FEATURE COVID-19
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Lessons learned We learned three main things from the first wave pilot clinic . Discharge support provided to these patients in this first wave of the pandemic was limited and unknown , as community services were required to change their provision at pace .
Once stepped down from the unit to the ward , patients often wanted to go home immediately and missed opportunities for further therapy assessment and support services to be arranged on discharge .
Lack of discharge referrals led to further identification of needs in the clinic and onward referrals to community services . We have now developed patient resource packs for all level one , two and three COVID-19 patients who leave hospital , so they are better informed of community services and symptom management .
The role of occupational therapy after critical care continues to be developed at Manchester Royal Infirmary ... It is hoped that non-COVID critical care clinics could be replicated with occupational therapy in the future .
Further education has been provided for all ward-based therapists regarding the common themes of deficits from this patient group ensuring onward discharge referral .
The variety and frequency of need for onward referrals and signposting to community services indicated the importance of such a clinic , to support these survivors in our community and address the deficits they are continuing to experience since being discharged from hospital .
The occupational therapist has been a key multidisciplinary member in identifying and completing these referrals .
Due to the sequalae of deficits physically and psychologically impacting function and the large proportion of patients at working age , upskilling the multidisciplinary team on return to work , driving and financial support has been required .
Finally , increased recognition of the psychological impact on level two patients , as this cohort of people remained awake throughout their critical care stay and may have witnessed some distressing events during their admission .
The inclusion of seeing these patients in the multidisciplinary team clinic was beneficial to signpost for further support minimising potential post-traumatic stress disorder .
Improvements made to our service We have developed an occupational therapy COVID-19 critical care to discharge pathway , to standardise patient care and therapy input , including cognitive screening to be completed on all patients to identify higher level cognitive dysfunction , ensure appropriate signposting to services on discharge and review of this in clinic .
With further networking , learning and experience of this cohort of patients , we have improved our knowledge on COVID-19 / PICS deficits . We have improved our resources to patients , including Your COVID Recovery , and identified further services to signpost with the development of a community rehab directory .
Monthly virtual meetings with community therapists has improved referral systems , knowledge of community services and feedback on patient progress .
We have been trialling PICUPS tools ( Post ICU Presentation Screen ) in critical care units to follow the patient journey , and there has been commitment to an occupational therapist once a week COVID critical care multidisciplinary follow-up clinic .
Following the evaluation of the pilot , occupational therapy and physiotherapy input in the COVID critical care multidisciplinary follow-up clinic continues as the second wave of patients are being assessed .
Unfortunately , the other multidisciplinary members have been unable to maintain commitment to the clinic , however their input was highly valued and recognised and onward referrals are made to these specialities as required .
The role of occupational therapy after critical care continues to be developed at Manchester Royal Infirmary through this opportunity of involvement in the clinic . It is hoped that non-COVID critical care clinics could be replicated with occupational therapy in the future .
References
British Thoracic Society ( 2020 ) Guidance on respiratory follow up of patients with radiological confirmed COVID-19 pneumonia . Available online at : www . brit-thoracic . org . uk / covid-19 / covid-19-information-for-the-respiratorycommunity / [ accessed 1 October 2021 ]
Faculty of Intensive Care Medicine ( 2019 ) Guidelines for the provision of critical care services ( second edition ). Available online at : www . ficm . ac . uk / standards-research-revalidation / guidelines-provision-intensive-care-services-v2 [ accessed 1 October 2021 ]
Merryn Turner , clinical lead occupational therapist , Surgery Therapy Team / Cardiac Rehabilitation Manchester Royal Infirmary , email : merryn . turner @ mft . nhs . uk . With acknowledgement of contributors Siobhan Wilde , senior specialist physiotherapist , and Maimoona Hussain , senior occupational therapist
42 OTnews October 2021