Recording activity relating to coronavirus (COVID-19)

Question:

Please can you confirm if the critical care minimum data set will need to be submitted for the additional COVID surge beds?

Answer:

The Critical Care Minimum Data Set overview states:

“The Critical Care Minimum Data Set has been developed to be used in all units where Critical Care is provided. That is where the CRITICAL CARE LEVEL is National Code:

• 02 Patients requiring more detailed observation or intervention including support for a single failing organ system or post-operative care and those 'stepping down' from higher levels of care

or

• 03 Patients requiring advanced respiratory support alone or monitoring and support for two or more organ systems. This level includes all complex patients requiring support for multi-organ failure.”

This includes non-standard locations where the delivery if care is CRITICAL CARE LEVEL 2 or 3 and the duration of care is more than 4 hours. These would probably be categorised as code 90 (non-standard location using a ward area) or 91 non-standard location using the operating department, in CRITICAL CARE UNIT FUNCTION.

There is also UNIT BED CONFIGURATION which describes the mix of critical care bed types.

To summarise, if a WARD has been repurposed on a more permanent basis as a critical care unit, then the ward operational plan details for that ward and those beds should be re-categorised as for critical care and reported through the Commissioning Data Sets as normal critical care beds (i.e. the 4 hour rule doesn’t apply – it’s any length of time). If, however, it is a very temporary utilisation of a theatre recovery area as short term critical care, then don’t categorise the bed as critical care.

By ‘temporary’ we would say where it’s only known at very short notice that an area was going to be used for critical care delivery (say a patient suddenly required organ system support but there were no beds available in usual critical care unit).  We wouldn’t say that if you are planning on setting beds up in non-standard locations and saving them for COVID patients (or for non-COVID patients with other conditions requiring critical care, if you are keeping COVID and non-COVID separate), that this would be classed as ‘temporary’. 

Question:

Is there a requirement to report admission/appointment cancellations due to COVID-19?

Answer:

We are not aware of any requirement to report admission/appointment cancellations due to COVID-19.

However, it is perfectly permissible for Trusts to locally record any code they like, as long as it is mappable to a national value for submission.

Question:

Can you clarify how COVID-19 cases should be coded in the Emergency Care Data Set (ECDS)?

Answer:

Can we refer you to the latest updated information on the ECDS page: https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/emergency-care-data-set-ecds/ecds-latest-update#communication-from-the-royal-college-of-emergency-medicine-rcem-

Subsequent to the publication of the guidance, NHS Digital Terminology Services have confirmed that 12407510000000100 - Disease caused by 2019-nCOV (novel coronavirus) should be used rather than the SNOMED CT international code mentioned by the RCEM.  However, if the international code IS submitted, Secondary Uses Service will accept the field and the submission will not fail.

Question:

Definition of proxy for Mental Health Contacts.

Our Mental Health Services for Older people dietetics team are currently working from home and rather than going on to the ward and seeing the patient they are contacting the ward via phone and speaking to the nursing staff about the patient. Would this occurrence ever be classed as a proxy contact?

Also, would this differ if they were contacting a Care Home via phone and speaking to the staff about the patient as opposed to visiting the Care Homes and seeing the patient?

Answer:

Given the circumstances it would be permissible to record these types of activity as care contacts, with a Patient Proxy (given that the patient would have been seen face to face in normal circumstances), in both the scenarios you describe. 

As you are changing the way you record activity, you may wish to discuss this with your Commissioner(s).