Trusts concerned over long waits for covid-19 test results

Last week at least three trusts in south London faced waits of five to seven days for test results, while several acute trusts in the Black Country waited five days, multiple sources told HSJ.

Positive covid-19 tests can take three days to complete for Basildon and Thurrock University Hospitals Foundation Trust, while a source at Countess of Chester Hospital Foundation Trust reported waits of between three to four days last week, but said the trust had now launched an in-house service resulting in 24-hour turnarounds.

It comes as the NHS attempts a five-fold increase of covid-19 testing across England.

Patients at risk of infection while waiting for tests

Covid-19 tests are supposed to be completed within 24 hours, although some trusts have reported turnaround times of as little as six hours.

Testing for the virus has been run by Public Health England, which has been approached for comment.

HSJ understands the long waits for covid-19 test results has caused problems for affected trusts due to patients being cohorted until the results have been confirmed.

This means patients awaiting covid-19 tests have remained on wards with other patients who either have the virus or are also awaiting their test. This results in increased pressure for staff, while a patient whose results eventually come back negative has been at risk of infection while waiting, senior sources have reported.

It also causes a problem with patient flow more widely, and with tracking the geographical spread and impact of the virus.

London, followed by the Black Country, have seen the highest number of covid-19 deaths in England so far.

NHS told to ramp up testing quickly

PHE has been in charge of covid-19 testing since January and is currently processing around 1,500 tests daily. However, last week NHS trusts were told to nominate lead laboratories across 29 areas which must each start providing 500 tests per day, as health chiefs seek to rapidly ramp up testing.

This equates to a five-fold increase overall, acccording to the Royal College of Pathologists — although some trusts have mobilised quickly. For example, Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust have created a process that enables tests to be turned around in six hours.

Today, the government indicated there would soon be a further major expansion of testing.

Cressida Auckland and Emma Hallett, who run the RD&E laboratory, said the trust already had a testing platform with the relevant kit in place to start testing for the virus — while RD&E and NDHT use the National Pathology Exchange service which enables test results to be automatically uploaded to both trusts’ IT systems. Many trusts do not have such a system in place. 

The trusts are currently running between 40 to 100 covid-19 tests daily, but expect to provide 500 tests by next week.  

Supply problems

However, the dramatic rise in tests required has coincided with supply issues cropping up, according to one former pathology chief.

Hugh Risebrow, who used to run a pathology firm working for NHS trusts, told HSJ there was a shortage globally of kit required to carry out tests.

Covid-19 tests are performed by taking a swab of the nose or throat, or samples of sputum, which is then examined by labs, where technicians extract genetic information which is mixed with other agents and put in a testing machine.

Mr Risebrow said there are “plenty of machines” in the NHS to carry out the process, but not always enough of the equipment needed to extract the DNA from a patient’s sample due to “global shortages”.

“The global supply chain is trying to get more of these kits made but obviously every country in the world needs these kits so that’s where the real bottleneck is,” he said.

Jo Martin, president of the Royal College of Pathologists, described the required increases in testing as “a considerable ask”, but added pathologists were “already rising to the challenge”.

She said: “We are working with government, multiple organisations and other stakeholders to help work through challenges with staffing pressures and difficulties with the supply chain at several stages in the testing process.”