Staff experience of routine breathlessness assessment on a virtual covid ward

IntroductionOur hospital redeployed healthcare professionals to implement a telephone-based Virtual Covid Ward (VCW) during the COVID-19 pandemic. Standardised clinical assessment included numeric (0 – 10) rating scales (NRS) for breathlessness and cough, and pulse oximetry.Aims and objectivesTo assess staff experience of routine breathlessness documentation by surveying feedback on the clinical effectiveness of assessment tools used in the VCW.MethodsData were obtained from an anonymous online survey distributed to VCW staff, summarised in themes and analysed with descriptive statistics.Results9/19 VCW staff completed the survey;9 female;5 nurses, 3 physiotherapists, 1 Operating Department Practitioner;8 were senior, 1 junior. 100% had acute or respiratory medicine experience, 66% had experience in remote assessments. 100% reported absence of breathlessness at rest the most reassuring sign when discharging patients. 100% confidence when assessing breathlessness over the phone. 100% felt breathlessness was a ‘red flag’. 66% found the breathlessness NRS useful and 67% found the cough NRS useful. 89% believed patients’ responses were meaningful at least half the time. 78% believed patients overestimated the breathlessness score at least half of the time and 55% believed patients underestimated respiratory distress.ConclusionVCW staff were confident in assessing patients remotely and using the NRS. Staff found assessment of breathlessness useful in predicting adverse patient outcomes, but were less confident using the NRS (0–10) rating scale to quantify breathlessness was clinically valuable.

Patient global impression of severity scale characterises symptom severity in chronic cough

P57 Figure 1Cough severity analogue scale (a) and cough-specific health status LCQ (b) ranges for Pateint Global Impression of Severity categories[Figure omitted. See PDF]ConclusionThe PGI-S scale is a simple tool that characterises cough severity in a format familiar to clinicians, and allows comparisons with other conditions. The PGI-S has a strong relation with validated cough measures such as VAS and LCQ. Future studies should investigate the reproducibility and clinically important threshold for change of the PGI-S.

The relationship between symptoms and functional physiological outcomes in survivors of severe COVID-19 pneumonia

P136 Table 1Results of correlation analysis Correlation analysis 4MGS 1STSreps SpO2% desaturation Results r p-value r p-value r p-value Pre-COVID mMRC dyspnoea score 0(0–1) -0.267** <0.001 -0.285** <0.001 -0.108 0.094 Post-COVID mMRC dyspnoea score 1(0–2) -0.442** <0.001 -0.457** <0.001 -0.143* 0.025 NRS breathlessness 3(0–5) -0.287** <0.001 -0.406** <0.001 -0.490 0.445 NRS fatigue 3(0–5) -0.315** <0.001 -0.379** <0.001 -0.190* 0.003 NRS cough 0(0–2) -0.660 0.292 -0.153* 0.017 0.083 0.194 NRS pain 1(0–4) -0.278** <0.001 -0.346** <0.001 -0.188* 0.003 NRS sleep difficulty 2(0–5) -0.246** <0.001 -0.386** <0.001 -0.122 0.057 Data are presented as median (interquartile range) or frequency (proportion%;95% confidence interval). SpO2% desaturation = SpO2% desaturation from baseline during 1 minute sit to stand test;1STSreps = repetitions per minute during 1 minute sit to stand test;4MGS = 4 metre gait speed;mMRC = modified Medical Research Council;NRS = 0 – 10 numerical rating scale;r = Spearman correlation coefficient. *indicates statistical significance at 0.05 level. **indicates statistical significance at 0.001 level.ConclusionRespiratory symptoms were not strong predictors of 4-metre gait speed and 1-minute sit-to-stand test performance. These data highlight the importance of face-to-face testing to objectively assess functional limitation in patients recovering from severe COVID pneumonia.

Early supported discharge with Domiciliary Oxygen and Integrated Respiratory Team (DO-IRT) care for hospitalised SARS-CoV2 patients

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.

Clinical, functional and psychological characteristics of survivors of severe COVID-19 pneumonia: a comparison of outcomes from the first and second waves

