P28 Developing a novel advanced clinical practitioner led severe COVID-19 follow-up service – a picture is not always worth a thousand words

Abstract

During the COVID-19 pandemic the British Thoracic Society produced national guidance advising for all severe COVID-19 pneumonia (defining our inclusion criteria as clinico-radiological diagnosis, oxygen requirements >35%, continuous positive pressure ventilation or mechanical ventilation) to have 4–6-week follow-up with all COVID-19 patients having imaging at 12 weeks.1 To avoid duplication of work streams, the district general hospital developed a pathway liaising with ICU to ensure follow-up 4–6 weeks post discharge, chest x-ray at 12 weeks and follow-up telephone appointment at six months with the aim of discharging back to the community or referring for further investigations. In total we followed up 272 patients who were referred to our service.In the first wave (April 2020 - July 2020) we followed up 117 patients of whom 99 had a follow-up chest X-ray. Chest x-rays were performed on average 80.4 (43–140) days post discharge. Of these patients, 14% had residual changes, with 86% having a clinic normal chest X-ray, with 33 (28%) requiring referral for further investigation and respiratory physician follow-up due to breathlessness (quantified by Modified Medical Council Research dyspnoea score) identified at follow-up clinic appointments, on average 168.4 (91–209) days post discharge.In the second wave (October 2020 – April 2021) we followed up 155 patients of whom 133 had a chest x-ray and 51 (38%) had residual changes. Chest x-rays were performed on average 88.7 (32–120) days post discharge and follow-up clinic appointments were on average 150.9 (92–172) days post discharge. Only 35 patients have been followed up to date (the remaining having not reached 6-months post discharge). Of these 15 (42.8%) required onwards referral for further investigation.This data shows that we have run a robust follow-up service for severe COVID-19 pneumonia patients. It is important that we think carefully about who is referred for further respiratory investigations as our data shows that chest x-ray resolution does not necessarily correlate with resolution of symptoms, and the implication for NHS services.British Thoracic Society. British Thoracic Society Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia [V1.2], 2020. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/