Health Research at Medibank: Recording patient COVID-19 screenings – every patient, every time

As COVID-19 spread across the world in early 2020, the challenges to healthcare workers and hospitals were enormous. In Australia, adequate personal protective equipment supply, managing bed numbers and ventilator availability, and the anxiety of exposure, have been constant concerns for healthcare workers since the virus took hold locally.

The Medibank Better Health Foundation is proud to support this new study assessing how COVID-19 screening questionnaires pre-surgery were being documented in patient records.

As the first wave of COVID-19 subsided in 2020 in Victoria, health officials turned their attention to the burgeoning elective surgery waiting list.

The most urgent categories were resumed, with new practices and procedures in place to protect healthcare workers and patients.

Professor David Story, Foundation Chair of Anaesthesia at The University of Melbourne and Australia and New Zealand College of Anaesthetists Council Member, said much was still unknown about COVID-19 when elective surgery first resumed.

“We needed to ensure there was confidence for healthcare workers in the pre-surgery patient screening. Robust screening and appropriate documentation of that provides an important safeguard for healthcare workers,” Professor Story said.

“Everyone knew that mandatory screening of patients should take place, testing their temperature and asking questions about symptoms and potential exposure, but the results were often not being recorded in the patient’s history.

“Was it happening at the hospital entrance? At the admissions desk? When the patient was admitted to the pre-surgery ward? By nurses, the surgeon or the anaesthetist? We worked with two major public hospitals in Melbourne to track how often this screening was being recorded in a patient’s charts.

“Not only does clear documentation provide confidence for healthcare workers, it also helps to ensure patients get the best possible surgical outcome. Patients with COVID-19 have worse surgical outcomes, so their surgery should be delayed if possible.”

The proposed minimum outcome was to have 85% of screenings documented on the assumption that all patients were being screened but not recorded, however only 72% of elective surgery screenings and only 38% of emergency surgery screenings were documented.

“While we can be confident that most or all of those screenings did actually occur, it is concerning that they weren’t recorded,” Professor Story said.

The results helped to inform the procedures that Safer Care Victoria put into place as Melbourne’s second wave suspended elective surgeries again.

“Victoria moved to mandatory swabs pre-surgery during the second wave, but the findings of this project will have an impact across Australia," Professor Story said.

"Everyone knows pre-screening must be done, but it also must be recorded in the patient’s history. We have champions in the hospital community pushing to improve this as a result."

The two hospitals from the study have COVID-19-status clearly displayed in patient history now, and if not, staff are alert to screen again.

“We’ve learned that when there are sudden dramatic changes in practice, we cannot just assume everyone will adhere to new guidelines or procedures. We need to ensure we provide ongoing education, champions to promote the changes, and feedback opportunities so we know what is and isn’t working," Professor Story said.

“This year has been incredibly challenging for healthcare workers across Australia, particularly those in Melbourne; I’ve never seen so much change so quickly in our sector.”

The full results of the joint ANZCA and Medibank study were published in the Australian Health Review in September 2020.

This research project is proudly supported by the Medibank Better Health Foundation. The Foundation is committed to better health outcomes for all Australians and we fund research into key areas of need for our customers and the broader Australian community. For more information, click here.