ABSTRACT
Introduction: Adverse consequences of critical illness are well reported, and include physical, psychological and social effects that can last for years post discharge (Needham et al. 2012). Access to physiotherapy and early rehabilitation have helped to address the physical deterioration experienced by patients in intensive care. The role of other multi-disciplinary team members such as occupational therapy (OT), speech and language therapy (SLT) and psychology is less well defined, but has the potential to support and enhance rehabilitation since they offer alternative, complimentary perspectives. Objectives: This service evaluation sought to investigate the impact of a multi-disciplinary rehabilitation team on intensive care length of stay, ventilator days and functional ability at the point of discharge. Methods: The project was registered with the local NHS Trust clinical governance team. Retrospective data were collected at two points, prior to and post implementation of the multi-disciplinary rehabilitation team. Inclusion criteria were adults intubated and ventilated for more than four days requiring active treatment. Those with a long-term tracheostomy or laryngectomy or needing an inter hospital transfer were excluded. Electronic notes were retrospectively extracted to gather demographics, rehabilitation needs, intensive care length of stay, ventilator days and Chelsea Critical Care Physical Assessment (CPAx) scores at admission and discharge. Results: In total, 589 patients were admitted to intensive care across the two time points. OF these 49 were eligible for inclusion in the pre-implementation group (T1) and 45 in the post-implementation group (T2). There were no statistically significant differences in patient characteristics between patient groups. Patients presented with a range of medical, neurological and respiratory pathologies, with a minority admitted for elective or emergency surgery. Patients in T2 only received physiotherapy, compared to those in T2 who were assessed and treated by OT, SLT and care managed by the rehabilitation coordinator. Joint sessions were completed where appropriate. There was no statistically significant difference in intensive care length of stay or ventilator days between the two groups. Median (interquartile range) for length of stay and ventilator days were 13 (8-22.5) vs. 14 (10-30) and 9 (5.5-11.5) vs. 10 (6-28.5) days for pre-implementation and post-implementation groups respectively (p=0.163 and p=0.202). There was a statistically significant difference in functional ability (measured by CPAx) at discharge (p=0.037). Patients in the post-implementation group had a median change in score from baseline of 16, compared with 13 in the pre-implementation group (p=0.037). Multiple regression suggested that patient age, frailty, pathology and rehabilitation group made a significant contribution to variance in CPAx score, explaining 18% variance (p=0.033) Conclusion: The multi-disciplinary rehabilitation team did not significantly impact intensive care length of stay of ventilator days. However, patients receiving multidisciplinary rehabilitation benefited from the improved physical function at discharge. This suggests that the effects of rehabilitation can be amplified when a wider team is involved. This work was undertaken during the Covid-19 pandemic, where discharge and timely patient flow was severely disrupted. Further research is required to explore further the impact of this innovative approach to the rehabilitation in intensive care.
ABSTRACT
Background: The COVID-19 pandemic has forced many medical education institutions to switch from in-person to online learning environments. There is an existing gap in knowledge about the effectiveness of virtual learning for medical students. Objective: The purpose of the study was to determine if virtual orthopaedic surgery away rotations (VOSAR) benefit medical students and programs. Methods: Virtual rotations were created at two large residency programs for fourth-year medical students. From October 12, 2020 through December 28, 2020, satisfaction and quality were assessed using a 22-question survey, residency interview, rank, and match data. Forty-two fourth-year medical students participated, 38 of whom responded to the survey. Results: Most students stated course objectives were clear and consistent with coursework. Most were pleased with the variety of cases and presentations and were able to meaningfully interact with faculty and residents. Most stated they would participate again and suggest the rotation to others. Twenty-five of 42 participants were ranked by at least one program;39 were accepted into residency positions, 21 of which were in orthopaedic surgery. Conclusions: The results indicate that the VOSAR benefits students and programs. Based on the success of the VOSAR, both programs continued to offer the curriculum for 2021. Level of Evidence: Level IV.