Area

Issue

Delay Phase Advice

Crisis Phase Advice

Who to test?

Is the test routine or urgent?

Decrease numbers attending the department and primary care (e.g. postpone non-urgent tests, use “virtual options” for CPAP review patients, remote monitoring of CPAP & NIV if possible; review of machine SD cards if remote monitoring unavailable)

Urgent includes; inpatient cancer, preoperative patients for urgent surgery where lung function or CPET is essential. 

Avoid airway challenge testing, which actively induces cough.

Emergency only in hospital. 

Cancellation of all non-urgent in primary and secondary care. (e.g. cancer, pre-operative)

Does the patient have COVID19 symptoms?

Contact patients by phone the day before their appointment to confirm symptoms & contact with COVID19. Non-urgent patients should not attend.  

Dismiss any patient attending with COVID symptoms and advise to self-quarantine using NHS 111 advice line only if they deteriorate.

Assume all patients and staff infected with COVID19.

Urgent patients may already have COVID19 and will need testing for urgent clinical reasons only (e.g. pre-operative testing for urgent surgery).

Which tests?

Which tests should be offered?

Spirometry, gas transfer, lung volumes, FeNO, blood gases, CPET, other urgent procedures in exceptional cases.

Blood gases (ABG, CBG), spot-check oximetry and exceptionally spirometry.

PPE should now include surgical mask, plastic apron, gloves and visor. Assume AGP (if patient coughing). 

How to test?

What infection control measures should be taken?

Additional hand sanitiser to be available to patients in waiting areas. Patients to sit >1 metre apart where possible. 

All patients and staff to use hand gel prior to entering and on leaving any clinical room/area. 

Routine Lung Function infection control measures should suffice (filters, wiping down contact parts with appropriate wipes e.g. alcohol/Clinell wipes between patients, etc.)

Immunocompromised patients (e.g. BMT patients) that must be tested should be tested as first patient of the day. 

Patients with long-term conditions that require monitoring with lung function testing (e.g. CF) must be considered on a case by case basis.

Routine Lung Function infection control measures should suffice for blood gases, with surgical mask, plastic apron, gloves. Assume AGP (if patient coughing). 

All forced manouevres (spirometry, mouth pressures, lung volumes, gas transfer, CPET, etc.)

PPE advice can be obtained by hospital infection control team. 

Most respiratory diagnostics will cease.

Extra infection control measures

All staff to wash hands appropriately whenever arriving or leaving the department and between patients. 

Wipe down equipment and surrounding areas after each patient and clean down department at the end of each day. 

Provide patients with tissues to cough in to. Patient to dispose in an appropriate clinical waste bin.

Personal protective equipment to be deployed as directed by your hospital infection control team.

All staff to wash hands appropriately whenever arriving or leaving the department and before and after patient contact. 

Wipe down equipment and surrounding areas after each patient and clean down department at the end of each day.

Personal protective equipment to be deployed as directed by your hospital infection control team.

How to deploy staff? (Secondary care)

Senior Bands (6-8)

Can be used to deliver specialist services (NIV, oxygen, blood gases – supporting respiratory wards and HDU/ITU facilities)

Can be used to deliver specialist services (NIV, oxygen, blood gases – supporting respiratory wards and HDU/ITU facilities)

Bands (2-5)

To deliver reduced routine service in accordance with usual standards.

May be redeployed contacting patients at home to perform virtual CPAP reviews, etc.

Can be redeployed contacting patients at home to perform virtual CPAP reviews, etc.

May be trained to support ward staff performing routine observations/care.

How to deploy staff? (Primary care)

GPs, Specialist respiratory nurses, practice nurses

To deliver appropriate services in accordance with the PHE/NHSE Guidance.

To deliver appropriate services in accordance with PHE/NHSE and Trust Guidance.

 How to provide NIV/CPAP
 

 Senior Bands (6-8)

 To deliver CPAP/Oxygen or NIV set up via non-ventilated circuits (see further ARTP Guidance) 

 PPE should now include FFP3 mask, plastic apron, gloves and visor; assume AGP.