Steps for Effective Patient and Staff Contact Tracing to Defend Against COVID-19 Spread

Steps for
Effective
Patient and
Staff Contact
Tracing to
Defend Against
COVID-19
Spread Josh Ferguson, APRN, ACNP, ANP-BC, VP of Clinical Outcomes Improvement
John Hansmann, MSIE, LFHIMSS, DSHS, Professional Services, VP
Mark Nelson, VP, Business Development
Monica Horvath, Strategic Consultant, Health Intelligence & Product Adoption

© 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Preventing COVID-19 Transmission
As the novel coronavirus spreads rapidly
through communities and until a vaccine
or effective treatment is available,
preventing disease transmission is likely
the best management strategy.
Because the virus that causes COVID-
19 (SARS-CoV-2) appears to spread
mainly through respiratory droplets from
person-to-person contact (e.g., coughs,
sneezes, or speech), knowing where
infected patients have been and with
whom they’ve been in contact is vital.

Contact tracing follows COVID-19-
confirmed patients through the health
system, informing surveillance teams
where patients have been in the
facility and with which staff members
they’ve interacted.
These vital insights support
transmission management by
informing testing, quarantine efforts,
and decontamination activities.

Before COVID-19, many health systems
did not prioritize the active monitoring of
the in-house spread of infectious disease.
While paper-based, manual tracing
processes have been the norm, they
generate only a limited picture of the
natural patient flow patterns across
hospital departments and fail to drive
preventive workflow modifications.
Now with COVID-19 making the need
for better patient tracing urgent,
organizations must adopt capable
patient-and-staff-tracing processes.

Patient and Staff Contact Tracing: Part of an
Active Infection Surveillance Strategy
Contact tracing aligns existing patient
flow data (from manual tracking) with
indicators of potential staff exposure
from the clinical record, such as which
parts of the facility the patient entered
and the types of treatments or testing,
they underwent.

Contact tracing aligns existing patient flow
data (from manual tracking) with indicators
of potential staff exposure from the clinical
record, such as which parts of the facility
the patient entered and the types of
treatments or testing, they underwent.

These rich insights into the patient journey help organizations plan their
strategy as they progress through the following phases:
Provides baseline
information about the
natural flow of patients
through a hospital
setting.
Preparation
Identifies infected
patient volume and
gives insights into any
emerging irregular
patient flow patterns.
Growth
Tracing allows incident
command centers to
develop and revise any
patient flow infected
patients while putting
other services (e.g.,
elective procedures) on
hold.
Infection Surge
As infection incidence
declines, health
systems need to
observe when patient
flow patterns are
returning to their natural
cadence and make
changes to avoid
exposing uninfected
individuals to the virus.
Recovery

To fulfill the above critical COVID-19
contact tracing roles, Health Catalyst
created the Patient and Staff Tracker early
in the course of the 2020 pandemic.
The tracker provides analytic insights
surrounding patient movement and
interactions between staff and patients with
either a confirmed or suspected infection.
These data can then encourage informed,
data-driven, and timely action.

From Identification to Action
The first step of contact tracing is to identify
the initial population of infected individuals.
Health Catalyst leverages cohort discovery
tools, such as its Population Builder™, to
allow searches for patients according to
customizable criteria.

Users can identify an initial population,
typically from diagnostic testing or
diagnosis codes, then enrich the results
with additional data, including the following:
Admit-discharge-transfer
data that describes the
movement of patients
through the hospital,
ideally at the bed level.
Data from electronic
documentation that
uniquely identifies staff
and their interactions with
patients (e.g., activity-type
interactions with patients,
orders, notes, etc.).

Once patient tracing insights are
available, dashboards provide
visualizations to inform infection
prevention teams, incident command
leadership, infectious disease experts,
hospital unit leaders, employee health,
and risk management departments.
COVID-19 response teams can then
leverage tracing data to drive
actionable insights.

The following questions can inform these insights:
• Are unnecessary departmental transfers minimalized to
reduce exposure risk to other patients and staff?
• Are there unrealized ancillary staff (e.g., environmental,
dietary, or transport services) interacting with infected
patients?
• Have additional patients been exposed through sharing
a room or other location with an infected individual?
• Are staff adhering to infection mitigation and
containment practices?

