ABSTRACT
Introduction: National Service Evaluations of COVID-19 ARDS care in the US and UK showed significant variability in clinical practice, and adherence to existing guidelines. To better understand the basis for this, we explored factors influencing decision-making around mechanical ventilation in COVID-19. Method(s): We conducted interprofessional focus groups identifying factors that influenced decision-making through thematic analysis. From this, we developed a questionnaire to validate these themes with a larger sample of critical care professionals across the UK. Kruskal- Wallis or Mann-Whitney U tests were used for data analysis. Result(s): There were 179 complete responses from doctors, nurses and physios. In their usual practice, 66% of clinicians reported adherence to national ARDS guidelines. However, 80% thought COVID-19 ARDS presented differently to their previous clinical knowledge/experience of ARDS and 72% thought deviating from usual practice was necessary. Doctors were more likely to think deviation was necessary (p < 0.001) but there was no difference across level of ICU experience (p = 0.845). Clinicians reported their ventilatory decision-making was most influenced by disease factors, followed by team then contextual and least by environmental factors (p < 0.001). Disease factor was seen as most important across profession and experience level. During COVID-19, 68% of clinicians reported not being confident in their ventilatory decision-making;however, clinicians who felt COVID-19 ARDS presentation fitted with their previous clinical knowledge/experience of ARDS reported greater confidence (p < 0.001). Confidence was not affected by experience (p = 0.522) or profession (p = 0.294) (Fig. 1). Conclusion(s): Clinicians were influenced by the uncertain understanding of COVID-19 ARDS, especially when they considered previous experiences to be less relevant. In the event of another novel disease, developing a consistent, understandable clinical models of disease should be prioritised to optimise decision making.
ABSTRACT
Aim To investigate patient and clinician feedback on remote telehealth consultations to determine their feasibility for use as an adjunct service. Methods A cross-sectional investigation of satisfaction with telehealth consultations. In total, one oral medicine specialist, four dentists and 88 patients were surveyed. Results A total of 88 video consultations were completed with patients in Christchurch and Wellington hospitals. There was always a dentist present with the patient during the consultation.Overall, 95.5% of patients found the experience to be comfortable, with no systematic differences by sex, age, ethnicity, or reason for visit. Most patients were satisfied with the treatment received during the video consultations. Fewer patients who presented with pain were satisfied with the treatment received than were those who presented with oral mucosal disorders or other issues (61.8%, 75.0% and 76.9%, respectively). Both the oral medicine specialist and clinicians involved found the process comfortable and did not find diagnostic capabilities to be compromised. Conclusion Video telehealth might be a valid alternative or adjunct to face-to-face consultations. This may open the way for remote video consultations to improve the availability of oral medicine services in rural areas.