SARS-CoV-2 is primarily a respiratory disease; however, there have been multiple reports of associated myocarditis. In our 463 bedded, district general hospital, we noted an influx of young patients with myocarditis shortly after the peak of the outbreak. We report two cases presenting with myocarditis, both of whom tested negative for the virus despite clinical and biochemical evidence of recent infection. Diagnosis was made based on positive transthoracic echocardiogram (TTE) findings and a raised troponin, not in the context of suspected acute coronary syndrome. We recommend that patients with negative coronavirus tests should still be considered at risk of potential sequelae from the disease. There should be a low threshold for performing basic cardiac investigations: ECG, troponin and TTE as well as seeking a cardiology opinion. Colchicine is a recognised treatment for viral pericarditis and should be considered as adjunctive treatment; however, further research is required specific to SARS-CoV-2.

Simulation-based clinical systems testing (SbCST) is a process that allows clinicians and hospital stakeholders to evaluate work carried out in new environments. Unlike work-as-imagined, SbCST takes into account the complex interactions resulting from human performance limitations [1]. These factors can result in errors that may even lead to patient harm [2]. Therefore, we used SbCST to evaluate a newly built children’s emergency department with the aim of identifying latent errors and implementing changes to minimise the risk of their occurrence, whilst also ensuring that the simulation experience was an independently valuable educational opportunity. Scenarios were created according to two criteria. Firstly, that they tested at least one specific environmental issue and secondly, that they focused on topics that the paediatric and Accident and Emergency departments felt would be educationally valuable to the participants. Once created, these scenarios were then carried out as un-announced in-situ simulations during the first 8-weeks of departmental opening. The participants were instructed to treat the scenarios as real, including the manner in which they called for help. Any equipment required came from the department and if single use, it was exchanged for training equipment. The participants then undertook a hot debriefing before feedback was gathered about both the educational value of the scenarios as well as any issues identified within the new department. In total there were 38 multidisciplinary participants including nurses, operating department practitioners, and doctors from 6 different specialties. The feedback from the sessions was positive with an average ranking of >4 out of 5 in 8 out of the 9 measured domains, including; realism, enhancement of knowledge, and usefulness of in-situ simulation in a new environment. We also identified greater than 50 problems spanning all 5 of the categories from the ‘SHEEP’ model [3]. Approximately 60% of issues were resolved within the 8 weeks, whilst the remaining are on the risk register and awaiting review at a stakeholder level. In-situ simulation is an excellent mechanism for carrying out clinical systems testing of new environments due to the fact that it simulates realistic events which are prone to the same errors as the real events, without the risk of patient harm. Once the source of an error is exposed the debriefing can help to identify methods to minimise the risk of future reoccurrences. At the same time, with appropriate planning, the scenarios can also provide an opportunity to deliver multidisciplinary training. 1. Colman N, Doughty C, Arnold J, Stone K, Reid J, Dalpiaz A, Hebbar KB. Simulation-based clinical systems testing for healthcare spaces: from intake through implementation. Advances in Simulation. 2019;4(1):1–9. 2. Reason J. Human error: models and management. Br Med J. 2000;320:768–770. 3. Rosenorn-Lanng D. Human factors in healthcare: level one. Oxford: Oxford university press. 2014.

Background SARS-CoV-2 is currently the cause of a global pandemic, putting significant strain on healthcare systems worldwide. Reports reaching the United Kingdom, ahead of the pandemic, and previous surge planning (H1N1 influenza) highlighted that pipeline oxygen supply could be strained. Therefore, this study was created to investigate the robustness of pipeline oxygen supply at Darent Valley Hospital. Coinciding news reports of hospitals declaring major incidents, due to oxygen failure, further backed the contingency planning. Methods The maximum sustainable flow from the vacuum insulated evaporator (VIE) was calculated, followed by a snapshot survey identifying the exact usage of oxygen (litres per minute) across the entire hospital, also highlighting areas of high demand. A flowchart protocol was created for clinicians and engineers to follow should pipeline pressure drop. Finally, a second audit, monitoring oxygen usage and pipeline pressure, throughout the surge period, was undertaken. Results The initial survey found a usage of 412.15 L/min, which increased to 1789 L/min during the surge, with the lowest pressure recorded at 3.6 bar. The output from the VIE plant was managed through cycling of its evaporators every 12 h, to prevent pipeline freezing. Conclusions Data and contingency planning ensured maintenance of pipeline pressure throughout a pandemic surge of 576 COVID-19 patients. It also served as the foundation of a business case that resulted in, planning, approval, and installation of a second VIE plant in four weeks, ensuring readiness for further surge activity and future pandemics.