LUC3 brings care home

By Jennifer Parraga, BA'93

As the COVID-19 pandemic took hold of the nation and the local community, four physicians from the Department of Medicine were thinking ahead, asking the questions: What will happen to patients recovering from COVID-19 when they leave the hospital? What type of follow-up care can we offer?

“What became very clear to us from our colleagues’ experiences from around the world was how dangerous it was for COVID-19 patients who experienced low blood oxygen levels and how quickly it could turn from bad to worse for the patient if they didn’t have immediate support,” said Dr. Erin Spicer.

Drs. Megan Devlin, Mark Mrkobrada, Michael Nicholson and Erin Spicer quickly developed a concept for an equitable, virtual clinic intended to support discharged patients and those in the community who had COVID-19 and who were referred from the health unit, family physicians or the emergency department. Drs. Inderdeep Dhaliwal and Jaclyn Ernst joined the team for expanded support in respirology and general internal medicine.

Named the LHSC Urgent COVID-19 Care Clinic (LUC3) and funded through the Department of Medicine, it has become an invaluable part of the COVID-19 care process in London and is an example of rapid quality improvement implementation in the face of a pandemic.

Within two days of a referral being received, patients receive their first phone clinic appointment with a physician and access to an on-call physician if needed. During their appointments, patients are assessed to determine if a pulse oximeter to monitor their blood oxygen levels at home, using an easy to use monitoring algorithm and a pulse oximeter is required and then delivered free-of-charge to the patient’s home.

To ensure even greater support for patients, a direct admission process to a COVID-19 patient bed was also established. This not only increases safety and reduces anxiety for COVID-19 patients, but also reduces the risk of exposure to other patients and care providers.

The initial plan was for patients to receive virtual care appointments with physicians, however, the model grew from there with more interdisciplinary supports added as health complications and needs of patients became more evident.

“What developed was a homegrown interdivisional and interdisciplinary project that provided patient-centred care to our community during a complex and ever-changing pandemic,” said Dr. Spicer.

As patient care continued, a three-pronged quality and safety project stemming from the Department’s Centre for Quality, Innovation and Safety was established. The goal of the project was to explore the clinical benefits of LUC3, to learn more about the patient experience and, additionally, to assess the financial impact of virtual care. Natasha McIntyre served as the project manager and helped to develop a patient experience questionnaire, coordinate data collection, analysis, and interpretation, working with a group of residents and medical students who assisted with the project.

Dr. Jennifer D’Cruz, PGY2, Internal Medicine, has been on the frontlines of data collection since the project began and is following patients as they engage with the clinic. In addition to gathering baseline characteristics from patients, she collected information on symptoms. Currently, Dr. D’Cruz is engaged in doing a cost analysis to determine the financial value and impact of the clinic.

Early results suggest that the clinic is supporting a diverse and isolated population and is being very well received by its patients. Sixty-one per cent of patients referred to the clinic required home pulse-oximeter monitoring, with patients reporting that the oximetry was reassuring and reduces unplanned visits to the Emergency Department. Of the nearly 200 patients seen through the Clinic, 75 per cent indicated that they had no problem communicating their healthcare needs during a virtual appointment.

The team is now looking at ways to address issues for those who did have concerns. Further data shows that 46 per cent of the initial cohort of patients experienced symptoms of stress and anxiety prior to their referral to the clinic. Of that group, 100 per cent indicated the clinic and the support they received have helped to alleviate their concerns.

Patients have also shared their appreciation for the quick and easy access to their appointments, compassionate and clear communication, the direct admission process and their care plans.

Dr. D’Cruz says being involved with the clinic was incredibly rewarding. “I really appreciated watching a group of physicians from different specialties come together to identify a gap in how we were delivering care and then collaborate to form the clinic,” she said. “I also appreciated how they were able to do something so quickly and have learned from them how to evaluate the program and ensure it is being effective, how to problem solve and how to revise based on patient feedback.”

With a background in quality improvement and patient safety, Dr. Spicer stresses the importance of qualitative research and how it provides information needed to make changes to the Clinic in a timely manner.

“Monitoring the patient experience and keeping track of quality and patient safety metrics has guided us to make some changes week to week,” she said. “We are tweaking things as we are going.”

Some of those changes have included expanded collaborations with colleagues in psychology, nutrition, physical therapy and otolaryngology.

“This has been the most gratifying work I have been involved with,” said Dr. Spicer. “We have been able to provide comprehensive, equitable care in acute and chronic phases of COVID-19 in a way that is constantly evolving to meet patient needs.”