Background: The response to the COVID-19 pandemic in the United Kingdom included large scale changes to healthcare delivery, without fully understanding the potential for unexpected effects caused by change. The aim was “ to a scertain the characteristics of patients, uncertainty over diagnosis, or features of the emergency response to the pandemic that could be modified to mitigate against future excess deaths”. Methods: Review of the entire pathway of care of patients whose death was registered in Salford during the 8 week period of the first wave (primary care, secondary care, 111 and 999 calls)) to create a single record of healthcare prior to death. An expert panel judged avoidability of death against the National Mortality Case Record Review Programme scale methodology and identification of themes using a structured judgement review format. Results: There were 522 deaths including 197 in hospital, and 190 in care homes. 51% of patients were female, 81% Caucasian, age 79±9 years. Dementia was present in 35%, COVID-19 was cause of death in 44%.Healthcare contact prior to death was most frequently with primary care (81% of patients). 46 patients (9%) had healthcare appointments cancelled (median 1 cancellation, range 1-9).Fewer than half of NHS 111 calls were answered during this period. 18% of deaths contained themes consistent with some degree of avoidability. In people aged ≥75 years who lived at home this was 53%, in care home residents 29% and learning disability patients 44% (n=9). Common themes were;delays in patients presenting to care providers (10%), delays in testing (17%), avoidable exposure to COVID-19 (26%), delays in provider response (5%), and sub-optimal care (11%). For avoidability scores of 2 or 3 (indicating more than 50% chance of avoidability), 44% of cases had >2 themes. Conclusions: The initial emergency response had unforeseen consequences resulting in late presentation, sub-optimal assessments, and delays in receiving care. Death in more vulnerable groups was quantitatively more likely to display avoidability themes.
Consequences of the emergency response to COVID-19: a whole health care system review in a single city in the United Kingdom