P135 Table 1Patient demographics, self-reported scores and functional test results by wave 1st wave 2nd wave p-value Demographics n=167 n=141 Age 59±13 58±12 0.564 Female 60 (35.93;28.94–43.40) 62 (43.97;35.97–52.22) 0.15 BMI (kg/m2) 30.5 (26.6–35.2) 32.1 (28.5–37.9) 0.009 ** BAME 115 (69.7;62.39–76.32) 72 (59.5;50.62–67.94) 0.073 Number of comorbidities 2 (1–3) 2 (1–3) 0.144 Patients Receiving Drugs Dexamethasone 11 (6.63;3.57–11.17) 138 (97.87;94.43–99.40) <0.001 *** Remdesivir 18 (10.84;6.79–16.24) 81 (57.45;49.20–65.39) <0.001 *** Other Immunomodulator 2 (1.20;0.25–3.81) 31 (21.99;15.76–29.35) <0.001 *** Questionnaire Scores n=164 n=132 NRS Breathlessness 2 (0–5) 3 (0–5) 0.153 ≥4 56 (34.78;27.75–42.36) 52 (37.14;29.47–45.34) 0.67 NRS Cough 0 (0–2) 0 (0–3) 0.439 ≥4 17 (10.56;6.52–16.00) 18 (13.64;8.59–20.26) 0.419 NRS Fatigue 3 (0–5) 3 (0–5) 0.867 ≥4 65 (40.63;33.24–48.35) 48 (36.92;28.99–45.43) 0.52 NRS Pain 0 (0–5) 1 (0–3) 0.682 ≥4 44 (27.50;21.03–34.78) 30 (23.08;16.48–30.86) 0.39 NRS Sleep disturbance 2 (0–5) 2 (0–5) 0.558 ≥4 52 (32.50;25.61–40.02) 49 (37.40;29.47–45.89) 0.382 Pre-COVID-19 mMRC 1 (0–2) 1 (1–2) 0.478 Post-COVID-19 mMRC 0 (0–1) 0 (0–1) 0.329 Post-COVID-19 mMRC ≥2 66 (40.99;33.61–48.70) 49 (38.58;30.45–47.23) 0.678 PCFS 2 (0–3) 1 (0–2) 0.055 PCFS ≥2 80 (50.00;42.31–57.69) 51 (42.15;33.62–51.05) 0.191 PHQ-9 ≥10 32 (20.38;14.66–27.19) 29 (23.02;16.33–30.92) 0.592 GAD-7 ≥10 34 (21.38;15.56–28.24) 16 (12.80;7.81- 19.49) 0.059 TSQ ≥6 43 (27.56;21.01–34.94) 27 (22.31;15.60–30.33) 0.319 Functional Tests n=160 n=139 4MGS <0.8 (ms-1) 67 (42.41;34.89–50.19) 47 (35.07;27.38–43.40) 0.201 1STS repetitions 18 (12–23) 17 (12–21) 0.460 <2.5 percentile 96 (60.00;52.29–67.36) 108 (77.70;70.25–84.00) 0.011 * Desaturation ≥4% 52 (34.67;27.40–4 .52) 42 (32.31;24.73–40.67) 0.677 Parametric data are presented as mean ± standard deviation, non-parametric data are presented as median (interquartile range) or frequency (proportion;95% confidence interval). Statistical significance indicated by * (p<0.05), ** (p<0.01), *** (p<0.001). BMI = Body mass index, BAME = Black, Asian or minority ethnic, NRS = Numerical rating scale (0–10), mMRC = modified Medical Research Council for dyspnoea (0–4), PCFS = Post-COVID-19 functional status scale (0–4), PHQ-9 = Patient health questionnaire 9 (0–27), GAD-7 = General Anxiety Disorder-7 scale (0–21), TSQ = Trauma screening questionnaire (0–10), 4MGS = 4-metre gait speed, 1STS = 1-minute sit-to-stand.ConclusionDespite shorter admission duration, and less frequent IMV, the burden of symptoms and functional limitation experienced post-hospitalisation for severe COVID-19 pneumonia was at least as severe during Wave 2 as in Wave 1. Identification of contributing factors and impact on post-COVID rehabilitation outcomes requires further study.

The prevalence of chronic cough amongst females with stress urinary incontinence

BackgroundStress Urinary Incontinence (SUI) is one of the major physical consequences suffered by individuals with chronic cough (CC). We investigated the prevalence of CC among women who reported having SUI.MethodsParticipants completed an online structured quantitative questionnaire in April 2021, to identify adult women with SUI. Demographic characteristics, causes/triggers of urinary incontinence, current or previous CC, cough frequency and duration, COVID-19 infection and its impact on CC were included.ResultsA total of 835 adult women reported having SUI, of whom, 153 (18.3%) concomitantly had urgency incontinence, 59 (7.1%) had overflow incontinence, and 28 (3.4%) had functional incontinence. The mean age was 52.3 years (Range: 21–86), the majority (604 (72.3%)) reported cough as a cause of their urinary incontinence, of whom 67.0% reported suffering incontinence because of cough at least once a week. One hundred and twenty-three (14.7%) women reported experiencing CC within the last year, and 84 (10.1%) reported still having CC currently. Fifty-seven (6.8%) women stated their CC had been diagnosed by a physician, and 150 (18.0%) women reported having suspected or confirmed COVID-19 (with or without CC). Of the 123 women who had CC in the last year, ninety-three (75.6%) had CC onset before COVID-19.ConclusionA majority of women with SUI reported cough as one of the leading triggers of their urinary incontinence. Almost 15% of the sample reported experiencing CC, but less than half of those had a formal diagnosis from a physician. Most cases of CC were not related to COVID-19. Future studies would be useful to further explore the burden of CC on SUI patients.Please refer to page A191 for declarations of interest related to this abstract.