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Caring for hospital patients with COVID-19

Quality of care in England examined by case record review.

The findings of the largest study to date of the quality of care given to patients in the UK with COVID-19 are outlined in this report.

This study recruited a sample and demographic representative of English hospitals’ experience of the COVID-19 pandemic. It gathered 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. These organisations collectively looked after over 26,000 patients with COVID-19 in 2020 with over 6,000 patients dying with the condition in their care. They reviewed 510 patient cases and their care to identify learnings from the pandemic.

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 concludes that overall care delivered was judged to have been adequate or better in 96.5% of the patient cases.

Care judged to be poor overall was very uncommon and occurred in only 3.5% of the total sample. When it did occur, it was related to end-of-life care issues, nosocomial infections, 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, illustrated in a series of vignettes.

The report includes a number of recommendations for the NHS and healthcare teams.

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