Helen O’Brien, Michael J. Tracey, Ciara Ottewill, Michael E. O’Brien, Ross K. Morgan, Richard W. Costello, Cedric Gunaratnam, Daniel Ryan, Noel G. McElvaney, Samuel J. McConkey, Cora McNally, Gerard F. Curley, Siobhan MacHale, Diane Gillan, Niall Pender, Helen Barry, Eoghan de Barra, Fiona M. Kiernan, Imran Sulaiman & Killian Hurley
Irish Journal of Medical Science
Findings in a nutshell
This article demonstrates the implementation of an integrated multidisciplinary assessment and treatment system that was established to provide a COVID-19 recovery service in Ireland. Evidence suggests that long-term and persistent impairments such as respiratory and functional limitations are likely health characteristics of COVID-19 survivors. In addition, intensive care unit (ICU) admission is associated with long term physical and psychological dysfunction, with particularly high rates of mental health complications. The model was developed to cater for the surge of COVID-19 presentations while delivering high quality care, reducing duplication of services and reducing wait times for patients after COVID-19 diagnosis.
To achieve this, a hybrid model, consisting of virtual and in-person clinics was supported by a multidisciplinary team of respiratory, intensive care medicine, infectious diseases, psychiatry and psychology services. In congruence with British Thoracic Society Guidelines on post COVID-19 care, the aim of the service was to create a safe, effective and multidisciplinary approach for patient follow-up after diagnosis of COVID-19. By offering virtual assessments, the model optimised the usage of outpatient services, reduced use of emergency services and minimised the impact on hospital outpatient departments.
The study includes 174 patients that were discharged from Beaumont Hospital between 15 March 2020 and 30 June 2020 after treatment for COVID-19. All patients had follow-up from a virtual clinic that included medical tests and assessment of symptoms, mental health status and quality of life. The aim of the virtual clinic was to determine a patient’s residual symptoms after COVID-19.
Patients were then reviewed by health professionals in a multidisciplinary meeting (MDM). Patients that had been admitted to ICU or received non-invasive ventilation (NIV) were referred to in an in-person clinic (12 weeks post-discharge) with those with greater needs also being referred to a COVID Survivorship Clinic for 12 months. Those patients that did not receive ICU or NIV treatment were referred directly to the virtual follow-up pathway and discharged into integrated community care consisting of GP, psychology and physiotherapy services.
At the time of publication, 50 patients had been reviewed at the MDM; 26 discharged into integrated community care and 24 requiring follow-up in person at the COVID recovery clinic. While it is too early to draw conclusions on the benefits of this timely and comprehensive approach, research supports the improved outcomes of inter-disciplinary teams and the association with longitudinal improvements from ICU patients post-discharge.
Implications in workplaces
Health professionals should consider multidisciplinary and novel methods to ensure health systems can provide timely, tailored and comprehensive post-COVID care. Employers can provide recovery support by understanding that COVID-19 residual symptoms; physiological and psychological can impair patients post-discharge and often for the longer term. Flexibility in workplaces can encourage recovery of a productive and sustainable workforce.
To find out more about An integrated multidisciplinary model of COVID-19 recovery care read the full article here.
Date published: August 2020
The authors are multidisciplinary and are from the Department of Respiratory Medicine, Beaumont Hospital, Ireland; Department of Infectious Disease, Beaumont Hospital, Ireland; Department of Medicine, Royal College of Surgeons in Ireland; Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland; Department of Anaesthesia and Critical Care, Beaumont Hospital, Ireland; Department of Liaison, Beaumont Hospital, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland; and Department of Psychology, Beaumont Hospital, Ireland.