A Series: COVID-19 and its Impact on the NHS – Acute Medicine

Acute Medicine

Over the last twelve months, since COVID-19 hit UK shores, healthcare providers and medical professionals have faced unprecedented challenges, testing the very limits for the safe and effective delivery of healthcare services in the UK.

In this special COVID-19 series, THEMIS explores how COVID-19 has affected the delivery of healthcare services in certain specialties, and discusses potential implications this may have for future litigation.

Acute Medicine Care and COVID-19

This article is written based on interviews conducted with practising Acute Medicine Consultants and emerging claims data.

The field of acute medicine has historically been extremely busy, even before COVID-19, with clinicians accustomed to patients presenting with an array of medical issues and complications, all requiring a quick diagnosis so that they can be cared for by the right clinicians.

Whilst working patterns have not drastically altered, there have been recurring trends that have developed over the course of the outbreak, which have directly affected the care given to patients in this field:

1) Assessments and testing procedures have faced severe delays, which has prolonged patient stays and caused a backlog of patients awaiting test results.

The amount of CTPA’s (Computerised Tomography Pulmonary Angiograms) and MRI Scans being requested have skyrocketed largely due to COVID-19, with patients needing access to these diagnostic tools to determine positivity for COVID-19.

Due to the large volume of the scans taking place, delays have become inevitable, whilst clinicians try and keep up with the influxes of patients needing specialised care.

2) The patient footfall within hospitals creates an opportunity for COVID-19 to spread and so the overall consensus is to limit those patients coming in wherever possible.

As a result, some clinicians are opting to send patients home, rather than have them wait in the hospital until they can be fully assessed or seen for their scan; this delay can lead to progression of injury/complication.

Additionally, some patients are attending hospital, but discharging themselves for fear of catching the virus whilst being treated, which has a direct impact on their safety and wellbeing.

3) In many districts, those working in Acute Medicine have been re-deployed to work in the ITU to treat patients on the ‘COVID Wards’. In addition to shielding and isolation, redeployment has led to staff shortages, meaning many clinicians have been asked to work extra shifts, particularly in the evenings. The combination of more patients and fewer staff on shift for the Acute wards leaves clinicians open to litigation risk.

Litigation Risk

THEMIS have analysed specific COVID-19 cases and spoken directly with clinicians from the NHS front line, to establish what litigation risks are emerging, in order to explore the trends and determine whether there is a way to prevent claims from developing.

Litigation Risks Identified:

1. Delays in Arranging and Carrying Out Scans

Predictably, delays are a large part of the claims being brought forward. Many patients are experiencing prolonged stays in hospital whilst waiting for scans (such as MRI or CT), due to the need to be tested for COVID-19 and priority has been shifted to those who have received their results.

Additionally, there is a significant rise in admissions to the ITU and AMU wards, with COVID-19-positive patients taking up a large percentage of available beds. These patients are being tended to by ITU nurses and consultants, along with Acute Medicine clinicians, due to re-deployment.

This has understandably caused scanning delays – COVID-19-positive patients with severe symptoms require CT and MRI scans to review the condition of their lungs and chest, therefore leading to longer wait times for each patient.

Complications can arise from a delay to initiate a scan, for example, delayed diagnosis or further developed symptoms. This can potentially cause some patients to suffer preventable complications, may limit treatment options (i.e. for suspected cancer patients) and put the patient at risk of further demise.

To minimise any unreasonable delay and risk of litigation, it is recommended to ensure wherever possible, scans are performed in order of urgency and patients are fully informed of any potential delays they may face whilst awaiting a scan. Transparency in these times is incredibly important and shouldn’t be overlooked, especially when a delay may be scrutinised in the future.

2. Discharging Non-Urgent Patients Without Treatment

An emerging trend amongst COVID-19-focused legal cases show that some patients are being discharged or choosing to postpone scans and treatment, due to the fear of COVID-19. Understandably, there is a common fear of catching or spreading the COVID-19 virus, however, in these times, this fear should not be detrimental to the care that a patient receives.

One such case already brought against a healthcare provider alleged that the attending clinician declined to provide the patient with a CT scan and instead decided to send the patient home due to COVID-19 concerns, as it was not deemed an emergency case. Some patients therefore may feel they are being ‘sidestepped’ or ‘overlooked’ due to the pandemic.

THEMIS recommends that whilst difficult, clinicians endeavour to always keep in mind the risk of missed diagnoses or delayed treatment when weighing up the risk of COVID-19 contagion.

Concluding Comments

After analysing specific COVID-19 cases and recurring trends, THEMIS recommends that patients should be encouraged to attend the hospital when they are in need of assessment and treatment. Additionally, clinicians should bear in mind that although discharging non-urgent cases may assist in keeping the wards COVID-19 secure, the risk to the patients may be increased where there is too much emphasis put on minimising contagion at the expense of an otherwise necessary admission, leading to possible litigious claims.

This article demonstrates that litigation risks are evidently evolving and may continue to do so.