Advice from the frontline on responding to COVID-19

Prepare for the unexpected and the unpredictable

This time last week I would probably have written an entirely different blog—the position is changing so quickly from week to week. I’m noticing and learning a lot every day from this rapidly evolving situation and I’m happy to share my experiences with other clinicians.

I should start by saying the most important advice is to prepare for the unexpected and the unpredictable and be prepared to make sacrifices above and beyond the regular.

Ranging from the personal to the system wide, here are my more specific tips for colleagues:

Look after yourself as well as you look after your patients

Be sure to take care of yourself so that you are fit to help others and make sure you are not over-committing in the short term, so that you can be well for the long term. Remember that this is a marathon not a sprint.

The hospitals are doing a great job of keeping cafeterias and shops open for staff, but the reality is that queues can be long and you might not have the time to stand in line in your breaks.

I’d advise bringing in food and drinks to keep fed and hydrated over your shift.

You may want to think about alternatives to public transport

Getting to work exposes you to infection posed by the connections, elevators and escalators and so on, in and out of buses and tubes, as well as on the transport itself. To avoid these, I’ve started taking advantage of the half price taxi apps offered to NHS staff if going to work early and then walking home. Free bike schemes as well as discounted car hire for NHS staff are also available in some cities.

Be strategic about where you can add most value and consider your risk profile

With the number of wards devoted to COVID-19 increasing by the day, the reality is that senior clinicians who have not practiced general medicine for decades may have to go back to doing 12-hour general medical shifts.  Many of us have other commitments and it’s that balance about where your skills can add most value to your hospital or the wider system. And consider your risk profile: it is very different if you are a 60-year-old physician with high blood pressure or a healthy 30-year-old with no underlying conditions. You may want to discuss this with your line manager.

Use any quiet time wisely

For now, some clinical staff may find it surprisingly quiet on their wards.  Use the time well – contact patients on your outpatient list in advance and advise them on self-care techniques and to be prepared for the possible deferment of outpatient clinics. Even senior consultants may need to move to COVID-19 wards very soon or be redeployed to some of the field hospitals, so use this time to get up to speed with published guidelines. Deal with practical issues such as setting up remote working from home, mask fitting and making sure any security badges are up to date – you will be challenged on arriving into the hospital. The trusts are doing a great job circulating regular updates from many different sources—Medical Directors, CEO, Department Leads. These are an invaluable source of information when things are changing around us so quickly. Spend time reading them.

Be vigilant about social distancing

Remember that health care professionals are a high-risk group for COVID-19, and we need to be vigilant about social distancing between one another even when patients are not present. So whether you’re gathering in a room for a staff update, or standing in line to be fitted for PPE equipment, do take care to keep your two metres of space.

Use online channels for internal comms

It has become very apparent even over the last few days how departments who have worked traditionally up until now with physical meetings once a week, have rapidly set up online and app-based communications channels to facilitate basic conversations. We’ve set up WhatsApp groups at department level for different specialties to rapidly update colleagues in real time on essential information like tips on patient care, where staff can pick up PPE equipment, access mask fitting, and so on.

Most patient interaction is now by telephone, email or video

We are all using remote applications to conduct our consultations. In my department we  have moved over to clinic.co  which is  freely available to anyone with an nhs.net email address and can be used by any patient with a laptop or smartphone—you don’t even need wifi to use it. It obviously has its limitations, but at least you can see the patient. In some specialties that clearly is important. However for many patients the reassurance of a telephone call is priceless. I’d emphasise to colleagues the need to think very proactively about benefits and challenges for using these tech-supported tools to support their long term use as the situation changes back to normal. We are significantly reducing the numbers of patients coming into hospital, and all junior trainees have been moved out of the neurology service to support frontline medicine, so senior doctors are now supporting non-COVID patients and we are discharging early where we can.

Track clinical and patient experience with new tech

My department has set up a simple excel spreadsheet to track patient and clinician experiences with new tech and answer questions such as: ‘What worked best- video, phone, or a specific app?’ ‘Has the use of video reduced the need for diagnostic testing or medication prescribing?’ This will be a useful tool for rating and developing healthtech for our team and others.

The need for systematic, consistent communications with primary care is paramount

I encountered an interesting example recently – a neurologist colleague presented a patient with myasthenia and symptoms of COVID-19. The patient’s GP had provided them with an online prescription for medication based on references to these as potential treatments on social media. Unfortunately, the drugs in that prescription are contra-indicated for that neurological condition so the patient had deteriorated and had to be immediately ventilated. Fortunately, because the problem was identified immediately, they are already making a good recovery. This type of interaction that would normally be picked up in secondary care needs to notified to primary care as they take up care of specialist patients.

Plan for team CPD

As junior doctors are seconded off to other parts of hospital and take the associated impact on their professional training, our neurology department is setting up online teaching programmes for trainees and others so that their CPD continues. This may be something that HEE could help to facilitate across London and the country. 

But it’s not all doom and gloom. It feels truly invigorating to be working with colleagues to make such an important difference to our patients and the population. To hear people clapping for the NHS at 8pm last Thursday and really feel the country behind me as a clinician, left me incredibly proud and uplifted. People are being so innovative, sharing solutions and working collaboratively. Working together like this with other staff and the support of the nation is what will bring us through this crisis—equipped with new ways of working for the future.