Outcomes of older COVID-19 patients in Acute Care at Home, Southern HSC Trust, Northern Ireland, from March - June 2020.

INTRODUCTION: The older population has been most affected by COVID-19, with mortality rates of around 27%. The Acute Care at Home (ACAH) team aims to improve outcomes in the older population by preventing hospital admission or facilitating early discharge, allowing patients to be treated in their own environment. During the COVID-19 pandemic, the ACAH team administered oxygen therapy, antibiotics, anticipatory medications and other vital interventions to combat the ill effects of COVID-19. METHOD: An observational approach has been used in this study. Patients were included if they were admitted to ACAH during March-June 2020 for treatment of COVID-19. Biochemistry, oxygen saturations and co-morbidities are among the studied parameters. Lymphocyte count and serum magnesium were compared with a non-COVID-19 cohort. Trends within parameters and associated mortality were analysed and tabulated. RESULTS: 70% of admissions were lymphopenic, whilst 54% were hypoxic. There was a 28-day mortality rate of 35%, with an 18% increase in mortality rate when comparing residence in long-term care facilities (LTCF) to personal residence. All patients had existing co-morbidities. CONCLUSION: The data indicates that hypoxaemia, hyperferritinaemia and hypermagnesaemia are associated with early mortality in the older population infected with COVID-19. National Early Warning Score and frailty score are predictive of mortality in this cohort, with higher scores correlating to worse outcomes. Those living in LTCF are at an increased risk of mortality. However, ACAH mortality rates are comparable to those admitted to hospital, validating the concept of ACAH. The highlighted trends can be used to improve outcomes in future admissions.

Virtually prepared! Student-led online clinical assessment.

The transition of medical education from a face-to-face to virtual setting due to the ongoing COVID-19 restrictions has been challenging. While both students and educators have now somewhat settled into new teaching methods, from Zoom™ lectures to online tutorials, the adaption of clinical skills teaching to the virtual setting has lagged behind. As a result, many students have been left feeling anxious and concerned about practicing practical and communication skills that are central to being a competent and safe doctor. In light of this, medical students at the Queen's University Belfast General Practice (GP) Society organised a series of virtual, mock Objective Structured Clinical Examinations (OSCEs) for students in Years 2-5 conducted via Zoom™. Medical students and doctors acted as examiners and simulated patients (SPs) with 'breakout rooms' being used to simulate distinct OSCE stations. This collaborative project was well received by participants and doctors alike, who found the virtual OSCEs improved their confidence in performing key clinical skills and virtual consultations. As medical students ourselves, we gained early career exposure to designing and delivering assessments and developed transferable skills, relevant both to medicine and teaching. Lastly, the peer-led approach disrupted the traditional hierarchy in medical education. Students are a key, and often overlooked, resource to overcoming challenges in medical education and educators should encourage students to become involved in medical education at an early stage in their careers.