Abstrakt

COVID-19 community pathway: How right did we get it?

William Evans, Gareth Evans*

Background: We report on the outcomes from a COVID community pathway established in Response to the first wave of the COVID-19 pandemic. Aim: A pathway was established to triage patients presenting with symptoms compatible with COVID-19, to identify those who would benefit from hospital-based assessment and those who could be safely discharged with safety-netting and self-care advice. Design and Setting: Patients presenting with symptoms compatible with COVID-19 were advised to contact NHS 24, and were referred to a COVID community pathway for further clinical assessment if necessary. Method: Outcomes for patients seen in this pathway between 1 and 30 April 2020 are presented. Results: 4,333 patients were referred to the COVID community pathway. 4.8% were directed to hospital Emergency Departments after initial telephone triage. 74% were discharged with safety-netting advice without a face to face assessment. Of these patients, 8 patients (0.25%) were subsequently admitted and died in hospital from COVID-19. 21% were referred to a COVID Assessment center. Of those seen face to face, 85% were discharged with safety netting advice, and 15% were referred to secondary care. Of those discharged, 0.5% subsequently died of COVID-19. Of those referred to secondary care, 40% were not admitted or discharged within 24 hours and 60% were admitted for 24 hours or more. Conclusion: Clinicians working within the COVID community pathway were able to appropriately triage patients using telephone assessment, and where necessary, face to face assessment to identify those who were most likely to benefit from hospital based assessment. Clinical Relevance and Contribution to Literature: Many primary care clinicians are experienced at community-based triage of patients presenting with a broad range of illness and injury. COVID-19 illness encompasses a range of presentations from mildly symptomatic through to severe pulmonary inflammation, and a subset of patients may deteriorate and require hospital admission. There are currently no validated prognostic models for patients, assessed in the community, to safely identify those patients who are at risk of deterioration. Primary care clinicians work in a COVID community pathway demonstrated safe and effective triage using telephone consultation, and where required, face to face clinical assessment focusing on a key clinical parameters: oxygen saturation, temperature, general appearance and respiratory rate.