Evaluation of Investigation and Care of Hospitalised Covid-19 Patients [COVID-19]
Research type
Research Study
Full title
Lessons from the frontline of Covid-19 NHS responses: Impact of time to symptom onset and hospital admission, diagnostic pathways, discharge, convalescence and readmission outcomes across mid-Essex region
IRAS ID
283916
Contact name
Gavin A K Wright
Contact email
Sponsor organisation
Mid and South Essex NHS FT
Duration of Study in the UK
0 years, 4 months, 24 days
Research summary
With our rapidly growing global experience of COVID-19 and the impact on patients and healthcare services, it is apparent that the pandemic will have profound and lasting effects on how we deliver secondary and primary care services to cope with this new reality. Typically male sex, increasing frailty, maturity and predisposing comorbidities are associated with higher morbidity and mortality. However, anecdotally we are seeing cohorts of frail patients present early from initial symptoms onset and later recover when initial prognostic indicators, garnered from the original Wuhan and now European data, would suggest poorer outcomes. Conversely, younger patients are presenting later following symptom onset with more serious disease and likely to require some form of ventilatory support with or without intensive care. Furthermore, while health systems have been geared to encourage early discharge of patients not requiring of on-going respiratory support, these patients may remain markedly affected by both respiratory and non-respiratory symptoms that can require hospital admission or discharge to community-based care facilities for further recuperation. Secondary care is also seeing patients readmitted with worsening symptoms following initial triage discharge, though the reasons for this remain unclear. In consideration of these concerns there is a fundamental need to rearrange and better integrate secondary and community–based services to manage these pressures. Additionally, we utilized a novel CT triaging system from the emergency Dept. to aid earlier diagnosis and cohort stratification. \nThis study will be retrospective; drawing on clinical data from 1st March to 30th April 2020, collected routinely from electronic patient record and clinical reporting systems; without impacting on current COVID-19 clinical responses. Our primary aims will be to understand if there is a divergence in clinical outcomes for hospitalized covid-19 patients related to time of symptom onset to hospital admission and pre-morbid frailty scores. Assess the prevalence and impact of individual COVID-19 symptoms (e.g. fatigue) and/or complications on post-discharge recovery from data collected from a small prospective questionnaire-based study of selected patient’s post-discharge. Further characterise relative impact of prognostic indicators on all-cause mortality. Understand healtheconomic impact to community care services of discharged, frail and recovering covid-19 patients. From a diagnostic imaging perspective, we aim to 1) evaluate the functional effectiveness of our CT triage system, and 2) volumetrically analys extent of lung involvement with CT and correlation with clinical parameters to determine disease burden and therefore presumptive viral load and hence outcomes.\nThe outcomes of this COVID-19 study should allow us to develop more targeted clinical and transitional community-based pathways to improve the patient’s clinical pathway, clinical outcome(s), improve clinical and cost-efficiency, with more effective use of resources. Moreover, it may allow for the development of a CT-driven risk stratification tool and a scoring system to predict the burden of COVID-19.\n
REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
20/EM/0135
Date of REC Opinion
21 Jun 2020
REC opinion
Further Information Favourable Opinion