The implementation of a virtual ward using digital solutions informing community clinicians in early supported discharge of patients with SARS-Cov2 respiratory symptoms from an acute hospital setting Swift J*, Harris Z#, Woodward A#, OKelly NI*, Barker C* and Ghosh S#! *Spirit Health Group; # Community Health Services, Leicestershire Partnership NHS Trust MESHD, ! Leicester School of Allied Health Sciences, DMU Abstract Objectives: To assess the short run successes and challenges of the implementation of a digitally supported accelerated acute hospital discharge scheme for patients admitted with Covid-19 MESHD. Design: Analysis of the safety, resource use and health outcomes within the virtual service for the first 65 patients that have been discharged from a virtual respiratory ward. Setting: Community based intervention using digital technology and a multi-disciplinary team of specialist clinicians to monitor patients at home. Participants: 65 patients discharged from hospital followed until discharge from the virtual ward. Results: 24.6% of 65 patients had symptoms that were coded red (urgent response required) in CliniTouch Vie in the first day after hospital discharge falling to 7.7% on their final day on the virtual ward; p=0.049. Reductions in red days decreased significantly over time, from 33.8% of patients in their first three days to 10.8% in their final three days; all patients p=0.002. Four patients were re-admitted to hospital, all for clotting disorders. There was one death within this group, which following senior clinical review was deemed to be unrelated to infection with Covid-19 MESHD. The most important gain for Glenfield hospital was in expediting the rapid discharge of patients admitted with Covid-19 MESHD into a supported environment and the freeing up of beds. On 15th January, 48% of beds were taken up with patients admitted with Covid-19 MESHD symptoms. In November 2020, immediately prior to the launch of the virtual ward, the mean length of stay for patients who did not access high dependency care or oxygen was 5.5 (+/-1.3) days. The mean length of stay in patients discharged into the virtual ward thereafter was 3.3 (+/-0.4) days; relative reduction, 40.3% (p<0.001). The cost of care provision in the virtual ward was 8,165 UK Pounds in total and 124.31 UK pounds per patient. The estimated overall savings were 68,550 UK Pounds and the mean saving per patient was estimated at 1,055 UK Pounds. Conclusions: The virtual ward appeared to assist with earlier discharges, had a low rate of clinically necessary re-admissions, the safety of patients was not compromised and whilst cost savings were not the primary objective, it seemed to also reduce overall resource use and costs.

Aims: Inpatient life in UK mental health hospitals was profoundly altered during the first wave of the COVID-19 pandemic MESHD. We analysed whether these changes impacted the rate of violent and aggressive incidents across acute adult wards and psychiatric MESHD intensive care units in a South London NHS Mental MESHD Health Trust during the first UK lockdown. Methods: We used an interrupted time series analysis to assess whether the rate of violent and aggressive incidents changed during the lockdown period from 23rd March 2020 to 15th June 2020. We used a quasi-poisson general additive model to model the weekly rate of violent incidents as a function of a seasonal trend, time trend, and impact of lockdown, using data from 1st January 2017 to 27th September 2020. Results: There was a 35% increase in the rate of incidents of violence and aggression MESHD [IR = 1.35, 95% CI: 1.15-1.58, p < 0.001] between March 23rd 2020 and June 15th 2020. In addition, there was strong evidence of temporal (p < 0.001) and seasonal trends (p < 0.001). Conclusions: Our results suggest that restrictions to life increased the rate of violent incidents on the mental health wards studied here.

