Mass food challenges in a vacant COVID-19 stepdown facility: exceptional
opportunity provides a model for the future
Abstract
Background: Internationally, the COVID-19 pandemic severely curtailed
access to hospital facilities for those awaiting elective/semi elective
procedures. For allergic children in Ireland, already waiting up to 4yr
for an elective oral food challenge (OFC), the restrictions signified
indefinite delay. At the time of the initiative there were approx 900
children on the Chidren’s Health Ireland(CHI) waiting list. In July
2020, a project was facilitated by short term(6wk) access to an empty
COVID stepdown facility built, in a hotel conference centre,
commandeered by the Health Service Executive Ireland(HSE). The aim was
to the achieve rapid rollout of an off-site OFC service, delivering high
throughput of long waiting patients, while aligning with hospital
existing policies and quality standards, international allergy
guidelines and national social distancing standards. Methods: The
working group engaged key stakeholders to rapidly develop an offsite OFC
facility. Consultant Paediatric Allergists, Consultant Paediatricians,
trainees and Allergy Clinical Nurse Specialists were seconded from other
duties. The facility was already equipped with hospital beds, bedside
monitors(BP, Pulse, Oxygen saturation) bedside oxygen. All medication
and supplies had to be brought from the base hospital. Daily onsite
consultant anaesthetic cover was resourced and a resuscitation room
equipped. Standardised food challenge protocols were created. Access to
onsite hotel chef facilitated food preparation. A risk register was
established. Results: After 6wks planning, the remote centre became
operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges
were commenced, 465 (98%) were completed, 9(2%) were inconclusive.
135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child
required advanced airway intervention. 8 children were transferred to
the base hospital. The CHI allergy waiting list was reduced by almost
60% in only 24 days. Conclusions: OFCs remain a vital tool in the care
of allergic children, with their cost saving and quality of life
benefits negatively affected by delay in their delivery. This project
has shown it is possible to have huge impacts on a waiting list
efficiently, effectively and safely with good planning and staff buy in
– even in a pandemic. Adoption of new, flexible and efficient models of
service delivery will be important for healthcare delivery in the
post-COVID-19 era.