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New pathway for COVID-19 pneumonia patients

Barbara McCready

A new pathway has been set up for patients after their discharge from hospital with COVID-19 pneumonia.

This means they can be followed up via telephone or virtual consultations to assess for any physical or psychological problems following their admission.

The service is being delivered flexibly by the acute respiratory team at North Cumbria Integrated Care NHS Foundation Trust and in collaboration with the Respiratory consultants and the wider respiratory team in the community.

Barbara McCready, Advanced Specialist Physiotherapist at NCIC, said: “We have approximately 75 patients on this pathway who have been discharged following COVID Pneumonia. We would normally see patients face to face in an outpatient clinic but we can’t do that at the moment.

“Some of these patients have had long stays in intensive care or in the ward areas and they can be significantly deconditioned following a COVID Pneumonia. This can be both due to the virus itself as well as the consequences of reduced mobility while being an inpatient. Our teams on the ward start the rehabilitation process but it can be limited due to infection prevention measures and patient fatigue.

“We have been carrying out telephone follow ups with these patients one to two weeks after discharge and completing a holistic assessment following National guidance. Within this assessment we talk about the patients experience as well as any physical or psychological limitations or problems they may be encountering.”

The team calls the patient to see how they are getting on. If they are suitable – and can use technology – then they may be invited to an Attend Anywhere video consultation session which is a new platform for the service.

Brogan MacGillivray, Specialist Physiotherapist at NCIC, said: “Video calls enable us to see the patient which is a lot better for us as we can pick up on a lot more from seeing facial expressions, posture and breathing patterns. We can assess their exercise technique and demonstrate how to perform the exercises correctly. We can also see how breathless they are while doing these exercises to individually grade them to the patient.”

Barbara said: “The patients that have participated in the video calls have enjoyed seeing us ‘face to face’”. This is so important as the last time many of the patients have seen health professionals they would have been wearing PPE including masks and visors. It makes it so much more personal.

“In terms of the video consultations, some patients are not able to access the system because they do not have support with IT so we would use a telephone consultation instead. However more patients than we had expected have been able to use the system which is great.

“The IT has been good although it took a little practice to use to its full capability. There have been a few issues with the Wi-Fi in our department but on the whole it has been good.

“The CHOC team helped us set up the Attend Anywhere service and it is working well. I think we will continue offering this service even when the Coronavirus pandemic is over as it gives more choice to patients.

“For patients in remote areas – or those that have to travel long distances – it is also an ideal way of assessing and reviewing their care.”

Patient Eddie Hadden, 74, is a big fan of the phone and video consultations.

He said: “I was in hospital for a month with COPD and pneumonia. The staff were great. I couldn’t fault anything. Everyone was brilliant.”

While in hospital, Eddie contracted Covid-19 Pneumonia. He said: “The hospital had started me on some antibiotics and this really helped in the fight against Covid. I didn’t see or speak to my wife or daughter for two weeks.”

Eddie is now back home in Carlisle and has been enjoying speaking to staff from the respiratory team each Tuesday.

He said: “I lost a lot of weight and I now do keep fit three times a week. They phone to see how I’m getting on and to check up on me. It’s an excellent way of keeping in touch when you can’t go to an appointment in person.”

Barbara said: “Eddie had two telephone consultations and his third consultation was via Attend Anywhere.

“Eddie wanted to thank the team for his care when he was discharged but he found this hard to do as everyone was dressed in PPE and he couldn’t really see their faces. We have linked him with the patient experience team and he has been able to share his thanks through a letter to the staff which the patient experience team will share. Eddie feels this was a significant step in his recovery in terms of his wellbeing and we are happy to have supported him to do this.

“The video technology has been particularly beneficial. We can assess his colour and his breathing pattern and work out best how to rehabilitate him. We have been able to assess him doing some physical exercise testing and progressing his home exercise plan to help him achieve his goals.

“A lot of our patients with pre-existing respiratory conditions are also benefiting from these sessions as they are shielding at this time. We are continuing to use telephone consultations and video calls to also review these patients. This encourages them to self-manage their condition and maintain activity while they are unable to carry out their usual exercise routines.

“We really want to highlight how developing the COVID Respiratory pathways have been a real collaboration between the community respiratory teams in the east and west acute respiratory team. The teams are working together to share knowledge and ensure both patients with pre-existing respiratory conditions as well of those with COVID and COVID Pneumonia have the rehabilitation they need.”

The Covid Pneumonia pathway if for those discharged following a COVID pneumonia.

Barbara said: “We are working with the community teams to develop other pathway streams including a respiratory pathways for COVID patients with pre-existing respiratory conditions as well as those that have just had COVID-19 alone. Its a lot of collaboration to try and ensure that patients get the rehab they need from the most appropriate service.”

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