New research focused on the COVID-19 screening of hospital patients during the first wave of the pandemic has found the documentation of patient screening procedures before surgery could be improved.
Medibank backed the COVID Screen Audit through its Better Health Foundation, along with research grants from the Australian and New Zealand College of Anaesthetists (ANZCA) Research Foundation.
The insurer said the research, which has just been published in the Australian Health Review, highlights important communication gaps in documenting results of coronavirus patient screening before surgery.
"Without documented screening, clinicians had to assume but couldn’t know, if a patient had a low risk of COVID whilst under their care," said Medibank in a statement.
The COVID Screen Audit analysed the admission records of 2,197 patients who underwent elective and non-elective surgery at two major Melbourne hospitals.
The study looked at cases between 1 April to 10 May 2020, during the mandated restrictions on surgery arrangements.
The study was led by Professor David Story, foundation chair of Anaesthesia at the University of Melbourne and the deputy director of the Centre for Integrated Critical Care (CICC) at the University of Melbourne.
“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,” said Professor Story.
"However, 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 study concluded, “Better understanding of implementing screening practices in pandemics and other crises, particularly for non-elective patients, is warranted.”
According to Medibank's chief medical officer, Dr Linda Swan, who is also the executive lead of the Medibank Better Health Foundation, “Currently, there’s no national government policy surrounding the documentation of COVID-19 screening prior to surgery. As COVID questions and temperature checks are an important part of ensuring the safety of hospital staff and patients, they need to be appropriately documented."
The screening process conducted during the research involved the checking of patient temperatures and a questionnaire about possible COVID symptoms and contacts. It did not involve a swab of the mouth or nasal cavity.
Both hospitals in the study had specific COVID-19 questionnaires as part of the patient electronic or scanned medical record. In the absence of COVID-19 questionnaires being recorded, the patient’s admission, medical and nursing notes were searched for evidence of COVID-19 related history.
“An important finding from this study is that the percentages of surgery patients observed to have had both COVID-19 screening and temperature documented could be improved, from 72% among elective and 38% among non-elective patients,” said Professor Story.
“Patients, health care workers, and the public will benefit if COVID screening is systematically documented in hospitals for patients before and after surgery,” he said.
Dr Swan said she hoped the findings 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," said Dr Swan.
“With the challenges of implementing any new safety and quality initiatives in healthcare already well-established, these findings provide new evidence to support greater attention to implementation strategies as part of pandemic responses,” said Professor Story.
He said most Australian hospitals had introduced screening for COVID-19 for patients before surgery. However, he said little was known about the efficacy and results of the screening programs and this could be a concern for patients undergoing surgery with an undiagnosed SARS-CoV-2 infection.
“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,” added Professor Story.