Virtual monitoring in COVID-19最新文献

{"title":"P23 Implementing a daily virtual COVID-19 multi-disciplinary team meeting in secondary care","authors":"J. Wingfield Digby, H. Petty, S. Brij, J. Bright, K. Irion, W. Khan","doi":"10.1136/thorax-2021-btsabstracts.133","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.133","url":null,"abstract":"P23 Table 1Radiological Code (n=200) Positive COVID-19 RT-PCR (n= 162, 81%) Negative COVID-19 RT-PCR (n = 38, 19%) CVCX0 (Normal appearances) 3 (1.5%) 6 (3%) CVCX1 (Classical/Probable COVID-19) 103 (51.5%) 8 (4%) CVCX2 (Non-classical/intermediate appearances) 51 (25.5%) 19 (9.5%) CVCX3 (Atypical – pleural disease/pulmonary oedema/lobar consolidation) 5 (2.5%) 5 (2.5%) ResultsAttendance ranged from 5–15 people and always included a respiratory and radiology consultant and microbiology/virology registrar. Of the 200 MDT cases reviewed (n=10 excluded due to inadequate CXR or missing PCR), mean age was 64 years old, 66% were male, 47% BAME ,median LOS was 7 days and inpatient mortality was 41/200 (19%). Over half of cases (54.5%) had both a positive RT-PCR and classic CXR appearances of COVID-19, but n = 5 (2.5%) had atypical features alongside a positive PCR, warranting discussion and consideration of dual pathology (TB/lung cancer/suspected phrenic nerve palsy all suggested). A significant proportion of patients with a negative RT-PCR, n= 8/38 (21%) had radiological appearances that were classical of COVID-19 pneumonitis, prompting appropriate treatment and ward triage (avoiding hospital spread). CTPA was suggested in 16/200 (8%) of patients’ and confirmed PE in 5/16 scans. Of those surveyed, > 75% felt that their knowledge of anticoagulation (prophylaxis and treatment) in patients with COVID-19 improved and over 50% of junior doctors’ submitted post-MDT work based assessments.ConclusionThe COVID-19 vMDT helped with diagnosis and management of patients during the SARS-CoV-2 pandemic, whilst simultaneously providing education to health care professionals.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116500876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P28 Developing a novel advanced clinical practitioner led severe COVID-19 follow-up service – a picture is not always worth a thousand words","authors":"T. Armstrong, R. Gillott, T. Bongers, A. Ashraf","doi":"10.1136/thorax-2021-btsabstracts.138","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.138","url":null,"abstract":"During the COVID-19 pandemic the British Thoracic Society produced national guidance advising for all severe COVID-19 pneumonia (defining our inclusion criteria as clinico-radiological diagnosis, oxygen requirements >35%, continuous positive pressure ventilation or mechanical ventilation) to have 4–6-week follow-up with all COVID-19 patients having imaging at 12 weeks.1 To avoid duplication of work streams, the district general hospital developed a pathway liaising with ICU to ensure follow-up 4–6 weeks post discharge, chest x-ray at 12 weeks and follow-up telephone appointment at six months with the aim of discharging back to the community or referring for further investigations. In total we followed up 272 patients who were referred to our service.In the first wave (April 2020 - July 2020) we followed up 117 patients of whom 99 had a follow-up chest X-ray. Chest x-rays were performed on average 80.4 (43–140) days post discharge. Of these patients, 14% had residual changes, with 86% having a clinic normal chest X-ray, with 33 (28%) requiring referral for further investigation and respiratory physician follow-up due to breathlessness (quantified by Modified Medical Council Research dyspnoea score) identified at follow-up clinic appointments, on average 168.4 (91–209) days post discharge.In the second wave (October 2020 – April 2021) we followed up 155 patients of whom 133 had a chest x-ray and 51 (38%) had residual changes. Chest x-rays were performed on average 88.7 (32–120) days post discharge and follow-up clinic appointments were on average 150.9 (92–172) days post discharge. Only 35 patients have been followed up to date (the remaining having not reached 6-months post discharge). Of these 15 (42.8%) required onwards referral for further investigation.This data shows that we have run a robust follow-up service for severe COVID-19 pneumonia patients. It is important that we think carefully about who is referred for further respiratory investigations as our data shows that chest x-ray resolution does not necessarily correlate with resolution of symptoms, and the implication for NHS services.British Thoracic Society. British Thoracic Society Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia [V1.2], 2020. