Respiratory failure, clinical course and community management of COVID-19 patients in a large Australian cohort.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. A thorough understanding of the characteristics of COVID-19 patients in Australia plus the strategies that successfully 'flatten the curve' are vitally important to contain this pandemic. AIM: To describe the clinical characteristics and outcomes of COVID-19 patients in the Sutherland Shire, and the management model adopted to manage these patients. METHODS: A retrospective case series of COVID-19 patients monitored in the Sutherland Shire between 19 March and 15 May 2020 was performed. Demographic, clinical and outcome data of COVID-19 inpatients at the Sutherland Hospital and demographic data of COVID-19 patients in the Sutherland Shire community were obtained. The Sutherland Hospital COVID-19 Management Model involved close collaboration among the Sutherland Fever Clinic, Sutherland COVID-19 community telemonitoring team (CTAC) and Sutherland COVID-19 inpatient team. RESULTS: Ninety-nine COVID-19 cases (median age, 49 years, 50 (51%) male) were monitored in Sutherland Shire, with 19 cases (median age, 54 years, 10 (53%) male) requiring inpatient management. Common comorbidities included obesity, asthma, hypertension and Type 2 diabetes mellitus. Six (32%) patients required supplemental oxygen and three (16%) patients required intensive care admission. There was one mortality. The CTAC team identified five (5%) patients requiring admission, and three (3%) patients requiring re-admission. The majority of COVID-19 source was from overseas travel (67%), with nine (9%) cases having unknown source. CONCLUSION: A comprehensive COVID-19 management model is needed to successfully manage COVID-19 patients in both outpatient and inpatient settings in order to 'squash the curve'.

Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital.

BACKGROUND: Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting. OBJECTIVE: To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital. METHODS: JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration. RESULTS: Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration. CONCLUSIONS: Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.

CF derived scoring systems do not fully describe the range of structural changes seen on CT scans in PCD.

BACKGROUND: Structural lung changes seen on computed tomography (CT) scans in Cystic Fibrosis (CF) and Primary Ciliary Dyskinesia (PCD) are currently described using scoring systems derived from CF populations. This practise assumes lung damage in the two conditions is identical, potentially resulting in a failure to identify PCD-specific changes. Our study addresses this assumption. METHODS: A total of 58 CT scans from 41 PCD patients (age 2-48 years) were examined and the presence and extent of abnormalities common in CF; bronchiectasis, bronchial wall thickening, atelectasis, mucous plugging, and air trapping noted. Further assessment of the PCD scans by an experienced chest radiologist identified several unique PCD specific changes. RESULTS: Bronchial wall thickening was the commonest abnormality seen in PCD. All abnormalities were present more often in middle and lower lobes than in upper lobes (P < 0.001). Bronchiectasis, mucus plugging, atelectasis, and air trapping were present more often in PCD than in the historic CF cohorts which formed the basis of two CF scoring systems (P < 0.05). Extensive tree-in-bud pattern of mucus plugging, thickening of interlobar, and interlobular septa, and whole lobe atelectasis were seen significantly more frequently in PCD than CF. CONCLUSIONS: Structural changes identified on CT scans in PCD are not identical to those previously described in CF patients and suggest assessment of PCD structural changes on CT should not use CF derived scoring systems.