ABSTRACT
Background University Hospitals of Morecambe Bay NHS Trust, witnessed an early peak of COVID-19 with related hospital admissions in early 2020, this created a need for a coordinated approach to post COVID-19 rehabilitation needs across the area. Objectives A three-armed COVID-19 rehabilitation pathway was devised in March 2020 with Arm 1 aiming to assess and address the immediate rehabilitation needs of those leaving hospital following an admission for respiratory complications of COVID-19. Methods Existing Pulmonary Rehabilitation teams were repurposed by integrated care network (MBRN) to be a new 'Virtual' rehabilitation service. A register of patients discharged from hospital sites was remotely screened for pathway suitability. Then, using a multi-professional template a holistic assessment needs was conducted using telephone and/or home visit consultations. Clinical assessment tools were built into the assessment process. Weekly 'acute-community' virtual in-service training sessions and multi-disciplinary case discussions supported the clinicians. Results To date 207 patients have entered the service for virtual triage, 138 patients were deemed suitable for further assessment and interventions. 427 direct clinician consultations were delivered to these 138 patients [122 initial telephone assessments;53 initial home visit assessments;168 follow-up telephone consultations;84 follow-up home visits]. Two of the 138 patients assessed died, both were expected deaths. No clinical incidents occurred and no staff contracted COVID-19 during this period. Feedback from the services' staff survey was very positive highlighting the supportive value of virtual training and MDT and the enjoyment of being part of creating and delivering this new service to patients recovering from COVID-19. Conclusions Utilising the skills of pulmonary rehabilitation staff to deliver a holistic rehabilitation and treatment service to those discharged from hospital after suffering respiratory complications of COVID-19 was feasible, safe and well tolerated by staff and patients. This service is now being used to address the needs of post-COVID-19 patients presenting with respiratory needs in the community. We aim also to assess clinical outcome.
ABSTRACT
P35 Figure 1ConclusionsUtilising the skills of pulmonary rehabilitation staff to deliver a holistic rehabilitation and treatment service to those discharged from hospital after suffering respiratory complications of COVID-19 was feasible, safe and well tolerated by staff and patients. This service is now being used to address the needs of post-COVID-19 patients presenting with respiratory needs in the community. We aim also to assess clinical outcome.
ABSTRACT
Background: The COVID-19 pandemic paused in- person clinic visits and introduced telehealth (TH) creating a paradigm shift in ambulatory practice. TH remains out of reach for many patients, highlighting healthcare (HC) disparities. Methods: We studied Nephrology ambulatory clinic schedules during the transition to TH (April 1 to May 15 2020) at the University of Kentucky (UK), Lexington KY. We estimated the proportion of patients who could perform TH visits, trends over time, compared TH use in Nephrology vs other clinics (cardiology, pulmonology, Infectious disease, women's health), evaluated causes for non-use, and studied the geographic variation of TH use/non-use across the regions served by the hospital. Results: TH was successfully adopted by 43.5% of the clinic population, without significant change across weeks (wk) 1 to 5. Wk 6 increased when reimbursement was allowed for telephone visits (p<0.01) (Figure 1). The % of patients unable to do TH dipped from 72% in wk 1 and remained steady at ∼56.5% thereafter. Lack of internet access and/or smart device was the most frequent reason. The Nephrology clinic trend did not differ from other clinics. By spatial analysis, TH non-use rates clustered in geographic areas of Eastern and Southern KY with the lowest socioeconomic indices (Figure 2). Conclusions: The Nephrology clinic at UK, serves the Eastern half of KY, that includes poorer and largely rural regions. While TH provides a remarkably useful tool to reach patients, over 50% did not benefit, and use-rates reached saturation rapidly. TH further highlights HC disparities and the need to mitigate them.