ABSTRACT
Aims Assessment of a supported discharge service for a cohort of patients admitted to Cork University Hospital with COVID-19 that were identified as being appropriate for remote patient monitoring. Methods Patients uploaded SpO2, subjective breathlessness scores, and temperature readings onto the PatientMpower application, and received a daily phone call from the physiotherapist. Readmission was triggered where appropriate. Patient satisfaction questionnaires were completed following service discharge. Results Over 12 weeks, 15 patients had a supported discharge. Readmission was triggered for 3 patients (20%). Compared to non-readmitted patient, readmitted patients had more abnormal SpO2 readings (9 (5.5-22.5) vs 1 (0-1), p= 0.022) and all 6 temperature spikes that occurred, but lower subjective breathlessness scores (3 (1-6) vs 4.25 (2-8), p = 0.003). Differences in mean abnormal SpO2% readings were not statistically significant. Conclusion A supported discharge service including remote monitoring and regular contact with healthcare professionals can facilitate safe, and timely discharges of select patient groups.
ABSTRACT
Background: A need arose to divert patients with psychiatric complaints from the emergency department to alternative settings for psychiatric consultations to reduce footfall during COVID-19. We assessed the effectiveness of alternative referral pathway in reducing COVID-19 infection in our service and its effect on service quality: response time and number of patients leaving before the review. We evaluated the satisfaction of patients, general practitioners (GPs) and mental health service staff with the pathway. Methods: All patients referred to the mental health service over a 2-month period following the introduction of the pathway were included. Findings were compared against the cohort referred for emergency assessment during the same period in 2019. Feedback surveys were distributed to patients, staff and GPs. χ2 and independent sample t-test were used to compare the variables. Results: Over 2 months, 255 patients received an emergency assessment via the pathway, representing a 22.3% decrease in the volume of presentations from the same period in 2019. There were no COVID-19 cases among our patients or staff on the roster for assessing patients. In comparison to 2019, response times were improved (p<0.001), and the numbers of patients who left the hospital before the review were reduced by 3.2% during the study period (p<0.001). Patients and GPs were highly satisfied with the referral pathway and believed that the pathway should be retained post-COVID-19. Mental health service staff were divided in their opinions about its sustainability. Conclusion: The pathway was successful in reducing the spread of infection, improving response times and reducing the numbers of patients who left without an assessment. Given the improved outcomes and acceptability, this is a preferable pathway for emergency referrals into the future. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
ABSTRACT
Background: The COVID-19 pandemic has created unprecedented disruptions to cancer clinical trial research across the world due to a temporary global suspension of patients' recruitment to cancer clinical trials. Access to clinical trials permits better treatment options and best clinical practice standards for patients with cancer. We present the impact of the COVID-19 pandemic on cancer clinical trial activity at the Cancer Clinical Trials Unit (CCTU) at the Mid-Western Cancer Centre, University Hospital Limerick (UHL). Over the last 4 years 28 clinical trials, both interventional and translational, have opened here, across a variety of primary disease sites, with 5 trials opened in 2017, 11 in 2018, 7 in 2019 but only 2 in the first 10 months of 2020 until 3 further trials were opened in December. Methods: CCTU records were reviewed to identify the number of patients screened and consented to participate in cancer clinical trials at UHL in 2020, which were compared directly with corresponding numbers for 2019. Results: In 2019, 17 clinical trials were open and recruiting at the CCTU, UHL. During 2020, 19 trials were recruiting although during the 1st surge of the COVID-19 pandemic recruitment was essentially suspended and CCTU staff were redeployed throughout the hospital. 1st Six months 2020 vs 2019 In the six months from January 2020 until the end of June 2020, 99 patients were screened and only 15 (15.2%) signed informed consent to participate in a cancer clinical trial. When these figures are directly compared with the first six months of 2019, there is a 33% reduction in patients screened for participation (147 vs 99) and a 60% reduction in patients consented (37 vs 15) to clinical trials. 12 Months 2020 vs 2019 In total during 2019, 376 patients were screened for inclusion to participate and 49 (13%) patients signed informed consent to participate in a clinical trial within CCTU at UHL. In 2020, 914 patients were screened for participation with 51 patients consented to participate (5.6%). The majority (45/51 (88%)) of patients consented to cancer clinical trials in 2020 at the CCTU, UHL were recruited to translational based studies and only 6 (12%) consented to interventional studies compared with 2019 when 30/49 (61%) consented to translational and 30/49 (39%) to interventional studies. Conclusions: During the COVID-19 pandemic, the percentage of patients consented to participation in a clinical trial reduced significantly, as compared to the previous year (5.6% vs 13%). Fewer interventional studies have recruited patients during 2020. As we enter the third surge of COVID-19 infections in Ireland, we must continue to monitor and identify effective strategies to navigate the ever-changing situation for cancer clinical trials, in an attempt to maintain access to high quality cancer clinical trial opportunities for our patients.
ABSTRACT
The COVID-19 pandemic has created unprecedented disruptions to clinical trial research across the world due to a temporary global suspension of patients’ recruitment to cancer clinical trials. Here within we present the negative impact of the COVID-19 pandemic on cancer clinical trial activity at the Clinical Trials Ireland Unit at the Mid-Western Cancer Centre. In the first six months of 2020 directly compared with the same period in 2019 there was a 33% (147 V’s 99) reduction in patients screened for participation and a 60% (37 V’s 15) reduction in patients consented to clinical trials within our unit. At the same time, the COVID-19 pandemic has led to increased clinical research activities in regard to the development of treatments, diagnostics and vaccines to control the pandemic. Extrapolating our observations from the swift implementation of COVID19-related clinical trials, we discuss strategies to improve the design and conduct of cancer clinical trials.