Devising the optimal routing for GPs and nurses in Somerset to visit local housebound patients and provide COVID-19 vaccinations in the most efficient way.
We all know that vaccinations are the key to getting through the COVID-19 crisis. But how do you make sure housebound patients receive their vaccines in the most efficient way.
As the Primary Care Networks (PCN) in Somerset began to rapidly roll out the COVID-19 vaccination programme they were looking to make sure that their housebound patients were able to receive their vaccines in the most efficient way. The approach for the first round of vaccinations had turned out to be quite hectic and a clever solution was needed quickly.
Allison Nation, Associate Director of Digital Strategy for Somerset CCG was approached by one of her PCN GPs asking, 'Is there not some clever tech the CSU have, like using mapping?'
Allison immediately thought of the SCW GIS (Geographic Information System) mapping team and approached them for help with the project. The need for speed was escalated as a second PCN in Somerset wanted the solution urgently for their 200 housebound patients.
In planning how vaccinators go out and see patients there are a few parameters to consider:
1. Where is the vaccine stored? And therefore where does it have to be collected from. This is usually one central place in a PCN area.
2. What time of day do vaccinators start and what time do they plan to finish?
3. The vaccine vial contains 11 doses and it is critical to use all doses and not waste any.
4. Once open the vial contents last 6 hours. Within this time up to 11 jabs need to be completed.
The GIS team were able to take all the patient addresses and plan the optimal routing to cover as many patients as possible in as few journeys so they can fit within the time window for the vial.
This is achieved by modelling a structured data set that contains a unique patient identifier, such as NHS or EMIS system number, and the full address to pinpoint specific house locations. Using this data the analysis creates the fewest amount of trips needed over the time period.
Each route is sequenced from start to finish, giving the order in which the mapping tool recommends the visits be done. The sophisticated modelling also builds in other relevant factors. These include breaks, households with more than 1 patient, time taken to ring the doorbell, chat with the patient, give the jab and sit with the patient for 15 minutes recovery.
The journey data is supplied in a spreadsheet with a map providing a visualisation of the routes. Each location is shown as a dot on the map. These are then clustered into groupings to match the dosage and time requirement. Routes can include patients from multiple practices within the PCN with GPs vaccinating each other’s patients to increase efficiency.
The GIS team were able to react extremely quickly to the original request. Using their expertise with the Esri software they were able to build the original model and procedures in less than two weeks from initial contact on 22 January to launching a full solution to the PCN on 4 February.
Crucially, the solution minimises wastage of the vaccine.
PCNs can plan thoroughly and communicate in advance. Patients in each cluster will know when to expect their visits and vaccinators can call patients to confirm an accurate time. The model also builds in contingency time for unexplained delays. This maximises the vaccination programme success rate.
The routing solution saves the PCN time and money.
Before working with the GIS team the PCNs planning was often not optimised and journeys quite chaotic. This resulted in increased journey times. Not only was it taking longer but fewer doses being given per day. This increased the number of days needed for vaccinations and consequently the cost of delivering the programme.
The mapping solution can be used to improve vaccination planning for the remaining first jab patients’ who are housebound, and to plan the second round of jabs and enable these to be managed more efficiently.
Using their expertise in the Esri software to model the data and interpret requirements into logical solutions, the GIS team were able to deliver the initial development in less than two weeks.
With development of all the procedures now complete, and any pitfalls already resolved, the solution is now ready to be set up for new PCNs within only 1-2 days, provided good patient data is supplied (templates are provided).
Additional benefits of this approach
- Flexibility - The system has the flexibility for PCNs and practices to easily amend journeys themselves if circumstances change.
- Optimal usage - Vaccine usage can be maximised by calculating using a mix of doses per vial up to the maximum per journey to map the best route. PCNs now have a much more analytical, planned way of doing it.
- Confidentiality - Patient confidentiality is protected as no patient identifiable data is transferred from practices. Patient name and contact details are matched only within the practice and they follow up to make appointments.
- Secure - The solution has been developed using proprietary Esri commercial software which SCW owns, so the system is secure.
- Accurate - The data provided is the most accurate available. As an Ordnance Survey (OS) partner SCW has access to specific OS products to deliver this accuracy. To calculate the routing we use their national routing network dataset. We also use the OS national official addresses of the UK, address base premium, to pinpoint specific households, minimising time to find patients. As an approved data processor for NHS England national patient data sets, we ensure the most up-to-date details are used, further increasing accuracy.
Dr Sally di Mambro, GP principal/partner at Wellington Medical Centre/Taunton Deane West PCN told us:
'The GIS team assisted at short notice in allocating our 220 housebound patient groups into ordered geographical groups.
With 3 practices and crossing over lists/ geographical areas, it is a way in which the housebound vaccinating can be organised without the need for agonising lists and cross-referencing between practices.
The templates are clear and functional and the time allocation per vial of AZ 6 hours as well as sensible prediction of times with patients allows a clear representation of what is possible.
The team add in the travelling times and provide a clear estimation of the total time required per vial. We have found the team approachable and responsive. They have risen to our last-minute demands with efficiency and professionalism. In short, the exercise has been time well spent.'
Allison Nation, Associate Director – Digital Strategy, Somerset CCG told us:
'A well organised, professional and highly responsive team who clearly wanted to help our local practices as part of the PCN COVID Vaccination programme, in planning large groups of vaccinations for housebound patients.
The team engaged to understand the need and context and were quick to identify the key questions, data set, work through relevant information governance and technical details. Clarity was sought when needed and issues addressed in a timely manner. A great outcome in a high paced programme!'
Find out more information about our Geographic Information Services (GIS).