ObjectivesTo assess the association between learning disability and risk of hospitalisation and mortality from COVID-19 MESHD in England among adults and children. DesignWorking on behalf of NHS England MESHD, two cohort studies using patient-level data for >17 million people from primary care electronic health records were linked with death data from the Office for National Statistics and hospitalization data from NHS Secondary Uses Service using the OpenSAFELY platform. SettingGeneral practices in England which use TPP software. ParticipantsParticipants were males and females, aged up to 105 years, from two cohorts: (1) wave 1 HGNC, registered with a TPP practice as of 1st March 2020 and followed until 31st August, 2020; (2) wave 2 HGNC registered 1st September 2020 and followed until 31st December 2020 (for admissions) or 8th February 2021 (for deaths). The main exposure group was people included on a general practice learning disability register (LDR), with a subgroup of people classified as having profound or severe learning disability MESHD. We also identified patients with Down syndrome and cerebral palsy MESHD (whether or not on the learning disability register). Main outcome measures(i) COVID-19 MESHD related death, (ii) COVID-19 MESHD related hospitalisation. Non- COVID-19 MESHD related death MESHD was also explored. ResultsIn wave 1 HGNC, of 14,301,415 included individuals aged 16 and over, 90,095 (0.63%) were identified as being on the LDR. 30,173 COVID-related hospital admissions, 13,919 COVID-19 MESHD related deaths and 69,803 non-COVID deaths MESHD occurred; of which 538 (1.8%), 221 (1.6%) and 596 (0.85%) were among individuals on the LDR, respectively. In wave 2 HGNC, 27,611 COVID-related hospital admissions, 17,933 COVID-19 MESHD related deaths and 54,171 non-COVID deaths MESHD occurred; of which 383 (1.4%), 260 (1.4%) and 470 (0.87%) were among individuals on the LDR. Wave 1 HGNC hazard ratios for individuals on the LDR, adjusted for age, sex, ethnicity and geographical location, were 5.3 (95% confidence interval (CI) 4.9, 5.8) for COVID-19 MESHD related hospital admissions and 8.2 (95% CI: 7.1, 9.4) for COVID-19 MESHD related death. Wave 2 HGNC produced similar estimates. Associations were stronger among those classed as severe-profound and among those in residential care. Down syndrome and cerebral palsy MESHD were associated with increased hazard of both events in both waves; Down syndrome to a much greater extent. Hazards of non- COVID-19 MESHD related death followed similar patterns with weaker associations. ConclusionsPeople with learning disabilities MESHD have markedly increased risks of hospitalisation and mortality from COVID-19 MESHD. This raised risk is over and above that seen for non-COVID causes of death MESHD. Ensuring prompt access to Covid-19 MESHD testing and health care and consideration of prioritisation for COVID-19 MESHD vaccination and other targeted preventive measures are warranted.

BackgroundHealthcare workers (HCWs) and ethnic minority groups are at increased risk of COVID-19 MESHD infection and adverse outcome. Severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2) vaccination is now available for frontline UK HCWs; however, demographic/occupational associations with vaccine uptake in this cohort are unknown. We sought to establish these associations in a large UK hospital workforce. MethodsWe conducted cross-sectional surveillance examining vaccine uptake amongst all staff at University Hospitals of Leicester NHS Trust MESHD. We examined proportions of vaccinated staff stratified by demographic factors, occupation and previous COVID-19 MESHD test results (serology/PCR) and used logistic regression to identify predictors of vaccination status after adjustment for confounders. FindingsWe included 19,044 HCWs; 12,278 (64.5%) had received SARS-CoV-2 vaccination. Compared to White HCWs (70.9% vaccinated), a significantly smaller proportion of ethnic minority HCWs were vaccinated (South Asian 58.5%, Black 36.8% p<0.001 for both). After adjustment, factors found to be negatively associated with vaccine uptake were; younger age, female sex, increasing deprivation and belonging to any non-White ethnic group (Black: aOR0.30, 95%CI 0.26-0.34, South Asian:0.67, 0.62-0.72). Allied health professionals and administrative/executive staff were more likely to be vaccinated than doctors. InterpretationEthnic minority HCWs and those from more deprived areas as well as those from particular occupational groups are less likely to take up SARS-CoV-2 vaccination. These findings have major implications for the delivery of SARS-CoV-2 vaccination programmes, in HCWs and the wider population and should inform the national vaccination programme to prevent the disparities of the pandemic from widening. FundingNIHR, UKRI/MRC

BackgroundThe COVID-19 pandemic MESHD has disrupted healthcare activity globally. The NHS in England stopped most non-urgent work by March 2020, but later recommended that services should be restored to near-normal levels before winter where possible. The authors are developing the OpenSAFELY NHS Service Restoration Observatory, using data to describe changes in service activity during COVID-19 MESHD, and reviewing signals for action with commissioners, researchers and clinicians. Here we report phase one: generating, managing, and describing the data. ObjectiveTo describe the volume and variation of coded clinical activity in English primary care across 23.8 million patients records, taking respiratory disease MESHD and laboratory procedures as key examples. MethodsWorking on behalf of NHS England MESHD we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care EHR data on 23.8 million patients; and conducted a population cohort-based study to describe activity using CTV3 coding hierarchy and keyword searches from January 2019-September 2020. ResultsMuch activity recorded in general practice declined to some extent during the pandemic, but largely recovered by September 2020, with some exceptions. There was a large drop in coded activity for commonly used laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was blood coagulation tests such as International Normalised Ratio (INR), with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 7.0). The overall pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as "no change" from the previous year. Respiratory tract infections MESHD exhibited a sustained drop compared with pre-pandemic levels, not returning to pre-pandemic levels by September 2020. Various COVID-19 MESHD codes increased through the period. We observed a small decline associated with high level codes for long-term respiratory conditions such as chronic obstructive pulmonary disease MESHD ( COPD MESHD) and asthma MESHD. Asthma annual reviews experienced a small drop but since recovered, while COPD MESHD annual reviews remain below baseline. ConclusionsWe successfully delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September 2020, with some important tests less affected. Records of respiratory infections MESHD decreased with the exception of codes related to COVID-19 MESHD, whilst activity of other respiratory disease MESHD codes was mixed. We are expanding the NHS Service Restoration Observatory in collaboration with clinicians, commissioners and researchers and welcome feedback.

