Characteristics and therapy needs of COVID-19 survivors during an enhanced therapy service provision between critical care and discharge: A service evaluation

Abstract

Background There was a significant change in therapy structure at the Royal London Hospital in response to the COVID-19 pandemic. This provided us with an opportunity to review the therapy interventions given to survivors between critical care and hospital discharge. Aims To describe the therapy needs and characteristics of COVID-19 survivors between critical care and acute hospital discharge during enhanced service provision. Method Notes screened retrospectively (30th March and 31st May 2020) and therapy interventions coded to allow a temporal analysis. This included 21 individual interventions provided by physiotherapists, occupational therapists and therapy support workers. Results Thirty-five patients were included. Demographics: 71% were male, average age was 53 (±13.7) and 55% identified as Black, Asian or Minority Ethnic (BAME). The mean length of stay was 23 days (±16.3). Critical care background: mean intubation time 13.6 (±6.4), 51% were delirious, 71% received oxygen therapy and three patients required tracheostomies. The mean Chelsea Critical Care Physical Assessment (CPAX) score was 30 (±11.3) following critical care. Therapy Interventions: 170 sessions were completed with a mean of 4.85 (±5). Mean time from step down to discharge was 9.74 days (±9.4). 57% returned to independence with the mean improvement of 9.7 (±8.7) on the CPAx score. Conclusion This descriptive analysis has helped the team gain a greater understanding of the therapy needs of COVID-19 survivors following a critical care admission and identified areas for development within the team. It has also demonstrated the resilience of the inpatient therapy team and redeployed staff in response to the first peak of the pandemic. Future work will explore the establishment of a critical care step down pathway to help establish individual rehabilitation complexity and therapy needs.