ABSTRACT
Background: As a standalone tertiary spinal cord rehabilitation program, our patients requiring diagnostic imaging during their inpatient stay need to be transported to an acute care hospital to receive these services. Over the course of inpatient rehabilitation, patients routinely travel to acute care hospitals for diagnostic imaging for surgical follow-up, musculoskeletal injuries, vascular complications such as deep vein thrombosis and other medical complications. Due to travel and wait time, patients typically miss at least a half day of therapy to attend imaging appointments. At the beginning of the COVID-19 pandemic, an urgent need arose to develop a new approach to diagnostic imaging due to a significant reduction in access to acute care diagnostic imaging and in order to reduce the risk of patient exposure to COVID-19. Objective: The goal of this initiative was to implement a new, mobile diagnostic imaging service that would minimize external travel during inpatient rehab, reduce risk of exposure to COVID-19, reduce lost therapy hours, while at least remaining cost-neutral. In order to evaluate this service, the costs and benefits associated with this mobile x-ray and ultrasound service were examined. Methods: With the support of Joint Department of Medical Imaging, our SCI rehab program partnered with STL Diagnostic Imaging to provide onsite x-ray and ultrasound imaging.The service began on May 11, 2020 and consisted of mobile x-ray imaging twice per week and mobile ultrasound scans once per week for two hours each. All imaging was conducted in patient rooms by STL technologists. Monthly STL billing costs were compared to estimated transportation costs for patients. Typical transportation costs range from $60-$284 depending on mode of transportation. Results: Between May 11, 2020 and January 28, 2021, 144 patients received 203 x-ray images over 67 x-ray days and 81 patients received 105 ultrasound scans over 37 ultrasound days. Over this timeframe, the approximate savings in transportation costs ranged from $7114 to $20,753. In addition, it is estimated that 225 - 450 lost therapy hours were avoided since patients did not have to travel for imaging and therefore avoided missing scheduled therapy appointments. Although not formally evaluated, physician, patient and nursing staff satisfaction regarding this new service has also been extremely positive. Conclusion: Although implemented out of necessity during the pandemic, this partnership to provide mobile diagnostic imaging has been cost-effective and beneficial to patients.
ABSTRACT
Background: COVID-19 presented unique challenges for patient wellbeing in tertiary SCI rehabilitation settings. Patients had long evening and weekend stretches to occupy themselves while isolated from their family and support network without access to volunteers, peer mentors, recreational outings or weekend passes. Objective: To describe the outcomes of a 7-day therapy model implemented during COVID-19 (Apr-Aug2020) from a patient perspective. Method: The pandemic provided an opportunity to redeploy outpatient staff to the inpatient program, and provide therapy services 7-days/week for 12 hours/day (vs. 5 days/week for 8 hrs) to: 1) enhance physical distancing ;2) intensify inpatient therapy;3) create opportunity to practice skills prior to discharge;4) facilitate daily e-visits (visitor restrictions);5) increase recreation/leisure offerings;and, 6) increase supportive care on units. In total 6 PT's, 4 OT's, 2 Assistive Technology Staff (ATS) were redeployed. Enhanced recreation therapy evening programs (bocce, movies, relaxation, adapted sport, etc.) and extended gym hours were provided. Supports for feeding, laundry, activities of daily living (ADL), 2, and e-visits were established. Leadership team worked extended hours and weekends. Seating clinic staff supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. Findings: Thirty inpatients, 77% male, 6 paraplegics and 24 tetraplegics, majority of non-traumatic etiology, with a median 57-80 day LOS indicated their preference for a 6-day (vs 7-day) therapy model.Weekend recreational programs had the best attendance, while recreational programming attendance was a predictor of greater program satisfaction. A majority of inpatients indicated their preference for 6-day per week programming indicating they would appreciate a day of relaxation (which could still be therapeutic, just less physical and more recreational perhaps). Conclusion: Temporary redeployment of staff resulted in increased inpatient support services and therapy availability. Study results underscore the importance of role clarity and goal setting, therapeutic recreation services, especially on weekends;the potential value of a 6-day therapy model;and, our reliance on volunteer and family caregiver services, therapeutic and weekend passes as essential components of care.
ABSTRACT
Objective: To describe the effects of the COVID-19 pandemic on inpatient length of stay (LOS) during traumatic spinal cord injury (t-SCI) rehabilitation, and to compare this to the same time period in the previous year. Methods: T-SCI patients admitted to Toronto Rehabilitation-Lyndhurst Centre, University Health Network between March 1-Nov 30, 2020 were considered as the study population during the COVID-19 pandemic. The same time period in 2019 was selected as the comparison group before the pandemic began. Data was collected as part of the Rick Hansen Spinal Cord Injury Registry study. Appropriate descriptive analysis was used to describe the demographic and impairment characteristics of the two cohorts. The Chi-square test was used to compare the number of admissions before and during the pandemic. The Shapiro-Wilk test was applied to test the normality of the samples, and the two independent sample t-test was used to compare mean LOS between groups. Multiple linear regression was used to explore the possible changes to inpatient rehabilitation LOS during the pandemic. SPSS 22.0 was used to perform the analysis and α=0.05 was considered as level of significance. Results: During the 2020 study period 37 t-SCI patients were admitted to rehab;73% male, mean age of 52.8 years and mean LOS of 75.4 days, excluding 3 patients who had not been discharged yet. In the 2019 comparison period 70 t-SCI patients were admitted;76% male, mean age of 53.8 years and mean LOS of 76.3 days after exclusion of three outliers. The number of t-SCI rehab admissions was significantly lower during the pandemic (P-value= 0.001). The Shapiro-Wilk test showed a normal distribution for LOS in both samples (2019: P-value=0.33, 2020: P-value=0.52). The two sample t-test showed no statistically significant change in mean LOS before and during pandemic (t=0.14, df=105, P-value=0.89). Linear regression showed no effect of year on LOS, adjusted for age, gender, and level of injury/AIS. Conclusions: The number of t-SCI patients admitted to inpatient rehabilitation was reduced during the COVID- 19 pandemic (March - November 2020), but their LOS remained unchanged. Despite multiple health system pressures LOS was maintained during the pandemic for these patients.