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ECH steps up to provide COVID rehab care
When it comes to the hospitalization of patients with COVID-19, we hear a lot about intensive care units, but not so much about what happens after the ICU – and that’s a significant part of their recovery. Coming back from COVID is a long road, and patients need a tremendous amount of care and support after they are discharged from intensive care.
For the staff at Elizabethtown Community Hospital, a small, critical access hospital that does not have an ICU, the need for this intense rehabilitation offered a way to “play their part” in helping the North Country respond to this pandemic.
Earlier this year, staff from various departments came together to plan and create an appropriate and safe space for treating post-acute patients with COVID-19. Five private rooms with UV air filtration and a dedicated rehab space were set aside for patients from intensive care units at UVM Health Network affiliates and other nearby hospitals.
While they weighed the pros and cons of committing both space and nursing staff to a COVID-19 rehab unit, the group ultimately decided on a dedicated recovery team, keeping in mind the importance of continuity of care. ECH Nurse Manager Victoria Savage says her team sees it almost as an elite placement and have shared, “that they feel really privileged to be a part of the COVID care team.”
Dedicating staff to the unit not only provides for continuity of care but also helps ensure consistency in the routine of donning and doffing personal protective equipment – a critical measure to protect the patients, the staff, and the staff members’ families, whom they go home to after every shift.
“We are continuously checking each other for proper use of all of the PPE, such as eye protection, when caring for patients with COVID-19,” said Savage. But after their experience caring for patients during COVID’s first wave, back in March, Savage said her nurses now have more confidence in the infection prevention measures in place. “We know what we have to do to keep patients and staff safe and that these measures will protect us and our loved ones when we go home from our shift,” said Savage.
Environmental Services’ critical role
With all of the intense cleaning and sanitizing processes necessary to prevent against any potential spread of infection, the environmental services team played a critical role in setting up the COVID recovery unit. “We worked closely with the nursing unit to brainstorm and problem-solve,” said Melissa Stoddard, environmental services team leader. Readying supplies for the unit -- such as face shields for cleaning staff and antibacterial wipes for the thrice-daily cleanings of all high-touch surfaces -- helped ensure the team was prepared for the stepped-up cleaning protocols.
As far as being comfortable on the front lines, Stoddard said that took some getting used to. “When COVID first started, I was very nervous. I was constantly asking myself, ‘Am I safe enough in this room? Do I have enough PPE on?’” But, like Victoria Savage, Stoddard said her experience over the last several months has made her much more comfortable. “Now it’s a matter of gearing up, having confidence in the PPE, and understanding that these patients are not any different than other patients.”
Helping patients cope with isolation
When asked about COVID patients’ biggest challenges, isolation was mentioned first by all of the ECH team members. During patients’ isolation period, Nurse Manager Savage stressed the importance of facilitating window visits and Zoom visits with family members, and safe interaction with the hospital staff. “It is so important to have individuals that are really ‘present’ while caring for these patients, as they are lonely and isolated from the normal day-to-day operations of a nursing unit.” They don’t see the normal hustle and bustle that is usually witnessed by patients, she explained, the importance of which can be easily underestimated until it’s not there.
Melissa Stoddard said that was a consideration from the environmental services team’s perspective as well. “Our presence with the additional cleaning gives these patients another opportunity to interact with people,” she said. “They are isolated, and I feel badly for them.”
Physical and occupational therapy, COVID-style
ECH is recognized as a center of excellence within the UVM Health Network in terms of post-acute or rehab care. But even for a team that is highly seasoned in setting up an optimal rehab space, configuring the new unit for the particular needs of COVID patients took some outside-the-box thinking.
While the team did set up a dedicated exercise space for these patients, they also found it useful to “bring the rehab to the patient” in many cases. First of all, this shift allows COVID patients to begin their rehab sooner, even before they leave isolation. “We developed bedside exercises, with portable bikes and portable pulse oximeters,” explained occupational therapist Angie Baker, “and we use plastic gait belts that can be wiped down afterwards, and thera-bands that can be disposed of.”
Even after patients are cleared to leave isolation, many are still too weak to make the trip to the rehab space, so physical and occupational therapy continue to happen bedside for a while. “Their tolerance for activity, even things like bathing, dressing and toileting, is well below baseline function,” according to Baker. “They often say they want to tackle a task and are full of energy to do so, but they fatigue before the task is complete,” which results in a level of frustration beyond what she typically sees in other patients.
That, coupled with the emotional effects of isolation, takes a real emotional toll. Mike Theeman, DPT, shared that, “many patients are surprised how rapidly they fatigue, and they can require a fair amount of guidance and reassurance initially.” Baker added that one of her biggest challenges is motivating the patient to participate when they are worn out, coughing and not feeling well. But, she added, “It is so rewarding to see them improve functions back to baseline.”
According to Dr. Theeman, “Many of the patients tell us they have been isolated for so long and really look forward to working with staff here. They are so thankful for the opportunity to recover and return home.”