The COVID-19 pandemic has had many ramifications on healthcare delivery and practice. As part of this, utilising biomarkers to risk stratify patients has become increasingly popular. During the COVID-19 pandemic the use of D-dimer has increased due to the evidence of COVID-19 induced thromboembolic disease. We evaluated the use of D-dimer on all hospital admissions during the peak of the pandemic and evaluated its sensitivity in diagnosing pulmonary embolic disease (PE). Patients without COVID-19 infection were as likely to have evidence of PE as their COVID-positive counterparts. However, the sensitivity of a D-dimer was higher in COVID-positive patients at a lower D-dimer level (>1,500 μg/L, sensitivity 81%, specificity 70%) than in those without clinical, immunological or radiological evidence of COVID-19 infection (D-dimer >2,000 μg/L, sensitivity 80%, specificity 76%). These data suggest higher D-dimer thresholds should be considered for the exclusion of pulmonary emboli.

Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

Working on a COVID-19 ward presents a number of challenges to staff, with communication between families, patients and staff being highlighted as a key challenge. Novel methods are needed to overcome the barriers presented by COVID-19, with many turning to technology to offer solutions. Recognising these challenges as an area for improvement on our own ward, we sought to introduce new methods of communication to improve patient, relative and staff understanding and wellbeing. Through our own experiences and a discussion of the literature on this topic, we have identified some key themes which we believe can assist in the development of communication strategies in the developing pandemic.

Introduction Over the course of the COVID-19 pandemic, supporting effective communication between patients and their families has been a recognised challenge in the healthcare environment. Virtual communication via telecommunication and video-calling is more important than ever, but with minimal clinician education, preparation and relevant technological infrastructure available in the context of a global pandemic, we have recognised communication as an area for improvement as junior doctors working on a COVID-19 ward. Methods We interviewed via telephone 22 nominated next of kin relatives of patients admitted to a COVID-19 ward in the University Hospital of Llandough during May 2020 using a pre-prepared survey. We then provided relatives with the opportunity to engage with video-call updates from a doctor (with the patient’s permission). In appropriate scenarios, we used video calling to break bad news and to facilitate difficult communications with family members. These video calls were provided via Accurx, an NHS approved video communication system. Results Initial survey results showed an average understanding score of their relative’s current clinical plan of 5.5/10, with 63% of respondents saying they did not feel well informed. Nearly a quarter of respondents (22%) had received difficult news over the phone during the COVID-19 pandemic, and 86% said they would find video communication useful. Post-intervention survey results suggested a unanimous improvement in relative satisfaction, with relatives reporting an increased understanding around the admission, reassurance around the quality of care being given and less isolation from the patient. Conclusions The COVID-19 pandemic has provided novel communication challenges to physicians, promoting flexibility and adaptation to some of the core inter-personal skills we develop throughout training. Technology plays a huge role in this, and the use of video calling in particular can preserve non-verbal communication within the doctor-relative relationship and improve emotional connection between patients and their loved ones.