Implementation and evaluation of a COVID-19 rapid follow-up service for patients discharged from the emergency department

Article Figures & Data

Table 1.

Pilot cohort: patient demographics and characteristics at emergency department presentation, 27 April – 3 June 2020

Demographics	All patients, n=192
Age, years, median (IQR)	43 (32–55)
Female, n (%)	96 (50.0)
Never smoker, n (%)	97 (50.5)
HCW or recent healthcare exposure, n (%)	45 (23.4)
Lives alone, n (%)	55 (28.6)
Characteristics
Day of illness, median (IQR)	13 (3–28)
Oxygen saturation, %, median (IQR)	98 (97–99)
Respiratory rate, breaths per minute, median (IQR)	18 (17–19)
C-reactive protein, mg/L, median (IQR)	2.2 (0.7–11.0)
Chest X-ray abnormality (any), n (%)	43 (22.4)
D-dimer, μg/L, median (IQR)^a	355 (210–585)
CTPA positive for pulmonary embolism^b	2/22
Swabbed for SARS-CoV-2 in ED, n (%)	153 (79.69)

Missing data: smoking status (10), household status (10), C-reactive protein (16), oxygen saturation (6), respiratory rate (5) and day of illness (5). Twenty patients did not have chest X-rays at ED attendance.
↵^a D-dimer was checked in 80 patients (low risk 52; medium risk 22; high risk 6);
↵^b 22 patients had CTPAs (low risk 10; medium risk 9; high risk 3). CTPA = computed tomography pulmonary angiography; HCW = healthcare worker; IQR = interquartile range.

Table 2.

Cohort trajectories

	All patients, n=192	Confirmed or probable COVID-19, n=83	Unlikely or uncertain COVID-19, n=109
Discharged with pulse oximeter, n (%)	8 (4.2)	6 (7.2)	2 (1.8)
Using own pulse oximeter, n (%)	21 (10.9)	17 (20.5)	4 (3.7)
Number of telephone encounters, median (range)	1 (1–6)	1 (1–6)	1 (1–4)
Planned reattendances, n (%)	23 (12.0)	18 (21.7)	5 (4.6)
Planned reattendances leading to admissions, n (%)	5 (2.6)	4 (4.8)	1 (0.9)
Unplanned reattendances, n (%)	9 (4.7)	6 (7.2)	3 (2.8)
Unplanned reattendances leading to admissions, n (%)	2 (1.0)	2 (2.4)	0 (0.0)

‘Planned reattendances’ refers to patients who were recalled for face-to-face assessment by the telephone clinic. ‘Unplanned reattendances’ refers to patients who reattended without prompting.

Table 3.

Outcomes

	All patients, n=192	Confirmed or probable COVID-19, n=83	Unlikely or uncertain COVID-19, n=109
Discharged back to GP, n (%)	131 (68.2)	35 (42.2)	96 (88.1)
Referred to respiratory COVID-19 follow-up clinic, n (%)	44 (22.9)	41 (49.4)	3 (2.8)
Referred to other secondary care clinic, n (%)	17 (8.9)	7 (8.4)	10 (9.2)

Table 4.

Validation cohort characteristics and trajectories; emergency department attendances 1 September – 23 October 2020

Demographics	All patients, n=134	COVID-19 positive, n=47	COVID-19 negative or swab not done, n=87
Age, median (IQR)	41 (28–56)	47 (29–60)	37 (27–53)
Female, n (%)	68 (50.7)	23 (48.9)	45 (51.7)
Characteristics at ED presentation
Oxygen saturation, %, median (IQR)	97.5 (96–99)	96 (95.5–98)	96 (96–98)
C-reactive protein, mg/L, median (IQR)	8.4 (1.3–25.4)	11 (3.7–24.7)	6.9 (0.6–25.6)
Cohort trajectories
Number of telephone encounters, median (range)	1 (1–8)	2 (1–8)	1 (1–5)
Total reattendances, n (%)	12 (9.0)	7 (14.6)	5 (5.7)
Planned reattendances, n (%)	5 (3.7)	3 (6.2)	2 (2.3)
Planned reattendances leading to admissions, n (%)	2 (1.5)	2 (1.3)	–
Unplanned reattendances, n (%)	7 (5.2)^a	4 (8.3)^b	3 (3.4)
Unplanned reattendances leading to admissions, n (%)	3 (2.2)	3 (6.2)	–

Missing data: oxygen saturation (2) and C-reactive protein (12).
↵^a of which five had been uncontactable by the telephone clinic;
↵^b of which two had been uncontactable; ED = emergency department; IQR = interquartile range.