ABSTRACT
COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.
Subject(s)
Ambulatory Care Facilities/organization & administration , COVID-19/therapy , Continuity of Patient Care/organization & administration , Pneumonia, Viral/therapy , Respiratory Care Units/organization & administration , Adult , Aged , Boston/epidemiology , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Referral and Consultation/statistics & numerical data , SARS-CoV-2 , Systems Analysis , WorkflowSubject(s)
Betacoronavirus , Continuous Positive Airway Pressure/methods , Coronavirus Infections/therapy , Hypoxia/therapy , Oxygen/administration & dosage , Pneumonia, Viral/therapy , Respiratory Care Units/organization & administration , Aged , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Female , France/epidemiology , Humans , Hypoxia/etiology , Male , Middle Aged , Pandemics , Patient Positioning/methods , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Prone Position , SARS-CoV-2 , Treatment OutcomeABSTRACT
Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.
Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Frailty , Geriatric Assessment/methods , Pandemics , Pneumonia, Viral , Respiratory Care Units , Respiratory Insufficiency , Aged, 80 and over , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Frailty/diagnosis , Frailty/physiopathology , Frailty/therapy , Humans , Lung/diagnostic imaging , Male , Outcome and Process Assessment, Health Care , Oximetry/methods , Oximetry/statistics & numerical data , Oxygen Consumption , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Care Units/methods , Respiratory Care Units/organization & administration , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Survival Analysis , Tomography, X-Ray Computed/methods , United Kingdom/epidemiologyABSTRACT
The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.