The Royal College of Physicians has conducted the largest study to date of the quality of care given to patients in the UK with coronavirus to identify learnings from the pandemic.
The study recruited a sample and demographic representative of English hospitals’ experience of the pandemic, gathering information about the quality of care delivered from 19 organisations in England which between them accounted for a population of almost 10.5 million people exposed to coronavirus. These organisations collectively looked after over 26,000 cases of coronavirus in 2020 with over 6,000 patients dying with the condition in their care. They reviewed 510 patients and their care.
Using a modified version of an established and validated structured judgement review process already used by many clinicians in the retrospective case record analysis of acute hospital deaths, the study concluded that overall care delivered was judged to have been adequate, good or excellent for 96.5 per cent of patients (good or excellent for 77.4 per cent).
Care judged to be poor overall was very uncommon and occurred in only 3.5 per cent of the total sample. When it did occur, it was related to end-of-life care issues, nosocomial infections (those acquired in hospital), delays in assessment and the two linked issues of poor communication and poor documentation.
The study looked at significant variations between hospitals when it came to end of life care experiences, assessment, documentation and communication, senior review, do not attempt resuscitation decisions and discharge planning. This revealed both excellent care and care that could have been improved.
In a report based on its findings, the RCP recommends that: hospitals and teams that have delivered excellent care during the pandemic should analyse the factors that enabled them to do so and publish key findings to support more consistent quality of care across the NHS; professionals and organisations should strive to reduce variation in care in key areas including: end of life care in hospital; early assessment; documentation and communication; and treatment escalation planning, conversations and documentation.
The RCP also says that particular attention should be paid to quality of care, decision making, communication and documentation required for vulnerable people, including those with learning disabilities, and that further analysis should be carried out of the variation in the number of deaths from coronavirus between different parts of the country.
Dr John Dean, the RCP’s clinical director for quality improvement and patient safety, said: “My colleagues in the NHS have been faced with unprecedented challenges during the pandemic but RCP’s study shows how almost all care provided has been of the right standard. We can, however, learn from excellent care, and variations in care, just as we can learn from poor care, and I am sure that this study will prove invaluable as we seek to learn from this extraordinary time.”
