Documentation of COVID-19 screening fell short of national imperative in Australian hospitals, says new study

MedTech News: New Australian research on COVID-19 screening of hospital patients during the first wave of the pandemic found that the documentation of patient screening procedures before surgery could be improved.

The COVID Screen Audit study has been published in Australian Health Review, the journal of the Australian Healthcare and Hospitals Association (AHHA).

Research team leader Professor David Story (University of Melbourne) said the study analysed the admission records of 2,197 patients who underwent elective and non-elective surgery at two major Melbourne hospitals between 1 April and 10 May 2020.

“Despite the national imperative to screen for COVID and communicate the results, the documenting of COVID-19 screening fell short of our proposed lower acceptable limit of 85% in almost all surgical groups,” Professor Story said.

“We are not saying screening wasn’t done, rather that the information wasn’t readily available for clinical teams caring for some patients. We would assume patients have been screened, probably several times, but we really need to know for sure. We need it in writing.

“The percentages of surgery patients observed to have had both COVID-19 screening and temperature documented could be improved, from 72% among elective patients and 38% among non-elective patients.

“We found that documenting screening varied markedly across surgical groups. In particular we found that non-elective surgical patients had the lowest rate of documenting and also the highest rate of COVID-19 related history and signs,” Professor Story said.

Identifying surgical patients with SARS-CoV-2 and COVID-19 disease is important for several reasons, including that patients with COVID-19 may have more complications and greater mortality after surgery. COVID-19 may also further increase the already increased risks for complications and mortality among non-elective patients.

Professor Story said the results of the COVID Screen Audit study were likely to apply to other Australian hospitals, and noted that both hospitals had instituted far more rigorous documenting during Victoria’s second wave of the pandemic.

Dr Linda Swan, Medibank’s Chief Medical Officer, said she hoped these important findings from the COVID Screen Audit helped inform policy to improve elective surgery safety, especially with a high backlog to clear.

“Relying on only swabbing all patients undergoing elective surgery is not the solution, as it’s not 100% accurate in determining all COVID positive patients. Plus, with urgent (non-elective) cases, surgeons don’t have time to wait for a lab result. This study highlights the importance of thorough documentation of questionnaires and temperature checks for all surgeries,” Dr Swan concluded.

The study was funded by research grants from the Australian and New Zealand College of Anaesthetists (ANZCA) Research Foundation and the Medibank Better Health Foundation.