77 Improving the initial inpatient blood investigation of COVID-19 patients at the Hillingdon hospitals NHS foundation trust: a quality improvement project

Background The COVID-19 pandemic highlighted the importance of evidence based guidelines and many studies have been published to identify appropriate investigations that may be used as predictors of mortality and ITU admission. The Hillingdon Hospitals NHS Foundation Trust (THH) produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, lack of awareness and education on these guidelines meant adherence could be improved. Aims To improve adherence to the local trust guidelines, targeting clinicians involved in the initial assessment of patients presenting with COVID-19 symptoms where appropriate. Methods Between 16th April 2020 and 14th April 2020, investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic order-request system that allowed prompts for appropriate investigations. A re-audit between 15th May 2020 and 14th June 2020 was conducted to assess adherence post-intervention. Results 383 patients were identified in the initial audit cohort, and 20 patients were identified in the re-audit cohort. Adherence to Full Blood Count, Urea and Electrolytes, C-Reactive Protein and Liver Function Tests increased to 100% (from 99.7%, 99.2%, 98.7%, and 96.6% respectively). Coagulation screen adherence increased from 72.8% to 90%. D-dimers were appropriately requested more often, increasing from 19.9% to 50%. Inappropriate troponin requisition decreased from 38.9% to 26.3%. Conclusions Reduced COVID-19 admissions meant that the re-audit cohort was not as large as the initial audit cohort. However, a user-friendly COVID-19 panel of investigations resulted in better-targeted management of patients, and improved adherence to guidelines. This showed the importance of disseminating information effectively. Education is essential during times of uncertainty, especially during a pandemic.