Surf's Up, Radical Approaches to Riding the COVID Waves

PURPOSE: Forewarned by the early COVID-19 experience elsewhere, and the need to create a COVID-safe environment for lung transplant (LTx) patients and their attendant health care workers (HCW), we radically re-structured our ambulatory out-patient model. We replaced our hospital-centric approach, with an entirely home-based telehealth service, that involved the majority of the LTx staff also working remotely from home. METHODS: Our hospital's LTx service manages over 800 post-LTx patients. From March 2020, LTx staff were instructed to work from home. Exceptions included the in-patient care team, the LTx pharmacist and one LTx physician; both of whom provided liaison between the home-based team and the hospital. The hospital's telehealth portal was used for patient consults, and daily clinics were established. Administrative, nursing, allied health, and physician staff were provided with computers, as well as remote access to the hospital's electronic medical record. Microsoft Teams facilitated communication between team members during clinic. LTx drugs were remotely e-ordered and then posted from the hospital. Pathology slips were emailed to patients and requested bloods were collected locally. Patients received weekly service updates via the Mailchimp email platform. The in-patient LTx team were available for critical in-person assessments, specifically for patients early post-LTx. RESULTS: Our LTx service remained operational despite two COVID-19 waves in 2020. To date, 66 LTx have been performed; an 11% drop in activity compared to 2019. The LTx team have remotely provided >175 medical and allied health reviews/wk. In-person reviews were limited to <10/wk. Over 20,000 separate LTx drugs were posted out providing uninterrupted access to LTx-critical medications. Access to spirometry and bronchoscopy remains suboptimal. Despite widespread community transmission, there was no COVID-19 infection in our LTx team, and only a single episode of self-limiting community-acquired COVID-19 infection in our wider LTx patient population. CONCLUSION: Reflecting the need to also provide a COVID-safe environment for HCW, we established a completely remote ambulatory service that maintained both LTx patients and LTx HCW at home. Whilst COVID-19 infections have been avoided, future studies will need to assess whether remote access to LTx has impacted on non-COVID morbidity and mortality in our LTx population.