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"295 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124235127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P18 Safety and effectiveness of an integrated, telehealth-led supported discharge service for Covid-19","authors":"A. Shaw, M. Moodley, K. McSporran, C. Thornley, H. Chiles, V. Smith, K. Moore, L. Taylor, P. Patel, T. Adam, H. Beenick, S. Harman, S. Lea, A. Woodward, Z. Harris, N. Patel, S. Ghosh, A. Murphy, I. Valero-Sánchez","doi":"10.1136/thorax-2021-btsabstracts.128","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.128","url":null,"abstract":"Introduction and ObjectivesThe Covid-19 pandemic has driven forward a number of remote monitoring schemes (virtual wards) across the country to support the early discharge of patients with covid-19. Technology can assist clinical teams to deliver comprehensive care in the community. In this study we aim to evaluate the safety and effectiveness of an innovative, telehealth-led virtual ward for Covid-19.MethodsPatients discharged from hospital respiratory wards with a diagnosis of Covid-19 and deemed at risk of readmission (or requiring home oxygen weaning) were eligible for referral. Monitoring equipment (thermometers and digital pulse oximeters) was provided and patients were on-boarded into a telehealth platform prior to discharge. Smartphones and tablets were supplied by the service if required. A Covid-19 digital clinical question set and triaging algorithm was developed locally. Patients were instructed to complete it daily remotely during follow-up and to enter their observations three times daily. Clinical data fed into a dashboard reviewed daily by the community respiratory specialist team who would contact and assess patients submitting symptoms of concern. Monitoring lasted for up to 14 days, and escalation processes to the acute Trust were in place for those patients showing evidence of deterioration.Results218 patients were monitored between December 2020 and May 2021, 29 for oxygen weaning. 41% were female, mean age 57 years old (minimum 21, maximum 89). Average oxygen weaning time was 11 days, with 319 days of hospital bed days saved by the oxygen weaning service and an estimated £127,600 cost saving to the system. Only 10 patients (4.9%) were readmitted after 14 days (versus 9% in usual care from hospital Covid-19 wards). Four patients (1.8%) died in hospital after a readmission. 83% of patients felt ‘very supported’ by the service and 73% expressed that it had ‘fully’ improved their confidence. Average score of satisfaction with the service, measured by a self-reported questionnaire, was 9.9/10.ConclusionsA telehealth-assisted remote monitoring service for Covid-19 is a safe way to provide specialist care at home and can reduce hospital readmissions whilst improving patient experience.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132309017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P20 Covid supported discharge: a Liverpool experience","authors":"L. Humphreys, A. G. Gálvez González, M. Hammond, S. Jones, J. Hadcroft, G. Brocklehurst","doi":"10.1136/thorax-2021-btsabstracts.130","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.130","url":null,"abstract":"Introduction The Liverpool Community Respiratory team (CRT) is a multi-professional team supporting patients with COPD exacerbations to reduce hospital admissions and length of stay. During the first wave of the Covid 19 pandemic, CRT piloted a service to support and monitor patients hospitalised with covid 19 pneumonia on discharge. Patients were provided with telehealth equipment for remote physiological monitoring, and were called daily by a member of the team. Results 157 patients (87 male, mean age 59.7, range 21–88) were supported by the CRT covid discharge service between May 2020 and May 2021. 11 (7%) were readmitted, 4 withdrew and 1 died at home. 141 completed 10–14 days of support. Mean hospital stay was 13.7 days (range 11–112). 8 were current smokers, 52 were ex smokers and 87 had never smoked. Mean BMI was 31.4 (range 18.5–54.5). Chair based exercises were introduced early and 141 were offered pulmonary rehabilitation, of whom 135 (95.7%) agreed to a referral; only 6 declined. Feedback from all patients supported by CRT was positive. We noted that anxiety levels improved subjectively during the period of CRT support so introduced GAD7 to further assess this. Although 28 patients achieved the minimal clinically significant difference, this was not seen consistently across the group. Conclusions Supported discharge after hospitalisation with covid pneumonia is safe and well-liked by patients. Readmissions were rare and pulmonary rehabilitation uptake was high. There may be some benefit in term of anxiety management, but numbers were too low for this to be proven.