As a national health and social care provider we work with the NHS and other organisations across numerous locations running a wide variety of services, and we have formed strong and valued partnerships in every area we operate.
This can be illustrated in the way we were called in at the outset to help with the design and response to the coronavirus pandemic in Reading and Wokingham, Berkshire.
And in just nine days we helped the local Primary Care Networks and the Royal Berkshire Hospital plan and set up something special –transforming our walk-in centre into a dedicated Covid Hot Hub to provide a second stage triage for symptomatic potential Covid-19 patients across the locality.
In collaboration with the acute trust and by using ultrasound devices, clinicians at the hub were able to develop a pathway to assess and identify high risk patients so they could get emergency treatment at the acute hospital Those seen as medium risk were monitored on a daily basis from home by the hospital team so they could be kept safe and out of hospital, but get emergency help quickly if their situation changed. Many of the assessment techniques adopted were based on learning from Brescia, Northern Italy, a region at the centre of the Covid outbreak in Europe. These novel techniques had not previously been tried in the UK.
Setting up the hub, was about trying to prevent capacity issues at the Royal Berkshire Hospital during the pandemic’s peak and letting emergency services target their limited resources where they were most needed.
What followed was a unique partnership – which is still ongoing – between primary and secondary care providers as well as ourselves. And this has brought about some very positive outcomes with more than 90 per cent of the 960 patients we have seen in a short period of time (by mid-July) either being monitored at home or sent home as they have been designated as at low risk. Without this innovative service more than 800 patients would have been admitted to hospital unnecessarily during the peak of the pandemic.
We are proud of the work we have achieved providing real help and adding value at a time of great need in the local communities in Berkshire. We were called in to help and utilise our experience of bringing numerous partners together to achieve the best results.
Providing support in the area for Coronavirus proved a challenge as many GP surgeries operate out of buildings unsuitable for social distancing and are unable to adopt one-way systems for patients due to their layout or to provide ‘hot’ and ‘cold’ zones.
Therefore, in March 2020 it was clear that a new system needed to be designed and put in place very quickly that could allow those who were symptomatic and deemed at potential risk of having Covid-19 to get a face to face second stage triage with clinicians.
These were people who would have already undergone a telephone triage after dialling the NHS 111 Covid-19 line. In line with the procedure across the country prior to widescale testing being available, they would need to seek medical advice through an appointment system as their symptoms, as presented in that telephone call, would have indicated they may be positive.
There was understandably a very real concern that, if something was not done, the Royal Berkshire Hospital would quickly have severe capacity issues as people would need to present themselves there at A&E instead.
So, drawing on research and experience from Brescia, in northern Italy, the NHS in west Berkshire sought to manage this capacity issue in a way no one else was trying in the UK.
Within nine days we supported the set-up of the Hot Hub in one of our buildings – which was called the Reading Primary Care Response Hub – and put in place a team consisting of clinicians, managers and administration colleagues.
These all worked closely with GPs and Primary Care Networks across Reading and Wokingham as well as the Royal Berkshire Hospital, and were able to see symptomatic patients who had already been telephone triaged via NHS 111 or their own doctor.
Using ultrasound devices connected to tablet computers – the same kind of equipment used on pregnant mothers – clinicians there could check the patients, including their lungs for complications such as pneumonia.
Using this technique, as well as checking each patient’s history and undertaking an examination, they were able to determine if someone was:
1: Well enough to go home without any further monitoring or intervention
2: Medium risk patients who could go home but would need close monitoring
3: Required to go to hospital
This ensured people received the care they needed and importantly meant services across Reading and Berkshire were able to keep hundreds of people who did not need to go, away from hospital during the peak, letting the medical teams there concentrate on those who needed help most.
The triage system was developed for people who presented with Covid symptoms and those designated as level 2 medium risk were given an LED monitoring device which attached to their finger to take home with them.
This monitored their oxygen level and the Royal Berkshire Hospital provided them with daily virtual consultations with their hospital team. During these, they discussed with the patient their symptoms and daily oxygen readings. If the oxygen level dropped below a certain point or their symptoms deteriorated, they could then be provided with additional support – or admitted into hospital.
And while the main focus of this ‘Community for Covid-19 Patient Pathway’, or TICC-19 was to identify patients at medium risk, a big part of its purpose was also to help detect whether complications such as pneumonia may have already set into a patient’s lung as identifying this before the patient is aware, or suffers any harmful and potentially lethal symptoms, allows faster treatment, reducing the risk of complications and the need for intensive support.
We are proud of this collaboration of GP practices and all their staff as well as support from hospital colleagues and it would not have been possible without everyone working together closely across the system.
We also believe our ability and experience of bringing about rapid transformation, working between primary care and acute care, being able to provide the resource needed to set up buildings and equipment, and the overarching governance all played a really important part.
In total, up to mid-July the hub had seen 960 patients since opening. Of these, 348 were categorised as medium risk – 36 per cent of all patients - and sent home with monitoring devices.
Forty-six were admitted to hospital with suspected Covid-19 after being deemed high risk. In addition, a further 36 were also admitted with other complications such as COPD. The rest were designated as low risk, and able to return home.
This was the first time the ultrasound technique has been used in the UK. It is in the process of being academically reviewed and other providers and services are now considering implementing similar services.
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