NHS Lothian care home probe finds 'fewer than five' cases linked to coronavirus outbreaks

NHS Lothian has identified five cases of patient transfers from its hospitals to care homes that coincide with outbreaks within care settings during the first wave of the coronavirus pandemic.

The health board, which has so far refused all freedom of information requests from journalists and politicians regarding patient transfers at the height of the pandemic, has now published an overview of its own internal investigation into care home transfers.

However, the health board is still refusing to say exactly how many hospital-to-care-home discharges likely resulted in coronavirus outbreaks in care settings.

The investigation, overseen by NHS Lothian’s executive director of nursing, midwifery and allied health professionals, Alex McMahon, sought to whittle down the number of discharges from hospitals to care homes and identify which were ‘probable’ or ‘possible’ causes of care home outbreaks.

NHS Lothian has identified five cases of patient transfers from its hospitals to care homes that coincide with outbreaks

Health chiefs analysed 787 discharges from March 1 to May 31 of this year ‘to determine the likelihood that they had introduced COVID into a care home’, although the investigation report admits ‘it remains unlikely that all discharges to care homes in the period have been captured’.

Of those analysed, 41 were felt to warrant further investigation, and were assessed against known outbreaks in Edinburgh and Lothian care homes.

Of the 41 discharge episodes, 38 patients were discharged to 21 different older people’s care homes in Lothian. Twelve of these homes were in Edinburgh with nine elsewhere within the NHS Lothian area.

Now, the health board is reporting that out of those 41 instances, five discharges, involving five different patients, have been identified as occurring at a ‘critical point’ of the respective care homes’ outbreak timeline.

A number of those five patients have been assessed as either ‘probable’ or ‘possible’ causes of care home outbreaks, but NHS Lothian is refusing to give an exact number, claiming that ‘statistical governance disclosure control prevents release of the exact number’.

The report adds that a full virology review, including genome sequencing, is being pursued for the cases identified as likely transmission events into a care home.

The report concludes: “A comprehensive review of the previously highlighted 41 cases established that, while some had been discharged positive, they had proper instructions to isolate upon discharge and the care home knew the patient was positive before accepting the patients.

“Additionally, several patients were found to be positive on or within two days of admission (from the same care home where they were later discharged to).

“Five discharge episodes were determined to have possibly introduced Covid into a care home following discharge from hospital.

“It should be noted that all these cases were prior to 22 April 2020 when the national requirement for two negative tests prior to discharge was instituted.

“Once those deemed, through separate clinical review by medicine of elderly clinicians, as ‘unlikely’ to have had covid at time of discharge are set aside, less than 5 remain, with discussions in every case documenting the need to ensure isolation of the patient in the care home.

“Statistical governance disclosure control prevents release of the exact number.”

In a press release, Mr McMahon said: “We recognise how concerning this has been for residents of care homes and their families and how important it is to understand the impact of the discharge of patients from hospitals to care homes in the early months of the pandemic, before testing was introduced. We are very sorry for the distress this has caused.

“In line with our values of openness and responsibility we are publishing this report at the earliest opportunity, as we said we would.

"It is a mark of the importance NHS Lothian places on this issue that our review has been so thorough and detailed.

"This has been a significant piece of work requiring meticulous examination of the medical records of well over a thousand patients discharged from NHS Lothian during the period from 1 March to 31 May 2020.

“We now know that there was a small number of discharges - fewer than five – involving patients who were later found to have had the virus and who could potentially have introduced it to their care homes.

"However, it is still not yet known if these cases were the source of onward transmission and further virology tests are required to establish that.”

Joseph Anderson, Local Democracy Reporter

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