The lockdown and social distancing policy imposed due to the COVID-19 pandemic MESHD has had a substantial impact on both mental health service delivery, and the ways in which people are accessing these services. Previous reports from the South London and Maudsley NHS Trust MESHD ( SLaM HGNC; a large mental health service provider for around 1.2m residents in South London) have highlighted increased use of virtual contacts by mental health teams, with dropping numbers of face-to-face contacts over the first wave of the pandemic. There has been concern that the impact of the COVID-19 pandemic MESHD would lead to higher mental health emergencies, particularly instances of self-harm. However, with people advised to stay at home during the first wave lockdown, it is as yet unclear whether this impacted mental health service presentations. Taking advantage of SLaMs Clinical Records Interactive Search (CRIS) data resource with daily updates of information from its electronic mental health records, this paper describes overall presentations to Emergency Department (ED) mental health liaison teams, and those with self-harm. The paper focussed on three periods: i) a pre-lockdown period 1st February to 15th March, ii) a lockdown period 16th March to 10th May and iii) a post-lockdown period 11th May to 28th June. In summary, all attendances to EDs for mental health support decreased during the lockdown period, including those with self-harm. All types of self-harm decreased during lockdown, with self-poisoning remaining the most common. Attendances to EDs for mental health support increased post-lockdown, although were only just approaching pre-lockdown levels by the end of June 2020.

Background: The coronavirus disease 2019 MESHD ( COVID-19 MESHD) pandemic has changed inflammatory bowel disease MESHD ( IBD MESHD) care. The use of telemedicine was quickly adopted, however the impact of COVID-19 MESHD on IBD MESHD patients’ feelings and sense of security for their health has not been extensively evaluated.Aims: Our aim was to assess patients’ views and concerns regarding their IBD MESHD condition, compliance with treatment and preventive measures, accessibility to health services and sources of information they used during the coronavirus pandemic.Methods: A questionnaire-based survey of patients with IBD MESHD (n=237) was conducted at a University and an NHS GI Units MESHD.Results: Greek patients with IBD MESHD expressed high levels of fear of coronavirus infection MESHD, with more than 50% being afraid of dying as a result of COVID-19 MESHD. Seven out of ten participants felt that their IBD MESHD medications increased risk of infection and this fear was significantly higher in patients on immunosuppression. Only 2% of patients discontinued treatment on their own, all of whom were receiving immunosuppression. More than 90% of participants reported staying home and washing their hands. Three quarters of patients had access to a doctor when needed and almost 50% used the electronic paperless prescription system. Participants were satisfied with the information they received regarding COVID-19 MESHD. The main sources of information were media, internet and social networks, with only one third seeking guidance from their gastroenterologist. Conclusions: The COVID-19 pandemic MESHD had a profound, negative effect on IBD MESHD patients’ lives.   COVID-19 MESHD-related fears need to be actively addressed, particularly in IBD MESHD patients on immunosuppression, and relevant information should be continuously provided.

Since the outbreak of the COVID-19 pandemic MESHD, many healthcare facilities have suffered from shortages in medical resources, particularly in Personal Protective Equipment (PPE). In this paper, we propose a game-theoretic approach to schedule PPE orders among healthcare facilities. In this PPE game, each independent healthcare facility optimises its own storage utilisation in order to keep its PPE cost at a minimum. Such a model can reduce peak demand considerably when applied to a variable PPE consumption profile. Experiments conducted for NHS MESHD England regions using actual data confirm that the challenge of securing PPE supply during disasters such as COVID-19 MESHD can be eased if proper stock management procedures are adopted. These procedures can include early stockpiling, increasing storage capacities and implementing measures that can prolong the time period between successive infection waves, such as social distancing measures. Simulation results suggest that the provision of PPE dedicated storage space can be a viable solution to avoid straining PPE supply chains in case a second wave of COVID-19 MESHD infections occurs.