Optimisation of COVID-19 diagnostic pathways in acute hospital admissions to prevent nosocomial transmission.

INTRODUCTION: In the management of acute hospital admissions during the COVID-19 pandemic, safe patient cohorting depends on robust admission diagnostic strategies. It is essential that screening strategies are sensitive and rapid, to prevent nosocomial transmission of COVID-19 and maintain patient flow. METHODS: We retrospectively identified all COVID-19 positive and suspected cases at our institution screened by reverse transcription polymerase chain reaction (RT-PCR) between 4 April and 28 June 2020. Using RT-PCR positivity within 7 days as our reference standard, we assessed sensitivity and net-benefit of three admission screening strategies: single admission RT-PCR, composite admission RT-PCR and CXR and repeat RT-PCR with 48 h. RESULTS: RT-PCR single-test sensitivity was 91.5% (87.8%-94.4%) versus 97.7% (95.4%-99.1%) (p = 0.025) for RT-PCR/CXR composite testing and 95.1% (92.1%-97.2%) (p = 0.03) for repeated RT-PCR. Net-benefit was 0.83 for single RT-PCR versus 0.89 for RT-PCR/CXR and 0.87 for repeated RT-PCR at 0.02% threshold probability. CONCLUSION: The RT-PCR/CXR composite testing strategy was highly sensitive when screening patients at the point of hospital admission. Real-world sensitivity of this approach was comparable to repeat RT-PCR testing within 48 h; however, faster facilitating improved patient flow.

Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19.

OBJECTIVES: Risk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown. METHODS: In this pre and post implementation study patients were evaluated across two time periods: March 1st to August 13th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14th August 2020 to 1st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19. RESULTS: 1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1-17.9) hours prior to introducing mPOCT and 1.0 (0.8-1.3) hours afterwards (p < 0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8-20.6) hours prior to introduction of POCT and 3.2 (2.0-5.6) hours afterwards (p < 0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43-0.70; p < 0.0001). In the period following the introduction of mPOCT up to 1st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2-18.9%) locally, compared with 43.8% (95%CI 37.8-49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4-33.5%) for all NHS trusts nationally. CONCLUSIONS: Routine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.

Development of a novel electronic referral grading & triage system

PTH-32 Figure 1Subspecialty Referrals vs Direct-To-Test Numbers[Figure omitted. See PDF]ConclusionsUsing a system as described here substantially improves data capture and efficiency. Direct to test reduces both need for clinic appointments and the urgency of subsequent appointments. IBD and UGI are the subspecialties most likely to benefit from direct to test approaches. IDA could be another suitable specialty and the plan is to address this in the future.Characters2414

Acute Kidney Injury in COVID-19: Identification of risk factors and potential biomarkers of disease in a large UK cohort

ABSTRACT Background COVID-19 is associated with increased risk of acute kidney injury (AKI). Risk factors and biomarkers linked to AKI have now been recognised by national guidelines in the UK. This analysis aims to validate and expand the comorbidities and biomarkers associated with the presence and severity of AKI in these patients. Methods Data was extracted via structured query language for patients with COVID-19 at University Hospital Southampton between first March and 10th June 2020. Demographics, comorbidities, common biomarkers and AKI stage within 48?hours of admission, peak during admission and the last measurement prior to patient outcome (discharge or death) were collected and statistically analysed. Results 632 COVID-19 positive patients were admitted during this period. 34.2% had an AKI during their entire admission, 20.3% had AKI stage 1, 8.5% stage 2 and 5.4% stage 3. This was higher when compared with data from the same period in 2019. AKI carried an increased risk of death, 50.0% vs 21.1% (p = <0.001). AKI stage was significantly associated with age over 65, diabetes, heart failure, peripheral vascular disease, haematological malignancy, hypertension, respiratory rate, albumin, C-reactive protein (CRP), D-dimer, ferritin, high-sensitivity troponin-I, neutrophil count, total white cell counts, National Early Warning Score-2 (NEWS-2), Charlson comorbidity index and alanine-aminotransferase. COVID-19 specific treatment, including dexamethasone, reduced discharge creatinine. Conclusions COVID-19 increases the risk of AKI and this kidney injury may be responsive to treatment. This analysis identified that AKI is associated with both previously described and new comorbidities and biomarkers. This article is protected by copyright. All rights reserved.