Team Lead for the COVID-19 Respiratory/Rehabilitation and Discharge Team, Jude Fewings has shared the process behind organising a new multidisciplinary team at the beginning of a pandemic. Keep an eye out next week when we will be bringing you the experiences of eight members of the MDT. 

 

Towards the end of March as more Covid-19 positive patients were admitted to the Trust and the Intensive Care Unit (ICU) became a ‘Red zone’, it became clear that our first surge of patients was starting.

Wards were moving and mass training started in order to upskill volunteers across the hospital. I was asked if I would move from my day job as the consultant therapist in neurosurgery and establish a team to provide therapy to this patient group. I agreed on the Wednesday and by the Friday we had started.

My vision was clear, to create a suitably staffed, skilled workforce that was multidisciplinary; centrally led, with excellent lines of communication. A seven day respiratory and rehab service that facilitated patient and carer involvement, goal setting and outcome measurement with an integrated step-down discharge service into the community.

From the outset, I was provided with incredible support and flexibility by the Therapies management team, in addition to which we were advised that there were funds available for equipment.

As word went out that a specialist rehab team was being set up, I was inundated with volunteers. I decided fairly quickly that to lead this team in challenging circumstances, I would require a few senior clinical colleagues. Requests to other service lines were granted and the leadership team started to take shape.

To bring my vision to life over the course of the next few days, I worked with the heads of the therapy departments to move staff into the team and create pathways for the Covid-19 patients.

Staff training and psychological support

Training was requested from and provided by the ICU clinical educators. On the 3^rd of April, a Friday morning and at 13:00 the initial Covid-19 Respiratory, Rehab and Discharge team commenced operations.

I approached Rachel Clarke and Alan Hassard from Psychology who between them provided short sessions, throughout our three months to assist and maintain the mental health well-being of the team.

Patient Information

A bespoke Covid -19 Rehab booklet for the patients was created using a fusion of original pre-existing patient information and exercise booklet and additional respiratory and psychology information.

Key points for daily efficiency

Communication and high-level standardised care was at the forefront of team.  Attendance at all the white board meetings/ward MDTs.  A daily ‘therapy MDT huddle’ occurred in order to establish numbers of priorities and discharges.

Logistically, care needed to be taken with every patient contact in the red zones. In order not to use PPE un-necessarily, thought regarding what equipment was required, joint working and above all safety went into every Covid positive patient contact.

At our daily therapy MDT we ensured that we co-ordinated our care and joint working, including referrals to our Rehab nurse specialist, SLT and Dietician colleagues.

Use of a WhatsApp group was invaluable to co-ordinate the team quickly and efficiently on a daily basis and for uploading rotas which at the time needed to have the versatility to flex up and down according the numbers of patients in each week and across the weekends.

Infection Control

The hydro pool area became our centre of operations, chosen for its location and also access to showers (every therapist  showered, post work to keep their families safe, if we were required to mix with the green therapy teams then scrubs were changed before) and space to allow social distancing.

The Domestic  team of Teresa, Margaret and Anna who serviced the pool area need mentioning individually. They were the silent, night-time members of the team who due largely to their skills and dedication to keep the areas in Hydro spotless meant that my team were able to stay well and infection free.

Equipment

The Covid budget was made available to the rehab team and the purchases made were carefully considered to be that which after Covid would be used to benefit all patients in the Trust.

I had approved:

• 40 Hydroflex chairs to enable all patients to sit out in a pressure relieving supportive seating.
• Cognitive assessments in order to have a wide range for the OTs to use.
• Hand and ADL equipment to maximise patient independence
• Parallel bars for the rehab garden to further increase the range of therapy that we can offer outside on different surfaces.
• Bean bag positioning cushions in a range of sizes and shapes to facilitate Prone (tummy lying) positions for those very breathless patients.
• A therapy table that can be height adjusted in order to rehabilitate in standing and use your arms for a functional task at the same time.
• Two Therapy bikes that patients in bed can use to maintain muscle strength and range of movement were rented on a long term lease.
• Four therapy bikes to use when the patient is sitting in chair were purchased.

All of the above equipment has been used and has had huge importance in contributing to functional gains in our patients.

Data and patient pathways

From the outset, data and outcome measures were of prime importance to be collected.

Patient follow-up on discharge was also of importance to us as a team. It was at this point that we joined forces with the Community Respiratory teams in Plymouth and Cornwall and together created a bespoke follow-up service for patients on discharge. A database was created for collation of the outcome measures, which can now also send the referrals from the acute team to the Community team. A big thanks to Roger on this work.

Team Work

I have nothing but respect for all of my team as we moved through the last three months together. We have had a challenging but enjoyable period of time creating a bespoke rehabilitation service. Their flexibility and can do attitude made my role easy and the assistance given to me by the senior team truly invaluable.

Final words

There is so much more to say and celebrate, so many staff across therapies who although not in the actual Covid therapy team have assisted and been part of the bigger picture that words in a blog just can’t express or cover.

Now with acute cases on the decline and the team de-escalated, we return to our pre-covid areas of work. The learning from the last 3 months has been extensive.

My take home message: Intensive, co-ordinated, borderless MDT rehabilitation has fantastic results for patients and for staff.