Abstract
ObjectivesThe second wave of the coronavirus pandemic is now established, occurring at a time of winter pressure on acute care in the NHS. This is likely to be more challenging then the first wave for the diagnosis of COVID-19 because of the similar symptomology with other respiratory conditions highly prevalent in winter. This study sought to understand the care pathways in place in UK NHS hospitals during the first wave (March–July 2020) for identification of patients with COVID-19 and to learn lessons to inform optimal testing strategies within the COVID-19 National Diagnostic Research and Evaluation Platform (CONDOR).Design, setting & participantsSixteen hospital-based clinicians from 12 UK NHS Trusts covering 10 different specialties were interviewed following a semi-structured topic guide. Data were coded soon after the interviews and analysed thematically.ResultsWe developed a diagrammatic, high-level visualisation of the care pathway describing the main clinical decisions associated with the diagnosis and management of patients with suspected COVID-19. COVID-19 testing influenced infection control considerations more so than treatment decisions. Two main features of service provision influenced the patient management significantly: access to rapid laboratory testing and the number of single occupancy rooms. If time to return of result was greater than 24 h, patients with a presumptive diagnosis would often be cohorted based on clinical suspicion alone. Undetected COVID-19 during this time could therefore lead to an increased risk of viral transmission.ConclusionsDuring the winter months, priority for provision of rapid testing at admission should be given to hospitals with limited access to laboratory services and single room availability. Access to rapid testing is essential for urgent decisions related to emergency surgery, maternity services and organ transplant. The pathway and prioritization of need will inform the economic modelling, clinical evaluations, and implementation of new clinical tests in UK.
Highlights
The global SARS-CoV-2 pandemic has put considerable pressure on healthcare services worldwide [1]
In the UK, as the second wave is coinciding with the winter months, clinicians are faced with further complexity in the diagnosis of COVID-19 due to the similar symptomology with other viral respiratory illnesses [5, 6]
Most clinicians expressed the need for quicker diagnostics, in particular point of care (POC) testing, in hospitals where access to rapid laboratory testing was absent
Summary
The global SARS-CoV-2 pandemic has put considerable pressure on healthcare services worldwide [1]. Health and care providers require clear care pathways and diagnostic strategies to rapidly identify patients infected with SARS-CoV-2, to ensure appropriate use of single patient occupancy side rooms, accurate cohorting of patients and early administration of therapies for coronavirus disease (COVID-19) [2]. The risks of nosocomial infection are high [3] and mechanisms to limit transmission of SARS-CoV-2 within hospitals and care facilities are an urgent priority, as many countries are dealing with a second wave of infection [4]. Ensuring a detailed understanding of identification and management strategies adopted during the first wave of infections is crucial in order to inform the design of effective clinical pathways for admitted patients. There is pressure to expedite test development and evaluation, and the demand on developing models to help identify optimal testing strategies is high. Patient care pathway analysis [7] is the first step in that direction, supporting the identification of the most effective role of new tests in the current care pathway [8]
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