Introduction A Virtual Covid-19 Follow-up Clinic was designed in response to the need to review a large number of in-patients, at a large hospital trust, recovering from Covid-19 but without any significant increase in resources.
Methods Patients complete a structured online/telephone symptom and psychological health questionnaire and have a chest x-ray 12 weeks after their illness. These results, and their medical records, are reviewed asynchronously by the medical team in a virtual clinic. Patients are then triaged to further virtual review, telephone review, face to face review, or are discharged. All patients receive comprehensive written information to aid their recovery.
Results During the first 8 weeks of the service, 388 patients have completed the questionnaire (63% online) and been reviewed. Current symptoms are shown in figure 1. The questionnaire has identified the holistic needs of patients and allowed triaged follow-up with 122 discharged and 53 urgent face-to-face review appointments completed. 25 CT pulmonary angiogram scans were arranged for patients with typical symptoms of pulmonary emboli; no thromboembolic disease was identified.
Conclusion This early experience of a new service has highlighted 5 learning points:
Virtual review is not necessarily quicker than clinic review in person, with holistic review taking 15 minutes per patient (excluding phone calls).
Patients appreciate clinical contact and this is particularly relevant in the post-Covid era of restricted healthcare attendance. All patients who attend for face to face review are extremely grateful.
A multidisciplinary team is necessary bringing together respiratory, cardiology, rheumatology, radiology, psychology and immunology in one holistic review. Patients benefit from therapy input, with 13 of 49 patients assessed by the physiotherapist in clinic diagnosed with breathing pattern disorders.
Medical staff redeployment during the pandemic, and the extreme pressures at that time, meant aspects of planned care were not arranged at discharge. Virtual review of medical records has addressed this, for example, re-arranging a referral for a pacemaker and arranging haematological review of a patient newly diagnosed with chronic lymphocytic leukaemia.
Regular multi-disciplinary strategy meetings have allowed guidelines to be revised weekly, based on increasing evidence, and experience disseminated.
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