P19 COVID Virtual Ward and Emergency Department discharges: clinical outcomes and recommendations following COVID pandemic phase 2

Abstract

P19 Figure 1Results119 COVNA patients identified (female 65 (55%);77 (66%) BAME;median age 51 years, IQR 38–62, range 16–88). Over half (55%) were between the ages 40 and 69. COVNA patients were relatively free from co-morbidity: 104 (87%) had low or intermediate risk ISARIC 4C scores;all had Charlson co-morbidity score of less than 9 representing low 10 year mortality.Median length of stay on VCW was 3 days (IQR 3–8, range 0–15);median number of calls undertaken was 3 (IQR 2–5, range 0–9).32 (27%) COVNA patients returned to ED, 8 of whom were discharged home with an overall admission rate 20%. Re-presentations within 5/7 were predominantly COVID related (20/23;87%). After 5 days, there were no attendances with worsening pneumonitis (figure 1). The commonest route for re-attendance was self-referral (17/32;53%) of whom 14 were admitted;all 10 persons referred to ED from VCW were admitted.COVNA patients issued with a saturation probe (48%) were more likely to re-present and be admitted (RR 2.2;95% CI 1.03–4.74;p0.0425).2 (1.7%) sustained pulmonary emboli;1 intensive care admission;4 patients died (3% unadjusted mortality).ConclusionsCOVNA patients have low mortality and morbidity from COVID. The VCW model has safely and successfully supported COVNA patients who are deemed fit enough to not require admission (clinical judgment and no oxygen requirement). Ideally, all COVNA patients should be issued with a saturation probe. COVNA patients should be warned that re-presentation and admission may be required. Worsening of symptoms and/or a drop in oxygen saturation should warrant return to ED. This pathway should be continued in COVID endemic phase.