Critical care
Feature
literature there appears to be limited investigation of occupational therapy in these clinics .
One example found was Guy ’ s and St Thomas ’ NHS Trust , which trialled a multidisciplinary team post-critical care clinic in 2015 , which included an occupational therapist , as a small pilot project ( NICE 2017 ).
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Due to the increasing number and complexity of critical illness patients in the second wave of the pandemic , as well as pressures on staffing , for example redeployment , it became clear that the needs of this patient cohort were unlikely to be met through existing infrastructure ; that is , individual site-based post-COVID respiratory clinics and post-ITU follow up clinics .
This has led to the development of the Barts Health NHS cross-site virtual COVID critical care follow-up clinic with multidisciplinary support to address these increased needs .
The role of occupational therapy
The role of therapies is recognised to be integral in the assessment and management of critical care patients , and the inclusion of an occupational therapist in the follow-up team is recommended in the guidelines for the provision of intensive care services ( FICM 2019 ), alongside an intensive care consultant , specialist nurse , clinical psychologist , physiotherapist , and dietician .
Furthermore , occupational therapy is identified to be essential in addressing the complex rehabilitation needs of COVID-19 critical care patients ( RCOT 2021 ).
In Barts Health NHS Trust , occupational therapists have not routinely been involved in critical care follow-up clinics , and in current
The virtual follow-up clinic
The Barts Health COVID critical care follow-up clinic ran between March 2021 and August 2021 . It aimed to address the needs of patients from the second wave of the COVID-19 pandemic , reviewing them three months after discharge virtually by telephone or video-call appointments .
The inclusion criteria , as per NICE CG83 guidance ( 2009 ), involved anyone admitted to an intensive care unit ( ICU ) with COVID-19 at any of the Barts Health NHS Trust sites .
Patients who were excluded were those with a very short stay on intensive care , with no impairments on hospital discharge , and those who were palliated .
The multidisciplinary team included a critical care consultant , specialist nurse , physiotherapist , and an occupational therapist . Clinics consisted of four one-hour appointments , with meetings and administration time . Multiple follow-up appointments were offered for patients with more complex needs .
I worked as the occupational therapist for the post-COVID critical care follow-up clinic , in which I helped develop the role . This involved :
• Identifying features of post-COVID-19 syndrome and PICS via multidisciplinary assessment .
• Having a key worker role , along with the multidisciplinary team , in assisting co-ordination of aftercare to ensure patient needs are addressed after discharge to accelerate recovery .
• Providing onward referrals to appropriate services , including community occupational therapy assessment and other therapy services , such as physiotherapy , speech and language therapy , psychological support , and general community rehabilitation .
• Cognitive screening and onward referral to appropriate services .
• Providing support for self-management , including education and written literature , rehabilitation advice and information about local resources .
• Liaising with community services , identifying gaps and establishing links , such as direct referral pathways with Long Covid hubs and talking therapies to improve therapy access and overall patient care .
April 2022 OTnews 25