A team of respiratory clinical nurse specialists at East and North Hertfordshire NHS Trust have been invited to speak at a national conference on Friday after setting up a virtual clinic to support patients discharged from hospital with suspected or confirmed COVID-19.
The telephone clinic launched in March, with the aim to ensure patients were continuing to improve after their stay at Lister Hospital in Stevenage – and to quickly identify those who needed further care if their condition deteriorated.
One of the first consultations identified a patient who was struggling with their symptoms, so they were asked to attend the emergency department. On arrival, the patient was immediately intubated and admitted to critical care.
The patient subsequently made a full recovery and returned home, with the case demonstrating the impact of the virtual clinic.
As well as identifying patients who have deteriorated at home, the clinic provides a safety net for patients, to educate and reassure, and ensure they are offered aftercare in line with the current guidance.
In response to the pandemic, East and North Hertfordshire NHS Trust set up a rating system to categorise the likelihood of a patient having COVID-19 – and this is used by the respiratory team to determine the level of support a discharged patient is likely to require.
For those who have tested positive for COVID-19 or where it is highly suspected, a respiratory clinical nurse specialist will call the patient the day after leaving hospital, and follow up again two days later and again after a week. The number of calls – where patients are asked a number of questions including about their breathing, chest pain and fever – can also be increased or decreased, based on clinical judgement.
For patients whose condition is not improving, an additional call with a doctor is organised, with the potential for a home visit from the trust’s integrated community respiratory team, or the patient is advised to return to hospital.
One of the initial challenges to running the virtual clinic was staffing – with four out of 10 members of the team self-isolating when it was launched in March. By sharing workloads and seeking support from colleagues such as junior doctors, it was able to be maintained and then later developed once colleagues were able to return to work.
By the end of June, 733 patients had been contacted by the virtual clinic and staff had conducted more than 1,500 calls.
Patients who had confirmed COVID-19 or where it was highly suspected were most likely to be called three times before they were discharged from the service, although a small number received six calls before the team were satisfied.
Up to the end of June, 33 patients who were contacted by the virtual clinic had to be readmitted to hospital– with seven identified by the respiratory clinical nurse specialist team.
These findings were part of an article written by four members of the respiratory clinical nurse specialist team which has been published in the Nursing Times, with the authors reflecting that the “gratitude expressed by patients to respiratory CNS team members has been extremely humbling, and the positive impact of the service makes the challenges we have experienced feel worthwhile”.
Following its publication, the team have now been invited to make a presentation about the virtual clinic at the Association of Respiratory Nurse Specialists’ virtual conference on Friday 14 August.
Sarah Lewis, who will be speaking at the conference alongside her fellow senior respiratory clinical nurse specialist colleague Angela Blundell, said: “The virtual COVID-19 clinic has given us the opportunity to ensure our patients are safe after discharge and provides reassurance to those who are isolated at this difficult time.
“As a team we have worked extremely hard to ensure this service can run effectively. We are hugely encouraged by the positive feedback we have had and hope it will inspire other services.”