Pandemic Changes to a Community Respiratory Service

ABSTRACT

Introduction: Before the covid pandemic we provided community respiratory nursing support for patients with chronic lung diseases especially COPD, pulmonary rehabilitation (PR) and a home oxygen service supporting/assessing patients needing oxygen in the community. The pandemic has led to refocussing our services and staff, helping to keep patients out of hospital. Group pulmonary rehabilitation classes were no longer possible. Methods: We have refocussed our service to provide covid-safe services with PPE and early staff immunisation. Some staff were seconded to a rapid response unit for those acutely ill. Others carried out a care homes initiative to review all patients with respiratory disease in care homes. The oxygen team picked up patients discharged post covid from hospital requiring oxygen at home. We identified high risk patients for regular telephone contact. Results: Referrals after admission for non-covid respiratory infections fell as patients stayed at home and reduced contacts. 1.1-1.4 2020v 2021 236 v 79;GP referrals also fell 1.1-1.4 2020-2021;87 v 35. Both have increased post lockdown. Referrals for PR fell. Total 1.1-1.4. 2020 v 2021, 373 v 107, GP referrals 226 v 54. Post lockdown 1.7.21-1.10.21 there has been an increase, total 139GP 81. Group PR is starting up again. Oxygen referrals after covid admissions up to 1.10.20 were only 8 from the first wave of disease, but 119 from 15.10.20-10.5.21, and 18 from 9.8.21-1.11.21 (11 ambulatory alone) all patients discharged after covid requiring oxygen at home are contacted by telephone and visited at home. We identified 380 patients who were rated as high risk, either having <3 admissions in 12 months, recent oxygen required at home or PCO2 <7.5Kpa. These were contacted weekly as they sheltered at home. Our staff reviewed 163 patients in nursing homes, 116 with respiratory disease, 31/116 already known to the service. 75% of patients needed a new reliever inhaler or spacer. 58% did not have a rescue pack of antibiotics and steroids, 85% required a salbutamol inhaler. Conclusion: Identification of “high risk patients allowed us to provide telephone support to keep them safe at home. Reviewing all residents in care homes identified unmet needs for therapy and support. Prompt review of patients requiring oxygen after admission for covid helps them once discharged. Admissions for non covid exacerbations fell as patients remained at home with limited contacts, but on re-entering the outside world, admissions for COPD have risen again.