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115804896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P19 COVID Virtual Ward and Emergency Department discharges: clinical outcomes and recommendations following COVID pandemic phase 2","authors":"ER Bradley, HJ Petty, J. Brackston, W. Khan, S. Brij","doi":"10.1136/thorax-2021-btsabstracts.129","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.129","url":null,"abstract":"P19 Figure 1Results119 COVNA patients identified (female 65 (55%);77 (66%) BAME;median age 51 years, IQR 38–62, range 16–88). Over half (55%) were between the ages 40 and 69. COVNA patients were relatively free from co-morbidity: 104 (87%) had low or intermediate risk ISARIC 4C scores;all had Charlson co-morbidity score of less than 9 representing low 10 year mortality.Median length of stay on VCW was 3 days (IQR 3–8, range 0–15);median number of calls undertaken was 3 (IQR 2–5, range 0–9).32 (27%) COVNA patients returned to ED, 8 of whom were discharged home with an overall admission rate 20%. Re-presentations within 5/7 were predominantly COVID related (20/23;87%). After 5 days, there were no attendances with worsening pneumonitis (figure 1). The commonest route for re-attendance was self-referral (17/32;53%) of whom 14 were admitted;all 10 persons referred to ED from VCW were admitted.COVNA patients issued with a saturation probe (48%) were more likely to re-present and be admitted (RR 2.2;95% CI 1.03–4.74;p0.0425).2 (1.7%) sustained pulmonary emboli;1 intensive care admission;4 patients died (3% unadjusted mortality).ConclusionsCOVNA patients have low mortality and morbidity from COVID. The VCW model has safely and successfully supported COVNA patients who are deemed fit enough to not require admission (clinical judgment and no oxygen requirement). Ideally, all COVNA patients should be issued with a saturation probe. COVNA patients should be warned that re-presentation and admission may be required. Worsening of symptoms and/or a drop in oxygen saturation should warrant return to ED. This pathway should be continued in COVID endemic phase.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122565864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P21 Development of a COVID-19 virtual ward to facilitate early discharge from hospital for patients with an on-going oxygen requirement","authors":"L. Boast, G. Lowrey, RE Aldridge, K. Hall, R. Evans, D. Subramanian","doi":"10.1136/thorax-2021-btsabstracts.131","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.131","url":null,"abstract":"Introduction and ObjectivesThe COVID-19 pandemic required rapid service changes in order to meet the emerging needs of our patients and to reduce pressures on hospital beds. In March 2020 we established one of the first virtual wards with the aim of supporting patients with a continuing oxygen requirement safely at home during their COVID-19 illness.MethodsThe virtual ward was delivered by the integrated care ImpACT+ service. This multi-disciplinary service comprises respiratory consultants, respiratory specialist nurses, physiotherapists, occupational therapists and fitness instructors. Our local criteria for on-boarding included: 10 days post onset of symptoms, oxygen requirement 4L or less and the ability to manage with home monitoring equipment. A mix of telephone and home contacts were offered and daily consultant MDTs undertaken. Therapy team members were up-skilled to support oxygen assessments and weaning regimes to maximise service capacity. A direct electronic referral icon was created on the hospital whiteboard system accompanied by a nurse-led telephone referral service. The scheme was advertised through posters and in-reach work into COVID-19 areas.Results107 patients were managed on our virtual ward since March 2020. This included 99 COVID-19 patients and 8 with other acute respiratory exacerbations. The mean continuous oxygen prescription on discharge was 1.5 L (range 0.5–4L) and for ambulatory purposes 2.4L (1–6L). 55 patients with COVID-19 were discharged on anticoagulation, 33 on steroids and 21 on antibiotics. 