Dr John Wort is a consultant and the clinical lead for the pulmonary hypertension (PH) service at Royal Brompton & Harefield NHS Foundation Trust.
He is also a Reader at Imperial College and is involved in both clinical research (looking at new treatments for PH) as well as basic science research (looking at patients’ cells in the lab to try and understand the disease better).
We spoke with Dr Wort about his work at the Trust and how COVID-19 has impacted on both his clinical and research work.
How has COVID-19 affected you in your day to day work?
We were of course greatly affected, especially because the normal working of the PH clinical service was effectively put on hold.
Patients with PH are very vulnerable in general but with COVID-19 even more so. They were advised by the Government to shield themselves at home, so it was effectively impossible to see them in hospital unless it was an emergency. As a result, much of the work we have been doing is ensuring the patients remained safe at home without being able to carry out the routine monitoring we would normally do.
As for new patients, instead of doing all the investigations we would normally do, we had to make treatment decisions based mainly on our previous experience and expertise.
Our hospital is one of seven specialist PH centres in the UK and we’ve been in close contact with the other centres on a weekly basis to ensure we had a coordinated response and helped each other out where necessary. For instance, if we weren’t able to get a patient in, one of the other specialist centres in London would look after the patient.
We’ve also had to adapt to the way we manage patients. Instead of having face to face consultations as we do in clinic or on the wards, we’ve had to move to telephone and video consultations. We’ve been using a system called “Attend Anywhere”, which is one used within the NHS and allows us to see and talk to patients in their home.
Were you and your team directly involved in caring for patients with COVID-19?
We were mainly involved in advising the teams working in the multiple Intensive Care Units (ICUs) here at the hospital on some of the complications that arise as a result of COVID-19 infection, which include PH, blood clots and problems with the functioning of the right ventricle. Luckily, we were able to use our expertise to advise on the drugs we normally use for our PH patients which include anticoagulants (blood thinners) and pulmonary vasodilators (which open up the blood vessels in the lung).
So, for our team it was a combination of maintaining the clinical services remotely, but also providing our specialist expertise for those incredible staff who were on the front line and who kept the ICUs running under extremely difficult circumstances.
How do you see your team, and hospitals in general, adapting the ways they deliver services in the long term?
I hope COVID-19 won’t be around forever but it won’t go away quickly. As a result, we’ve been forced to rethink how we do everything. It’s like pressing a pause button and reconsidering how we work in the future.
I think one thing we will be changing about our PH service will be to go from 100% of our follow-up outpatient clinic appointments taking place in person, to eventually roughly half of them being done virtually, via telephone or video.
Something else we’d been planning to do pre-COVID-19 was to introduce more day-cases, effectively minimising the stay for patients in hospitals so they don’t have to stay overnight more than they need to. Normally, patients suspected of having PH would come in early in the week, stay on the ward, have all their investigations over several days and then be discharged at the end of the week. Instead of that, we’re now moving towards a more efficient way in the form of two day-case visits, where we fit in the investigations in those two days and then review the patients at the end of the second day.
Have there been any positive effects from the new ways of working that you’ve had to adapt to?
As I’ve already mentioned, it’s accelerated a lot of things we’d been thinking about anyway, like the virtual clinics and day-case reviews.
However, I think the next step will be to make these new ways work as efficiently as they possibly can. We will need to introduce the use of technologies that allow us to remotely monitor blood pressure, walk tests, oxygen levels and activity. This will maximise the benefit we get from these virtual clinics and hopefully be of more benefit to the patients.
What research were you working on before COVID-19 and how have these projects been affected?
All of our research, along with research in the rest of the hospital, stopped in early March. Before that we had several clinical trials running, which were testing established treatments in new ways as well as some novel treatments. We were also working on basic science research projects which involved using cells from patients and growing them in a lab to look at how PH develops, and how novel treatments might prevent it from developing. For instance, we are particularly interested at how ‘anti-inflammatory’ drugs may treat PH.
Now that some research projects are restarting, what are some of the safeguards that are being put in place to protect both patients and staff?
We’ve only recently been given the go ahead to restart some observational research studies, which involves things like collecting blood samples and clinical information from patients who are now starting to come into the hospital. These patients are following strict pathways. For instance, when they are coming for right heart catheterisation (the main test we use to diagnose the type and severity of PH) they require a negative COVID swab test done within 72 hours of the test. Bloods that are taken at the time of the catheter are done so with the appropriate PPE equipment, processed and stored safely.
We’ve not been given the go ahead yet to do the clinical trials, which would involve patients coming into the hospital. However, this is constantly being reviewed by the Trust along with direction from NHS England.
Published on 31 July 2020