Timothy Hicks1,2, Amanda Winter3,4, Kile Green3,5, Patrick Kierkegaard6,7, D Ashley Price3,4, Richard Body8,9, A Joy Allen3,5, Sara Graziadio3,4. 1. NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. Timothy.Hicks@nhs.net. 2. The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK. Timothy.Hicks@nhs.net. 3. NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. 4. The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK. 5. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. 6. NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. 7. CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK. 8. Division of Cardiovascular Sciences, The University of Manchester, Manchester, M13 9PL, UK. 9. Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.
Abstract
OBJECTIVES: The second wave of the coronavirus pandemic is now established, occurring at a time of winter pressure on acute care in the NHS. This is likely to be more challenging then the first wave for the diagnosis of COVID-19 because of the similar symptomology with other respiratory conditions highly prevalent in winter. This study sought to understand the care pathways in place in UK NHS hospitals during the first wave (March-July 2020) for identification of patients with COVID-19 and to learn lessons to inform optimal testing strategies within the COVID-19 National Diagnostic Research and Evaluation Platform (CONDOR). DESIGN, SETTING & PARTICIPANTS: Sixteen hospital-based clinicians from 12 UK NHS Trusts covering 10 different specialties were interviewed following a semi-structured topic guide. Data were coded soon after the interviews and analysed thematically. RESULTS: We developed a diagrammatic, high-level visualisation of the care pathway describing the main clinical decisions associated with the diagnosis and management of patients with suspected COVID-19. COVID-19 testing influenced infection control considerations more so than treatment decisions. Two main features of service provision influenced the patient management significantly: access to rapid laboratory testing and the number of single occupancy rooms. If time to return of result was greater than 24 h, patients with a presumptive diagnosis would often be cohorted based on clinical suspicion alone. Undetected COVID-19 during this time could therefore lead to an increased risk of viral transmission. CONCLUSIONS: During the winter months, priority for provision of rapid testing at admission should be given to hospitals with limited access to laboratory services and single room availability. Access to rapid testing is essential for urgent decisions related to emergency surgery, maternity services and organ transplant. The pathway and prioritization of need will inform the economic modelling, clinical evaluations, and implementation of new clinical tests in UK.
OBJECTIVES: The second wave of the coronavirus pandemic is now established, occurring at a time of winter pressure on acute care in the NHS. This is likely to be more challenging then the first wave for the diagnosis of COVID-19 because of the similar symptomology with other respiratory conditions highly prevalent in winter. This study sought to understand the care pathways in place in UK NHS hospitals during the first wave (March-July 2020) for identification of patients with COVID-19 and to learn lessons to inform optimal testing strategies within the COVID-19 National Diagnostic Research and Evaluation Platform (CONDOR). DESIGN, SETTING & PARTICIPANTS: Sixteen hospital-based clinicians from 12 UK NHS Trusts covering 10 different specialties were interviewed following a semi-structured topic guide. Data were coded soon after the interviews and analysed thematically. RESULTS: We developed a diagrammatic, high-level visualisation of the care pathway describing the main clinical decisions associated with the diagnosis and management of patients with suspected COVID-19. COVID-19 testing influenced infection control considerations more so than treatment decisions. Two main features of service provision influenced the patient management significantly: access to rapid laboratory testing and the number of single occupancy rooms. If time to return of result was greater than 24 h, patients with a presumptive diagnosis would often be cohorted based on clinical suspicion alone. Undetected COVID-19 during this time could therefore lead to an increased risk of viral transmission. CONCLUSIONS: During the winter months, priority for provision of rapid testing at admission should be given to hospitals with limited access to laboratory services and single room availability. Access to rapid testing is essential for urgent decisions related to emergency surgery, maternity services and organ transplant. The pathway and prioritization of need will inform the economic modelling, clinical evaluations, and implementation of new clinical tests in UK.
Authors: Peter Horby; Wei Shen Lim; Jonathan R Emberson; Marion Mafham; Jennifer L Bell; Louise Linsell; Natalie Staplin; Christopher Brightling; Andrew Ustianowski; Einas Elmahi; Benjamin Prudon; Christopher Green; Timothy Felton; David Chadwick; Kanchan Rege; Christopher Fegan; Lucy C Chappell; Saul N Faust; Thomas Jaki; Katie Jeffery; Alan Montgomery; Kathryn Rowan; Edmund Juszczak; J Kenneth Baillie; Richard Haynes; Martin J Landray Journal: N Engl J Med Date: 2020-07-17 Impact factor: 91.245
Authors: Patrick Kierkegaard; Timothy Hicks; A Joy Allen; Yaling Yang; Gail Hayward; Margaret Glogowska; Brian D Nicholson; Peter Buckle Journal: Implement Sci Commun Date: 2021-12-18
Authors: Charles Reynard; Joy A Allen; Bethany Shinkins; Graham Prestwich; Johnathan Goves; Kerrie Davies; Richard Body Journal: Emerg Med J Date: 2021-11-05 Impact factor: 2.740