8 30-day readmissions, 3 deaths (2 expected). The total number of bed days on the virtual ward was 2010 (mean 21 days) and in total the activity that service delivered included 904 telephone calls and 274 home visits. Service feedback demonstrated a high level of satisfaction with patients commenting that they valued being at home with support during their recovery.ConclusionsThis service has shown a supported discharge Covid-19 oxygen weaning service is a valuable initiative to relieve pressures on the acute hospital service and provide high quality care to facilitate early discharge from hospital. This virtual ward highlighted the value of having an integrated respiratory team and extension of this model to other respiratory conditions should be possible with considered adaptions.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121417581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P26 Knowledge seeking behaviour of the COVID-19 population. Analysis of the first million UK users of Your COVID Recovery®","authors":"R. Barclay, N. Gardiner, E. Chaplin, A. Watt, G. Mills, M. Baldwin, K. Hicklin, S. Singh","doi":"10.1136/thorax-2021-btsabstracts.136","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.136","url":null,"abstract":"","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124139085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P27 The need for rehabilitation programme after an episode of COVID-19","authors":"M. Alhotye, E. Daynes, C. Gerlis, S. Singh","doi":"10.1136/thorax-2021-btsabstracts.137","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.137","url":null,"abstract":"P27 Figure 1Preferred rehabilitation programme[Figure omitted. See PDF]ConclusionThe survey responses indicate a significant need for a support package of care. The majority preferred a face-to-face intervention;although a significant minority would prefer a digital intervention, regardless of mode there will be a substantial burden on services.ReferenceDaynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition-A cohort study. Chronic Respiratory Disease. 2021;18:14799731211015691.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122642638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P25 The effect of post COVID-19 rehabilitation on health status using the EQ-5D- 5L","authors":"T. Williamson, F. Dyer, D. Garvey, A. Miers, C. Morris, C. Wells, S. Rahman","doi":"10.1136/thorax-2021-btsabstracts.135","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.135","url":null,"abstract":"P25 Table 1Mean (SD) scores for EQ-5D-5L index pre and post rehabilitationPre rehabilitation Post rehabilitation change P value* 0.611 (0.195) 0.733 (0.172) 0.127 (0.187) < 0.05 Paired t-testResultsBetween July 2020 and May 2021 136 patients completed post-COVID rehabilitation. Mean age was 56 (12.25). 38% male. Table 1 illustrates change pre and post rehabilitation.ConclusionPost COVID rehabilitation improves health status in patients following COVID-19 with ongoing health concerns.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"10 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120906512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P22 Early supported discharge with Domiciliary Oxygen and Integrated Respiratory Team (DO-IRT) care for hospitalised SARS-CoV2 patients","authors":"MS Johnson, LH Edis, EM McElhinney, V. Meyrick, L. Smith, P. Cho, I. Patel","doi":"10.1136/thorax-2021-btsabstracts.132","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.132","url":null,"abstract":"P22 Table 1Clinical characteristics of patients in DO-IRT pathwayResults24(22%) of 109 referred inpatients were accepted onto DO-IRT;22/24(92%) for oxygen weaning and 2/24(8%) for LTOT. Clinical characteristics are shown in table 1. Majority of declined referrals (55%) were patients who were above target saturations on oxygen and were supported to wean to air by IRT as inpatients. Duration on DO-IRT pathway was mean (SD) 16.3(7.2) days;median (IQR) length of stay saved for the oxygen weaning cohort were 9 (7–13) days. All-cause 30-day mortality and readmission rates on DO-IRT were 0% and 21% respectively. 14(58%) patients completed the satisfaction survey;14(100%) reported confidence in their care and were ‘extremely likely’ to recommend DO-IRT.DiscussionEarly supported discharge with home oxygen weaning for SARS-CoV2 pneumonia patients is feasible, safe and well-received by patients. Integrated respiratory teams with specialist oxygen expertise can make a valuable contribution to supporting acute medical flow. Future studies should investigate the feasibility of supported early discharge pathways with domiciliary oxygen in other conditions.","PeriodicalId":319670,"journal":{"name":"Virtual monitoring in COVID-19","volume":"450 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124287084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}