Adherence to NHS England-BSTI radiology decision tool in suspected COVID-19 patients

Abstract

Category: General Background to the audit: Chest radiographs are typically the firstline imaging modality used for patients with suspected COVID-19.1 British Society of Thoracic Imaging (BSTI) and NHS England (NHSE) have released a COVID-19 radiology decision-support tool to aid clinicians on the optimal work-up of suspected COVID-19 patients.2 This audit aims to review adherence to this guidance when healthcare staff suspect hospital inpatients of newly developed COVID-19 infections. Standard: According to the NHSE-BSTI decision-support tool: 1. Every patient suspected of COVID-19 and clinically deteriorating should have a chest X-ray requested along with their COVID-19 swab 2. Clinical deterioration is defined as oxygen saturations < 94% or <90% in patients with COPD or scoring at least 3 on the National Early Warning Score (NEWS). Indicator: Degree of compliance with the standard guidance. Target: 100% compliance. Methodology: A retrospective study design was performed using electronic health records to identify inpatients who received COVID-19 PCR tests. A predetermined exclusion criterion was strictly adhered to: 1. Patients who did not co-present with clinical deteriorations were excluded. Included records were assessed to determine if chest X-rays were ordered alongside the COVID-19 PCR tests. Results of first audit round: 1. 50 hospital admissions who received COVID-19 PCR tests were identified through the electronic health records database. 2. 66.0% (33/50) co-presented with clinical deteriorations and were included. 3. 69.7% (23/33) of the clinical deteriorating patients have been found to not have a chest X-ray requested at the time of their swab. First action plan: 1. Present findings at hospital grand round. 2. Circulate NHSE-BSTI radiology support tool via email communication and posters in hospital wards. 3. Re-audit in three weeks.