Introductions and Objectives BTS guidelines advise that patients with a clinico-radiological diagnosis of COVID-19 undergo follow-up based on severity of disease: either Group 1 (required ICU/HDU admission or significant respiratory support), or Group 2 (any other admitted patients).
The BTS guidelines themselves address concerns that delivering this follow-up might prove difficult due to disrupted working patterns and large caseloads. To address these concerns, we established a post-COVID-19 Pre-Follow Up Multi-Disciplinary Team (pre-FU-MDT). We have reviewed its impact on COVID-19 follow-up streams.
Methods To capture all relevant patients we cross-referenced a list of all RT-PCR swabs sent for symptomatic purposes against those who had a recent CXR. The CXR reports, coded in real time, were used to establish a list of patients who had CXRs consistent with or indeterminate for COVID-19 pneumonia.
The database was screened by a specialist respiratory nurse who assigned follow-up streams based on level of respiratory support required and CXR report.
All Group 1, Group 2 and Indeterminate cases were discussed at MDT, which consisted of a consultant respiratory physician and a thoracic radiologist. Cases were discussed with discharge summaries, results and imaging. Follow-up streams were reallocated as necessary. Time for MDT was re-allocated from services reduced during the pandemic.
Results Of 1532 ‘symptomatic’ swabs, there were 495 patients with a potential clinico-radiological diagnosis of COVID-19 pneumonia discussed at the Pre-FU-MDT.
We performed a subgroup analysis on 392 consecutive cases (Table 1). The pre-FU-MDT changed the follow-up pathway in 21% of non-indeterminate cases (23/108). Follow up was ceased in 5% (17/108). Patients with indeterminate CXRs represented the largest cohort. The pre-FU-MDT ceased follow-up in 57% (150/261) and the remaining 43% (111/261) were stratified to Group 1, Group 2 or other appropriate non-COVID follow up.
Conclusions A Pre-FU-MDT has significant clinical impact. By redistributing clinicians’ time, an efficient mechanism has been created to reduce unnecessary CXRs and clinic appointments, and focus on those most likely to require follow-up. Review of our follow-up outcomes is ongoing and the results will be available at the time of the BTS meeting.
BTS Guidance on Respiratory Follow-Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia ( 2020)
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