ABSTRACT
Aims: COVID-19 may have delayed cancer diagnoses. We compared times from first symptom to presentation, diagnosis and treatment of lung cancer before and during the pandemic, and patient and general practitioner (GP) responses to COVID-19. Method(s): Questionnaires were mailed to Victorian patients with primary lung cancer (n = 218, response 34%) diagnosed within the previous 6-months (Nov 2018-Nov 2020, 89% had surgery, 72% stage I/II). Their GPs were also sent questionnaires (n = 140, response 69%). Fifty-four patients were diagnosed from April 2020 (COVID- 19 period);47 patients and 25 GPs completed COVID-19-specific questionnaires. Interviews were conducted with six patients diagnosed in June/July 2020. Diagnostic route and timeliness of care before and during COVID-19 were compared using Chi-squared and Fisher's exact tests. Content analysis was applied to interview data. Result(s): Routes to diagnosis were similar for those diagnosed before and during COVID-19 (77% and 65% via symptoms to GP, respectively, p = .31). Median time from first symptom to presentation was marginally shorter after COVID-19, 17 versus 23 days (p = .08). Time from presentation to diagnosis and treatment did not differ. DuringCOVID-19, few patients had telehealth for initial appointments (5% GP, 11.5% specialist appointments). Almost all (98%) reported no delays due to COVID-19. Similarly, 79% of GPs reported no impact of COVID-19 on their patient's diagnostic pathway. However, more broadly, 33% of GPs ordered fewer blood tests and imaging, saw fewer patients, and 72% perceived waiting longer for specialist/hospital appointments post-COVID-19;with most (74%) reporting increased use of telehealth. In interviews, patients' greatest difficulties were related to hospital experiences, particularly not being allowed visitors. Conclusion(s): For lung cancer, we found no adverse impact of COVID- 19 on timeliness of diagnosis and treatment, and presentation may have been quicker. Telehealth use for lung cancer patients was limited, though more general changes in GP practice due to COVID-19 were evident. .
ABSTRACT
Background: Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019. Methods: Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner. Results: There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery <48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall;87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding. Conclusion: Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.