-19. The third is a ‘dictionary’ of codes for specialty conditions and procedures. ICD-10 and OPCS have been used and new SNoMed CT codes are also included for ease.
The language and definitions used in these grids and this document, have been shared with other specialties and organisations and are being used to inform a government advisory for the tracking and assessment of service nationally.
The narrative in this document is intended to be read in conjunction with:-
Grid 1: Defining and identifying the phases of an epidemic for GI service planning purposes
Grid 2: What to do and when – an advisory on priority service activity in defined phases of the COVID epidemic
Grid 3: Dictionary of coding for use in tracking
Grids 1, 2, 3 and this summary narrative are the proposed ‘tool kit’ for specialty GI service planning. This consensus guidance for COVID-19 has been produced by the BSG and will be reviewed and updated in due course.
This document assumes the following national mitigations will be optimised:-
- continued non-pharmaceutical control measures to suppress contagion
- the security and adequacy of the PPE supply chain
- the roll out of rapid and widespread COVID-19 testing facilities
- the emergence of new data on treatment efficacy
Cathryn Edwards, BSG President
Alastair McKinlay, BSG President Elect
On behalf of the BSG COVID-19 Emergency Executive: Andy Douds, Stuart McPherson, Phil Newsome, Beverly Oates, Ian Penman, Adrian Stanley, Tony Tham, and Mark Hacker (CEO)
This grid has been produced to aid the standardisation of language and definitions as they relate to the phases of the COVID-19 epidemic in the UK. The evidence base for such definitions is limited (3,4). A practical and pragmatic approach has been taken, using commonplace terms: these will be adjusted as standardised language usage is updated.
The aim is to give Units a standard frame of reference and to allow them to assess where their Unit sits within the timeframe of the epidemic. This allows them to apply Grid 2 principles to service planning and delivery.
The purpose of this service planning and delivery grid is to avoid, where possible, unintentional harm to patients with non-COVID-19 related disease, as a result of disruption to service provision due to the COVID-19 environment. The content is consensus opinion based and is offered as guidance.
Each workbook holds a list of the most frequent clinical presentations, diagnoses, conditions and endoscopic procedures for each sub-specialty of GI medicine. The grid lists have been categorised in this manner, to align with ongoing requests from Government for data on these particular conditions. They have been prioritised on a clinical basis, fitting with our understanding of, emergency (<24 hours); urgent (1-2weeks); soon (within 4 weeks) and routine (>30 days) priority (see column A of each workbook).
The rest of the columns indicate the priority for service action, based on a ‘Continue’ (green) ‘Suspend’ (yellow) and ‘Start’ (orange) instruction.
There is general acceptance that the infection rates with COVID-19 may fluctuate as public health measures relax, so moving backwards to the level of activity in the preceding phase of the epidemic may be necessary for some Units. This will have to be judged at a local level.
NHS England intend to perform a gap analysis on data from all Trusts in England to estimate the delay to OP service times for patients referred to specialty care; comparing last year to this. By identifying the commonly used codes for the clinical descriptors we have generated, the aim is to support a unified approach using specific ICD-10 or OPCS coding.
Whilst the NHSE request is specific to England, it is likely that similar exercises to track and analyse service delivery for non-COVID-19 disease during the epidemic will be undertaken by all of the devolved administrations. Consistent use of codes by units throughout the UK will therefore be of paramount important if an equitable assessment of national services is to be made.
Although SNoMed coding is not widely used in most current hospital systems, looking to the future, we have been grateful to a national expert in this area to translate the clinical descriptors to SNoMed, so that future tracking might be made more consistent and further unified. Currently, procedures i.e. diagnostics, are not translatable to SNoMed, so only ICD-10 or OPCS codes are supplied for these.
Grid 3 is, therefore, a dictionary of codes to help standardise tracking and follow up.