Tracing Data Supports Multiple Processes
How organizations fold contact tracing into
their exposure investigation efforts depends
on the unique needs of the specific hospital
and the community it supports.
Some sites may choose to integrate
exposure monitoring into outpatient case
management workflows for uniquely at-risk
individuals.
If detailed transfer data from outside
facilities are available, including it in the
contact tracing data strategy might lessen
both exposure risk and unnecessary testing.

Tracing Data Supports Multiple Processes
Additionally, contact tracing can help
employee health departments at health
systems understand whether infected staff
members were possibly exposed at work,
as their treatment may become a workers’
compensation claim.
And risk management teams may want to
conduct risk assessment activities on
potentially exposed patients and staff and
collect more in-depth data regarding
personal protective equipment usage or
perceived exposure length of time.

A Must-Have Short- and Long-Term Capability
As the long-term impact of many of the
COVID-19 treatment protocols remains
unknown, aspects of the patient
experience captured within contact tracing
can support ongoing preparation.
By revealing the most common pathways
through hospital departments for different
care episodes, contact tracing feeds
forecasting methods, allowing
organizations to scale their disaster
planning approaches by outbreak severity.

Tracing insights might also inspire
workflow efficiencies to limit future
exposure risk, and aspects of the
contact tracing data, such as how
long an infected patient spends in a
department, may have meaningful
relationships to lifelong outcomes.

COVID-19 is not likely the last
infectious disease crisis the U.S.
health system faces, and there’s no
known end to the current pandemic.
Some models suggest the need for
rolling lockdown periods while the
outbreak fluctuates seasonally.
For organizations committed to
continuous improvement, historical
contact data will be invaluable to
future disaster planning efforts.

The Bigger Picture of Emergency Management Planning
While patient-staff contact tracing is a focus
for the current COVID-19 pandemic, health
systems can use many of the same
strategies to prepare for future outbreaks
with the potential for similar capacity strains.
Organizations must strengthen their data-
driven emergency planning and monitoring
capability to react in an appropriate, efficient,
and timely manner.

The Bigger Picture of Emergency Management Planning
For many organizations, COVID-19 has
highlighted gaps in their patient flow
data strategy.
Looking towards contact tracing using
existing data sources is a meaningful
first step in growing an active infection
surveillance strategy.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
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Health Catalyst Editors

Josh is a nurse practitioner who has over 20 years of nursing experience. Most recently,
Josh joined Health Catalyst as a Clinical Outcomes Improvement Director. In this role,
he helps healthcare organizations achieve their improvement goals. Prior to joining
Health Catalyst, Josh worked at Intermountain Healthcare in a respiratory and medical
intensive care unit as a nurse practitioner. During this time, he also worked closely with
multiple clinical program leads and clinicians to develop and implement systemwide
applications, protocols, and order sets to reduce variation in care. You will also, on
occasion, find him lecturing to nurse practitioner students at the University of Utah.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Josh Ferguson APRN, ACNP, ANP-BC

John Hansmann, MSIE, FHIMSS, DSHS joined Health Catalyst in October, 2015 as a
Sr. Director. He has over 30 years of healthcare experience in operations, productivity
management, strategic and IT analyses. Prior to coming to Health Catalyst, John was
the Senior Director of Labor Management & Productivity for Tenet Healthcare
Corporation. Prior to Tenet, John worked for Intermountain Healthcare as the Urban
South Region Manager of Management Engineering. He has expertise in the
development of standardized nursing care models and staffing practices, optimizing
patient throughput, work redesign and leading workflow analysis. John is a Fellow of the
Healthcare Information and Management Systems Society (HIMSS), a senior member of the Institute of
Industrial Engineers (IIE) and Diplomate within the Society for Health Systems (SHS.) He is a past Board
member for HIMSS and past President for SHS. He currently serves on the Advisory Board for the school
of Industrial and Manufacturing Engineering (IME) at North Dakota State University (NDSU.) He received
his BSIE and MSIE from NDSU.
John Hansmann, MSIE, LFHIMSS, DSHS

Population Health and Quality analytics solution designer with deep experience serving
healthcare organizations. 19+ years experience in the design and execution of research
methodology, informatics, and analytics. My mission is to design and deploy products
and services that meaningfully improve the value, quality, safety, and experience
patients receive when getting healthcare.
Monica Horvath

No Bio at this time.
Mark Nelson

Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in
support of more than 65 million patients for organizations ranging from the largest US health system
to forward-thinking physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

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