Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

Abstract

As part of the UK National Health Service (NHS) preparations to manage the impact of the COVID-19 pandemic on hospital services, clinical guidelines that emphasized the expansion of the acute care capacity in managing the anticipated surge in COVID-19 cases were implemented. Clinical wards were reconfigured and routine face-to-face outpatient clinics were suspended. Some of the changes include workforce and facilities reorganization. One of the changes implemented at the Hull University Teaching Hospitals NHS Trust (HUTHT), was the relocation of the Complex Rehabilitation Ward from its 15- bed base in the Queen’s Centre for Oncology to a repurposed 12-bed surgical ward within the main Castle Hill Hospital (CHH) building in March 2020. Methods: A comparative review of the admissions and outcome measures data (admission diagnosis; referral source; PCAT: Patient Categorization Tool; LOS: Length of Stay; Bed occupancy and discharge destinations) over a 4-month period (March-June 2020) was undertaken and compared to retrospective data from a corresponding 4-month (March-June 2019) period in the previous year to determine the impact of the ward relocation on the delivery of specialist rehabilitation to patients with complex needs during the pandemic episode. Results: A reduction in total number of admitted patients (n=28 in 2019; n=18 in 2020) with reduced bed occupancy from 99% in 2019 to 72% in 2020 despite a reduction in bed base was noted following the ward relocation. A shorter length of stay with a mean of 29 days was noted following relocation of the ward while an increase in patient complexity as demonstrated by the PCAT scores was observed. The proportion of patients achieving a home discharge destination as opposed to other residential care facilities increased, accounting for 89% among discharged patients. Conclusion: This review demonstrated some of the impact of the measures implemented to combat the 1st wave of the coronavirus pandemic, specifically the relocation of the specialist inpatient rehabilitation ward in a tertiary hospital setting. Though a higher proportion of the admitted patients had increased complexity, a shorter length of stay with a significant proportion of the patients achieving a home discharge destination were observed following ward-relocation in 2020 compared to a similar quarter in 2019. The findings also reflected a reduction in bed occupancy despite reduced bed base capacity. Though there is a noted reduction in duration of stay in hospital and a greater proportion the patients achieved a home discharge destination, this was achieved with a compromise on the rehabilitation process due to the constraints of the new ward environment. Significant impact in the quality of the therapy programmes delivered was observed. The longer-term impact of this will need to be monitored. This review highlights the need for consideration of specialist rehabilitation as part of the acute response planning process in pandemic and mass casualty events.