TICC-19 in the BMJ

During the first COVID peak we have managed over 250 patients through the COVID ambulatory clinic: 1/5 of patients have been referred from the ward, 1/5 via the GP hot hub and 3/5 via ED. 

It’s great for our COVID virtual ward to feature in this week’s BMJ:

Acute medicine consultant Andy Walden says: “It gives patients the confidence to go home so they feel much safer, knowing that they’ve got someone they can ring and that someone’s going to ring them.”

Joseph Nunan, ultrasound fellow in the acute medical unit, says: “From our early data, patients with non-severe covid-19 can be safely managed in the community instead of being admitted to hospital. A virtual ward provides a safety net for this cohort of patients.”


TICC-19 Statistics

TICC-19 is a COVID-19 triage pathway developed at the Royal Berkshire Hospital which allows some patients to be sent home with a sats probe. Then they receive a daily phone call from our Ambulatory COVID Clinic. This is our ‘Virtual COVID Ward‘ out there in the community.

As of 24/04/2020:

100 patients had been referred to the COVID Ambulatory Clinic to go into the Virtual Ward. Of these 100 patients…

  • 67 patients had been discharged from the virtual ward
  • 27 patients were still under review in the virtual ward
  • 6 patients were in hospital
  • 16 patients reattended the ED, and of these:
    • 12 patients were readmitted

Of these 100 patients…

  • None of the patients have died

Ambulatory Emergency Care services expect to convert about 10% to an inpatient admission*. We converted 12% so this means we are managing patients with the right level of ‘acuity’.

The Bottom Line: From our early data, patients with non-severe COVID-19 can be safely managed in the community instead of being admitted to hospital. A ‘virtual ward’ provides a safety net for this cohort of patients.

*See Directory of Ambulatory Emergency Care for Adults PDF:


Press Release: Royal Berkshire Hospital launches pioneering Covid-19 scheme

Press release (reproduced with permission) from Royal Berkshire Hospital. Text starts below.


Royal Berkshire Hospital launches pioneering Covid-19 scheme

A pioneering scheme which allows some patients with suspected Covid-19 symptoms to be monitored and managed from home has been launched at the Royal Berkshire Hospital.

It is believed to be one of the first places in the country to use this triage pathway following its successful trials in the Covid hotspots of northern Italy.

The system aims at freeing up demands on hospital staff, and beds and easing pressure on frontline clinicians.

Patients who arrive at the Emergency Department (ED) with breathing difficulties are given routine tests on their heart, blood pressure, oxygen levels and respiratory rates as usual.

Doctors then decide whether the patient needs to be admitted or is suitable to be sent home with a pulse oximeter which will monitor their oxygen levels.

For about five days, clinicians will be in daily phone contact with the patients as part of a robust system of keeping a check on their condition. If, at any time, they become concerned about a patient’s oxygen readings, they can be called back into the hospital for observation or treatment.

Dr Joseph Nunan, Ultrasound Fellow in the Acute Medical Unit said: “This Covid triage pathway, was shared with us by doctors from Brescia, Italy, working in what was then the second Covid hotspot in Europe.

“The collaboration, which has led to the Royal Berkshire Hospital adopting this Italian triage pathway, has shown the NHS and the RBH at their very best. We’re keen to share our experience with other hospitals, so we have built a website:”.



Follow TICC-19 on social media!

TICC-19 is live on Twitter, Facebook, YouTube and Instagram! Follow us for more news, training and developments. #SavingLives


The ‘Hot Hub’ Medics

Local GPs have volunteered for new front-line roles in our hot clinics to tackle the coronavirus outbreak.

We’re delighted the local GP Hot Hub will be using the TICC-19 pathway. Those who need to go home with a sats probe will be monitored by our TICC-19 team at the RBH.

This has been the NHS at it’s best: collaboration between different teams to benefit patients.

The GPs running the Hot Hub needed to learn lung ultrasound so we ran a training session for them. We’re putting together some learning materials that you can use in your hospital too. Watch this space!

Video credit: BBC, Image Credit: Elena Orr


TICC-19 is on Twitter!

Our twitter feed @ticc_19 was launched this week. The aim is to help get the word out about our pathway to other hospitals who might want to pilot it or something similar. We were inspired by FOAMed (free open access medical education). If we come together as a medical community and share our knowledge, ultimately our patients benefit. 

Watch Our Story to find out more about how TICC-19 came to be.


TICC-19 Webinar

Our first webinar on Wednesday was a huge success. Dr Andy Walden and I fielded great questions from doctors from other hospitals interested in adopting the TICC-19 pathway.

It was a great opportunity to share the experiences we had had so others can hit the ground running, and use our materials such as the patient leaflet and pathways.

Do you have questions about adopting the Triage Into Community for Covid-19 Patients pathway in your hospital? Contact us.

Dr Joe Nunan