LONG COVID FEATURE
When the Coronavirus pandemic hit last year , NELFT NHS Foundation Trust was already working hard with its partners at Barking , Havering and Redbridge University Hospitals NHS Trust ( BHRUT ) to ensure patient flow and safe discharges from their acute hospitals were maintained , as pressure increased for beds .
Following the government ’ s response to the crisis , NELFT ’ s Hospital Discharge Service ( HDS ) was formed , which includes a team of AHPs , bed managers , administrators , and assistants , to manage referrals from hospitals in and outside of our boroughs .
These hospitals require support in discharging residents back to their homes as , often , the hospital is not familiar with the services available in their patient ’ s home borough , as we continue to operate across different systems in differing trusts .
Having started small over a year ago now , the HDS communicates constantly seven days a week , from 8am to 8pm , with other discharge hubs to ensure safe discharges for our patients .
Originally an occupational therapist within the Intensive Rehab Service , my role was to develop care plans , request support packages , complete welfare checks , and risk assess patents for safety and rehabilitation at home within 48 hours of discharge .
However , if needed we could also utilise our inpatient rehabilitation wards should home not be a safe option . I was also responsible for escalating any unsafe discharges and referring assessed patients needing rehabilitation at home to one of our crucial community rehabilitation teams .
Within the HDS you are required to adapt quickly and advocate for the patient under pressure , using your knowledge and expertise as a practitioner , but also to communicate at a high level in a clear and concise manner , not only with other teams over email and telephone calls , but in working as part of a new and ever-changing team of people .
It is hugely rewarding when patients are safely discharged , but I also feel my time in the HDS helped me to develop my leadership skills – managing high volumes of referrals and organising therapy visits for the team when needed .
By the end of 2021 , it was becoming apparent that the needs of patients who were experiencing Long COVID were not going to go away , and I was keen to learn more about the role my profession could play in Long COVID rehabilitation .
While admissions were still increasing , over the summer of 2020 the Barking , Havering and Redbridge Clinical Commissioning Group ( CCG ) had commissioned one of the first of 60 Long COVID clinics in England .
This was the beginning of a partnership between BHRUT and NELFT to provide specialist support to patients within our boroughs who were 12 weeks after discharge from being in hospital with COVID-19 , or 12 weeks after a positive test with COVID-19 in the community , and who were still experiencing side effects , such as breathlessness , cognitive changes , insomnia , taste and / or smell loss and fatigue .
For me it was a fantastic opportunity to be a part of a new service , putting existing skills and new evidence together for patient treatment and returning to rehabilitation skills . The challenging part was interviewing for a role that was not established , and patients ’ needs and occupational therapy expectations were not very well known .
The team is led by a respiratory consultant within BHRUT , alongside a specialist physiotherapist , a clinical psychologist , an assistant and a specialist occupational therapist , which is the role that I am now in .
We have also seen demand for the support of our speech and language therapy and dietetic colleagues , which is something we hope to look further into .
Our Long COVID team operates both with an outpatient weekly clinic and through virtual and home visit appointments in the community . Currently , due to our size and being a new service , we only accept referrals via a GP .
Interventions for the treatment of Long COVID are often likened to the interventions for other long-term conditions , but I am cautious that it is very much still a new condition . However , from an occupational therapy perspective the assessment does have similarities .
I complete assessments of daily tasks , which are consuming energy or contributing to breathlessness , and agree on goals with the patient so that these activities can be adapted with them .
It has also been beneficial to provide anxiety management / meditation techniques to provide focus and control over breathing and brain fog , to help reintroduce engagement in activities that are important to the patient .
As a team we have been overwhelmed by the number of services willing to help within the social care and voluntary sectors , and which we have been able to link up with to get extra financial support , for example for those people who are struggling with changes in role and identity because of COVID-19 symptoms .
For some it is the adaptation to living with fatigue that oftencompensatory approaches can be beneficial for , for others it is knowing they have a support group . We have recently introduced the offer of using a self-management app for our patients so they can monitor their symptoms and communicate directly with us , at any time .
With each patient used to being of such high function , there is often a lot of emotion to work through and at times I have found this difficult , as frequently it is the patient ’ s first experience of having their feelings towards their recovery validated .
My time so far within the Long COVID rehabilitation team has challenged my self-development , whether I am learning about staffing , management strategies or service development , or juggling a mixed caseload of patients .
I am now able to focus on finding the real occupational therapy interventions and outcome measures that can demonstrate the benefit our profession has to offer Long COVID recovery patients .
Natalie Morgan , lead occupational therapist , Long COVID Team , NEFLT NHS Foundation Trust . Follow on Twitter : @ ot _ natalie
OTnews July 2021 39