Nick Scriven: Hospital winter planning must include regular covid-19 testing of all frontline staff

The ongoing and re-escalating covid-19 pandemic has affected all areas of medical practice, but the work during the last seven months by the Acute Medicine Units (AMUs) and their staff has largely flown under the radar. These teams are in a prime position to see how hospitals have coped with the pandemic to date and express concerns for the next few months. They are an essential cog in treating acutely unwell patients who need hospital care, but also making sure people who can be safely looked after at home do not end up in hospital.

Over the last four months the Society for Acute Medicine have twice surveyed members on the effects of the pandemic on them and their units, and how they see the next few months. In each survey there were just over 200 respondents.

One would have expected that as front line workers looking after largely undifferentiated patients those working in AMUs could have a high prevalence of covid-19, but our survey has shown consistently that just over half of those surveyed had not had time off, 24% had been sick with symptoms and a further 19% were at some point in isolation. After antibody testing was rolled out, by October, 20% of members had not been offered a test yet, but the worrying data were that 21% had got positive covid antibodies without either qualifying for a swab test or having had a negative one. To us this, together with the rate of in-hospital infection, has serious issues for workplace infection control and strengthens the argument for regular testing of all frontline staff. As well as illness, other factors, have impacted on staff working in AMUs. By definition they are usually highly skilled in acute care, including respiratory and level 2 support, and it was no surprise that just over a third of our staff, predominately nursing and junior doctors, had been redeployed to other specialities, primarily intensive care units, emergency departments, and respiratory medicine, not to mention those seconded to help set up and then staff Nightingale units.

One of the key areas of acute internal medicine is the provision of Same Day Emergency Care (SDEC) with the bulk of that being done in areas under the auspices of Acute Medicine. SDEC is a key part of any short, medium, or long term plan in trying to free up inpatient bed capacity and it is concerning to hear only a third of areas were at a normal level of activity with the barriers to this being pressure due to social distancing, staff restrictions (redeployment/sickness), diagnostic capacity, and other pressures including bedded patients. If the NHS is going to manage capacity this winter, we really need to try to get these areas functioning again.

With regards to current activity, it is worrying to hear that 43% of units felt they were already busier than usual for this time of year, of which two thirds put this down to covid related illness. With this in mind our members were asked how prepared their hospitals were and only 25% felt their hospital was ready for this particular winter season and 30% felt their AMU would not be able to deliver the care they would aim for in the same time frame. The limiting factors in this were bed availability downstream from the AMU, medical staffing numbers, other staffing issues, capacity in community based care, additional covid workload, and rising non covid workload. It was equally disappointing to hear that for a speciality at the centre of acute hospital care only 49% said the AIM team had been asked to help in hospital winter planning.

While all this paints a bleak picture there are messages here to those in hospitals and the NHS to listen to and work on. We need our teams back, we need our SDEC units working, and we really need regular covid testing for frontline staff to keep our patients as safe as we can make it in hospital. 

Nick Scriven, immediate past president of the Society of Acute Medicine

Competing interests: none declared.