How a local community COVID-19 service treated up to 200 vulnerable patients every day

On June 15, 2021, NHS England asked all Integrated Care Systems (ICS) in the country to set up local units that would provide potential COVID-19 therapies to patients. At the time, there was new evidence that neutralizing monoclonal antibody (nMAB) treatments could protect vulnerable patients from COVID-19, but the UK medicines regulator had yet to grant marketing authorisation. market for any of these treatments.

Barts Health NHS Trust has been identified as the lead provider of the COVID-19 Medicines Delivery Unit (CMDU) for ICS North East London. As a team, we were already running a vaccination center at Westfield Shopping Center and a vaccination awareness service, but this was a new challenge for us and an opportunity to impact the health of our local people.

The first problem was identifying a suitable location. Those in attendance would be COVID-positive, so the service needed to ensure that patients could walk in and out with little contact with other members of the public. We were lucky enough to finally find a location in a building on the site of Mile End Hospital in east London which, with some adaptations to the ventilation system and the way staff and patients moved through the building, was a perfect home for the CMDU.

Staffing model

The second problem was staffing. Planning for the new service began in August 2021, with an expected opening date of early October 2021, but there was little information on any staffing model, so we had to create our own.

Then, for various reasons, national deployment timelines slipped to December 2021. This posed some challenges for us as some staff who initially expressed interest had already moved on to other opportunities, leaving us with gaps in our staffing. However, our colleagues have stepped up to support the service and this, combined with additional temporary staff, has enabled us to continue with plans to go live on December 16, 2021.

We already had more than 70 references waiting to be sorted on the day the service went live.

The third, and perhaps most important, issue we faced was the very high number of referrals we received when opening the service. At the time, cases of the Omicron variant of COVID-19 were increasing rapidly and we already had over 70 referrals waiting to be triaged on the day the service went live. Over the following weeks, especially during the festive period, the daily referral rate remained at a very high level, reaching 217 referrals on New Year’s Eve.

These references were significantly higher than the original modeling, meaning we did not have enough staff to perform the required triage. This was exacerbated by the Christmas holiday period as many of the staff who would normally have been available to help were on holiday. However, we managed to get coverage to work with the team to help manage these referrals and they were supported by our excellent nursing and pharmacy team. We were also supported by our clinical commissioning group, who arranged for us to train a group of dentists and nurses to support referral triage.

Lack of information

Initially, the service was designed to provide intravenous infusions of sotrovimab, a neutralizing monoclonal antibody (nMAB) treatment, to high-risk patients who had a positive PCR/side test. However, we had limited information to plan and develop the service throughout.

Ongoing research has led to CMDUs being asked to also schedule the delivery of molnupiravir, an oral antiviral drug that could be delivered to patients at their homes. This request was given just weeks before the December go-live date, leaving very little time to plan and organize this. Once again, our pharmacy team rose to the challenge by arranging the delivery of the medicine, staff training and a contract with a courier service to enable delivery.

To date, we have triaged nearly 5,000 patients and treated over 1,000 patients, with all people accessing sotrovimab infusion therapy being contacted 24 hours after treatment for follow-up. Of those contacted, a sample of 49 patients were interviewed in early 2022, all providing positive or neutral feedback regarding their recovery trajectory and the care and treatment provided; none reported adverse effects.

Quality improvement

Based on initial patient and staff feedback, a quality improvement project was initiated to improve the patient and staff experience at CMDU. Based on focus groups, written feedback and workshops, a set of 63 change ideas were generated, such as improving team training, using digital technology to streamline services and the improvement of the clinical and working environment.

Baseline data from feedback surveys submitted in January and February 2022 showed satisfaction scores of 97% for patients and 82% for staff. Further surveys will be conducted during 2022 to provide data on the effectiveness of the changes that are being implemented.

Secondary goals include implementing a digital workflow, researching long-term patient outcomes after treatment, as well as reviewing patients who may benefit from treatment but are currently unresponsive current treatment criteria.

We are truly proud of this successful example of interprofessional practice and the opportunities it has provided for system-wide learning. Implementing a new clinical service at a new location can seem overwhelming, but it can also be exciting. We have found open communication with all key stakeholders to be important and recognize that it can take a long time for the team to fully integrate into the clinic. If you have a clear vision of the site’s clinical role and are able to establish an effective learning environment, you can be successful.

Tejal Patel is head of pharmacy; Suzette Fernandes is operational manager; Jon Dalton is director of the service; and Rachel Evans is matron for CMDU services, all at Barts Health NHS Trust