COVID-19 FEATURE
An additional aim was to develop a model for future follow-up clinics that could be replicated , be time efficient , valuable , cost effective and funded .
The multidisciplinary team had not been involved in previous critical care follow-up clinics and this may provide evidence to support a broader business case to benefit all post-critical care patients ( COVID-19 and non-COVID-19 ) in the future .
The COVID critical care multidisciplinary follow-up clinic targeted patients admitted to the unit with a primary diagnosis of confirmed or suspected COVID-19 , who required mechanical ventilation and organ support .
These patients on the unit required either level two care ( needing single organ support excluding mechanical ventilation ) or level three care ( requiring two or more organ support or needing mechanical ventilation alone ).
The critical care follow-up team contacted the patients using the COVID-19 Yorkshire Rehab Screening ( C19 – YRS ) tool to identify concerns , and patients were invited to the outpatient COVID critical care multidisciplinary follow-up clinic based at Manchester Royal Infirmary .
Prior to the pandemic , occupational therapy provision on the critical care units was limited and significantly understaffed , as indicated by the standards in Guidelines for the provision of intensive care services ( FICM 2019 ).
Manchester Royal Infirmary had an established critical care followup team , consisting of critical care nurses and physiotherapists . Over the past decade , the role of the critical care follow-up team has been to provide support , reassurance and additional rehabilitation to the post-critical care patients , as well as assisting ward therapists and nursing staff to devise appropriate medical and rehabilitation plans to facilitate discharge .
The nurses completed telephone follow-up calls and had been running an ad hoc clinic for these patients before the pandemic .
It has been documented extensively that when patients leave critical care they can experience physical , psychological and cognitive compromise , which is known as post-intensive care syndrome ( PICS ).
Not only do these patients have the effects of critical care admission , but our growing knowledge and understanding of the sequalae of deficits survivors of COVID-19 experience place occupational therapists as a core member of any inpatient or outpatient service .
The pilot provided an ideal opportunity for occupational therapists to demonstrate our person centred , holistic skills and knowledge base .
The pilot clinic The follow-up nurses and physiotherapists identified COVID-19 critical care patients who had been discharged from hospital back into the community . They completed a virtual tele-clinic and utilised the COVID-19 YRS tool : 24 patients were invited to the clinic ; 22 of these patients required level three care , and two patients required level two care .
Symptom and deficits
Fatigue 83 % Sleep 83 %
Deficits in Activities of daily living
Of the 24 people who attended ; 67 per cent were male and 33 pr cent were female . The average age was 49 years , ranging between 20 and 68 .
These patients were discharged from hospital on the following discharge pathways : 63 per cent of patients – pathway 0 ( discharge home with nil change in care provision ), 29 per cent of patients – pathway one ( discharge home with either reablement or therapy input or both ); 8 per cent of patients – pathway two ( rehab bedded unit , including neurological rehab units ).
Occupational therapy input All 24 patients were assessed by the occupational therapist in clinic , as the COVID-19 YRS tool identified areas of concern , including reduced engagement in activities of daily living , fatigue , poor sleep hygiene , increased anxiety and depression , breathlessness and cognitive dysfunction .
These deficits were not surprising given the prolonged critical care length of stay and the COVID-19 sequalae of deficits . Use of screening and assessment tools identified the percentage of patients experiencing varied symptoms and deficits ( see table one ).
Following assessment , our input included symptom management advice and education , along with signposting to appropriate services to further support patients in the community . Onward referrals were made as shown in the graph above .
Percentage of patients experiencing
70 %
Psychological changes 67 % Breathlessness 50 %
Cognitive dysfunction 46 % Return to work 46 % Upper limb deficit 5 %
Table one
Onward referrals
Social prescribing 16 %
Psychological support 25 %
Community neuro rehab 22 %
General rehab 12 %
MSK 4 %
OTnews October 2021 41