Data Manager, Roger Gardner and Physiotherapist, Susie Wolstenholme have shared their experience of being part of a new multidisciplinary team in the face of COVID:
Roger Gardner – Cardiothoracic and Cardiology Data Manager
Whether we like it or not technology is here to stay and in fact COVID-19 has led many of us away from our traditions and forced to adopt new practises. I always favoured an agile approach of designing solutions quickly involving users, doing what’s difficult but achievable. The COVID response recognised the need for this given its urgency.
Putting patients at the centre of projects is so important. I have had the privilege to work with many great clinicians who saw the significance of data in their decision making. Over many years I’ve learnt to be sceptical of data (and I am more than most) you only need see just how important data will be in ending the pandemic. I ask the question where did the data come from and how reliable is it? I never fail to offer my services to ICU as what they ask is considered and valued. They have more data than you can shake a stick (20 GB of live data at any one time) so it’s some task. Whilst our ability to record data has eased (I remember Psion organisers and dBase and the pain that came with them) analysing very large amounts of data has become a new challenge. We often have too much data to write a simple query and we have to be selective about what we choose to examine.
I’ve done two things to support ICU at this time. Firstly I did an amalgamation (massive data dump) of patient variables/ventilation data for COVID patients from the back end of the main ICU database, Innovian. This system records lots of data at various intervals. We were eventually able to ‘bin’ the data for useful analysis and generate SOFA scores (severity of illness scores) for COVID patients during points in their stay, the principle being to identify effective treatments – watch this space. Many thanks to Rob Jackson, Sergei Dudnikov and Debbie Webster for their patience in helping me get the data right. It took four weeks of iteration.
Data whilst in ICU is one thing, patients hopefully go back to general wards and then into the community for their ongoing care. To this end the ICU team and I also developed a physiotherapy database that recorded key interventions and wellness, producing a summary at the end of their stay. It collated data and drafted an email physios could easily share with community colleagues so that care could be continued in an informative and joined up manner.
These projects really demonstrate that clinicians need the right cut of data to assist their treatments and that as data specialists we should be flexible enough to transform data into what is useful and that means learning enough clinical information to assimilate data and to challenge requirements. You could call that effective data mining. Learning from data is a journey and a privilege given how much more difficult it must have been in previous times such as 1918 flu pandemic.
Susie Wolstenholme – Physiotherapist
Following a recent short deployment to Samoa over Christmas 2019 with UKEMT (Emergency Medical Team) to support their healthcare system during a measles pandemic, when I was asked to support the set up of a COVID rehabilitation team I was quite happy to do so. At no point was I ever worried about my health, merely that of others.
As a physiotherapist with primarily neurological and critical knowledge, until my experience in Samoa, I would probably have shied away from a medical caseload but during that time I treated every type of patient from babies to adult amputees, so felt far more confident that my skills were transferable to COVID.
Starting on ITU in full PPE was daunting but after the first session I quickly realised it was no different except a little warmer! The opportunity to treat patients throughout their inpatient journey with a proper seven day service has been amazing.
Providing patients with interesting and more effective rehab including circuits, group work, and in the rehab garden has had excellent engagement and addressed both physical and emotional wellbeing. The outcomes in particular for post ITU patients say it all really and as a team we are so proud to say that all step down patients have walked out of hospital and gone straight home!
Working with other therapists from different departments and specialities has been incredibly rewarding and we have all learnt so much from each other. In particular OT’s having the capacity to provide rehab rather than just discharge planning has been invaluable.
Despite it being a challenging time with rapidly changing processes, my overriding feeling of the period has been incredibly positive as a time where we were able to provide a service that we would like to be the norm. I only hope that now we have deescalated and people have returned to their normal roles, that the joint working and more intensive rehabilitation is able to continue across specialities recognising everyone’s ‘Right to Rehab’.