Rehabilitation pathway for Covid and post-Covid patients

 

A hospital rehabilitation service has been implemented in the Hospital of Cittadella, ULSS 6 Euganea - Health Trust (District of Padua) to offer hospitalized Covid and post-Covid patients a tailored rehabilitation pathway in the treatment of the different phases of the disease. The SARS-CoV-2 pandemic has determined the admission of a large number of acute patients in Intensive Care Units (ICU), Semi-Intensive Care Units (S-ICU) and non-critic hospital wards. Patients recovering from COVID-19 experience a wide range of impairments requiring the implementation of multidisciplinary rehabilitation care protocols; these include the assessment for anticipated impairments (especially for patients admitted to ICU, older patients, and patients showing indications of impairment); patients who had severe-critical disease usually require a period of inpatient rehabilitation. Between October 2020 and April 2021 at Cittadella Hospital 450 patients (ICU, S-ICU, non-critic hospital wards) were enrolled in the Rehabilitation pathway and followed daily by a team made by physiatrists, physiotherapists and speech therapists. Referral options (hospitalization, community based rehab or discharge with follow up), based on the conditions of the patients, were assessed. The reduction of surgery and orthopedics patients to rehabilitate and the decrease of outpatient rehab services during Covid emergency made it possible to convert Rehabilitation ward (20 beds) to Covid Rehabilitation; according to epidemiological scenarios, patients admitted to Rehabilitation ward were initially SARS-CoV-2 positive with mild, moderate and severe symptoms, then post-Covid SARS-CoV-2 negative discharged from Covid wards. The definition of a tailored rehabilitation pathway in the treatment of the different phases of Covid disease has represented an important professional and organizational challenge for the Hospital. Rehabilitation plays a pivotal role in the management of Covid and post-Covid patients.

Key messages

Patients recovering from COVID-19 experience a wide range of impairments requiring the implementation of multidisciplinary rehabilitation care protocols. The definition of a tailored rehabilitation pathway in the treatment of the different phases of Covid disease has represented an important professional and organizational challenge for the Hospital.

Risk stratification for the safety of patients and hospital health workers during Covid-19 emergency

Covid-19 emergency has forced hospitals to face enormous organizational challenges in order to implement solutions to minimize the impact of the infection and guarantee at the same time the quality of health services provided and the safety of patients and health workers. ULSS 6 Euganea - Health Trust (District of Padua) has defined four levels of risk for Hospital Units (from the highest to the lowest risk: Red, Yellow, Green and White) based on the following parameters: type of patients hospitalized (SARS-CoV-2 positive, Covid-like, negative), type of health services provided, time of assistance and care for hospitalized patient.

This risk stratification in the Hospital of Cittadella - ULSS 6 Euganea has been applied to different contexts, such as distribution of personal protective equipment, health surveillance, frequency of cleaning and sanitation. Since February 21 (first confirmed case in Veneto Region), in the Hospital of Cittadella personal protective equipment has been delivered daily to health workers; the quantity and quality of devices provided have been carefully monitored, with particular regard to high-risk settings (Red Areas: Intensive Care Unit, Emergency Room, Covid Wards, Operating Room, Radiology, swab samples Area, Morgue).

The performance of nasopharyngeal swabs has been periodically organized for every health worker, according to the level of risk of their Unit: every 10 days for Red Areas, every 20 days for Yellow and Green Areas, every 30 days for White Areas. The frequency of cleaning and sanitation has been intensified in Red and Yellow Areas, following the guidelines released by the World Health Organization.

The definition of four levels of risk for Hospital Units is proving to be a useful and flexible tool in the management of Covid-19 emergency; further research in the next months needs to be made to assess the impact of risk stratification on the different aspects covered (ex. number of health workers infected).