Rapid implementation of a community monitoring service for COVID-19: Staff and patient experiences and perceptions

Abstract

BackgroundThe coronavirus pandemic (COVID-19) has put unprecedented demand on health services. Provision of support and monitoring for patients with mild to moderate illness who are at risk of deterioration may allow hospitals to reduce the risk of exposure for health care workers, assist with reducing community spread, and improve capacity to accommodate those with more severe illness.MethodsThis is a data-based triangulated qualitative study using staff interviews and patient surveys to explore the experience of implementation and delivery of a COVID-19 community monitoring service. Interview questions were guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were coded and analysed using a grounded inductive approach and final themes were related back to the CFIR. Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses.ResultsAll 15 staff in the service were interviewed and 271 patients were surveyed (42%). A total of four final overarching themes emerged, service commissioning enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths, with subthemes aligned with 18 CFIR constructs in the staff interviews. Staff perception of patient experience was supported by results of the patient survey. ConclusionRapid commissioning of this community monitoring service was enabled through shared resources, engaging a ready-to go workforce of furloughed staff, dividing tasks amongst senior personnel and having a flexible approach that allows for ongoing improvements following implementation. Benefits for patients included early identification of deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges experienced by both staff and patients was the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.