ABSTRACT
Telehealth has been used to care for patients at a distance in specific clinical and demographic situations, but the demand for physical isolation during the COVID-19 pandemic has expanded its application to the broader community. This systematic literature review, of very recent publications, elucidates the new ways telehealth has been implemented, confirms it's acceptability, accessibility and safety by collating reviews, trial and cohort studies from peer reviewed journals meeting defined risk of bias criteria.Five literature reviews, three qualitative studies and 22 quantitative studies were included, which confirmed that telehealth is a safe medium for delivery of surgical health care, is accessible and efficient for the majority of patients and clinicians across the age and socioeconomic spectrum. It is time and resource efficient for providers and recipients and improves the delivery of patient-centred care. Many providers have published innovative solutions to the difficulties of telehealth, such as conducting a physical examination or technological limitations at the remote site. Health care can now be delivered directly to the home or the workplace.Routine in-person postoperative review of patients should be replaced by patient-led telehealth unless there is a specific reason for face-to-face review. Assessment and management of new cases could be managed more efficiently if a carefully planned digital referral process is developed and adopted.
ABSTRACT
The early stage of wave 2 in SJH was a very busy and rapidly evolving situation for the medical team. Dexamethasone and remdesivir had recently been introduced into clinical practice following RECOVERY trial results. High clinical demand, and a rapid turn-over of junior medical staff in the COVID wards meant unfamiliarity with the treatment. My COVID Bundle was designed as a support tool for medical staff in safely managing patients who tested positive for COVID-19 to: 1. Improve easy to see documentation of target oxygen saturations in patients with COVID-19 disease 2. Improve the monitoring of blood sugars when patients were started on dexamethasone for COVID-19 disease Thirty covid positive patients were included in the initial baseline data collection from the medical wards. Of these, only four (13.3%) had clear documentation of target oxygen saturations. Fifteen were commenced on dexamethasone, of which seven (46.7%) had appropriate monitoring of their blood sugars. A series of interventions were then implemented. Initially I created a ‘COVID Bundle’ for patient’s bedside notes which prompted staff on 1) target oxygen saturations, 2) escalation status, 3) resuscitation status, 4) checking BMswhen on dexamethasone. I then updated and combined my COVID Bundle with a COVID treatment poster, which was placed in all ‘red’ patient notes. I had several rounds of data collection during the series of interventions. The clear documentation of target oxygen saturations increased from 13.3% to 100%, while appropriate monitoring of BMsincreased from 46.7% to 93.3%. The management of COVID-19 is an ever evolving area, which can be difficult for both medical and nursing staff to keep up with in an ever busy working environment. This small scale QIP shows that the ‘COVID Bundle’ is a useful aid for staff in the safe management of patients with COVID-19.