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Timely testing: Improving the efficiency of infectious disease screening processes

This project aims to improve the efficiency of infectious disease screening processes to support the NHS to safely re-start routine healthcare services and address backlogs at a faster rate.

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  • Proposal
  • 2020

Meet the team


  • Callum Allen-Ridge (Senior Improvement Practitioner - Perform)
  • Leonie Williams (Improvement Manager - Perform)
  • NBT Infectious Disease Ward Manager
  • NBT Outpatient Pre-operative Service Manager
  • NBT Hospital at Home Service Manager
  • Professor Claire Hulme (Professor of Health Economics, University of Exeter)

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

With an estimated £10 million NHS-wide backlog from cancelled appointments/admissions/surgical procedures during COVID-19 (NHS Employers, 2020), there is mounting pressure to improve COVID-19 (and other infectious disease) testing processes as a prerequisite for re-starting routine healthcare services. However, there is a lack of UK evidence regarding how to improve operational efficiencies in infectious disease testing.

An initial audit of COVID-19 testing processes in 3 North Bristol NHS Trust (NBT) acute clinical areas revealed significant variation and time wastage of up to 8 hours. This negatively impacted timeliness of care provision and prolonged risk of COVID-19 transmission whilst patients of unknown COVID-19 status awaited test results.

Our improvement team formed new collaborations with staff in these clinical areas to identify challenges, develop process maps, and co-design standard operating procedures. Using coaching and data to continually drive improvement, the pilot resulted in 38% reduction in time from admission to test result.

What does your project aim to achieve?

The COVID-19 testing pilot has highlighted an opportunity to improve standardisation of test procedures in other settings (e.g. outpatients, pre-operative services, community services), for other infectious diseases on general infectious diseases wards, as well as improve how Trusts manage the scaling up of repeat testing.

The objectives of this project are to:

  1. Identify contextual factors that facilitate or pose barriers to timely infectious disease testing procedures in various acute, outpatient and community services
  2. Assess the impact of variation in testing processes on potential health inequalities (e.g. during the pilot, delayed testing in Emergency Department disproportionately affected patients with mental health concerns).
  3. Collaborate with a range of Trust settings to enhance operational improvements to testing procedures
  4. Develop rigorous methods by which these operational improvements are evaluated
  5. Develop resources and ‘drop-in clinics’ to support teams in NBT and other NHS Trusts to implement similar improvements

How will the project be delivered?

Project team: The project will be jointly led by clinical teams and the NBT ‘Perform’ improvement team. An Evaluation Lead will assist with analysis and write-up. Business Intelligence will create bespoke metric dashboards. Health economist expertise will be provided by University of Exeter.

Implementation: Service champions will help explore inefficiencies, inequities, facilitators and barriers, then co-design procedures and manage unintended risks/consequences (e.g. change fatigue on the infectious disease ward after multiple relocations/restructures since the pandemic). Each service will undergo ≥2 PDSAs. Further ‘drop-in clinics’ will assist teams to integrate procedures into ‘business-as-usual’ and support new teams within and outside of NBT.

Evaluation: A pre/post design will be utilised for the focused implementation phase, with data collected pre, post, and 3 months post intervention to measure sustainability.

Outcomes: Number of patients tested, sub-process timings (arrival -> specimen request -> specimen logged -> results available), patient experience, and cost of time saved.

How is your project going to share learning?

We will collaborate closely with the Q community. The project team will share the process maps and standard operating procedures for specific services as they evolve, and invite Q Community members to take part in online discussions regarding the design of more efficient processes. Following implementation, updates from each new PDSA cycle will be shared through Q Exchange project page updates. Through a Q Community hosted event/live webinar, operational improvement tools and project learnings will also be shared. We will then invite the Q Community and their wider networks to join us in ‘drop-in clinics’ to explore how similar services in their organisation can be supported to undertake similar improvements.

We plan to write-up the completed project findings for publication in a peer-reviewed journal (e.g. BMJ Open Quality), submit conference abstracts to conferences (e.g. IHI International Forum), and will create a Special Interest Group for operational improvement in healthcare.

How you can contribute

  • Your support to help us to develop our proposal will be greatly appreciated, particularly with regards to the development of ‘drop-in clinics’ that will allow us to share our learnings and expertise in using operational improvement tools for testing procedures more widely beyond our Trust. You can help us by being:
  • The networker and promoter: Help us to promote our idea and reach teams in different Trusts who may be interested in attending our ‘drop-in clinics’ to assist their service to improve infectious disease testing process.
  • The critical friend: We would like your honest feedback to tell us your thoughts about our idea and how we can improve it.

Plan timeline

2 Nov 2020 Complete evaluation of drop-in clinics and sustainability
1 Feb 2021 Final approvals from participating services
1 Mar 2021 Nomination of co-design champions
5 Apr 2021 Finalisation of evaluation plan; resource consultation with Q Community
12 Apr 2021 Co-design group session 1; Baseline data collection
19 Apr 2021 PDSA cycle 1 commencement
17 May 2021 PDSA cycle 1 review, co-design group session 2; Data collection
24 May 2021 PDSA cycle 2 commencement
21 Jun 2021 Begin write-up of evaluation for dissemination (Jun-Dec)
21 Jun 2021 PDSA cycle 2 review, co-design group session 3; Data collection
19 Jul 2021 Event/webinar (share final outcomes with Q Community, launch drop-in clinic)
2 Aug 2021 Drop-in clinics (Aug-Oct)
31 Dec 2021 Submit journal manuscripts and reports; project close


  1. Claire,

    This is a great idea and I do hope that you take it forward. If you need any process visualizations done then please let me know as I'd love to help. Good luck with your idea.


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