Lessons learned from the COVID-19 pandemic: Improving initial investigations with the implementation of a COVID-19 blood request panel.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the Hillingdon Hospitals NHS Foundation Trust produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, insufficient education meant inconsistent adherence to this guidance. OBJECTIVE: To examine whether the implementation of a COVID-19 blood request panel improves adherence to local trust guidelines. METHOD: Between March and April 2020, initial blood investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic system that provided prompts for appropriate investigations. A re-audit between May and June 2020 was conducted to assess adherence post-intervention. RESULTS: 383 patients were identified in the initial audit cohort and a sample of 20 patients were re-audited. Adherence to Full Blood Count, Urea and Electrolytes, C-reactive Protein and Liver Function Tests increased to 100% from 99.7% (p = 0.8), 99.2% (p = 0.69), 98.7% (p = 0.61), and 96.6% (p = 0.4) respectively. Coagulation screen adherence increased to 90% from 72.8% (p = 0.09). Appropriate requesting of D dimers increased to 50% from 19.9% (p = 0.001). Inappropriate troponin requesting decreased to 26.3% from 38.9% (p = 0.23). CONCLUSION: A user-friendly COVID-19 panel of investigations resulted in improved adherence to guidelines. Clear communication and education are essential to help alleviate uncertainty during a pandemic.