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A. Thomas1, J. Rich1, M. Coman1
1Barts Health NHS Trust, Physiotherapy, London, United Kingdom
Background: The United Kingdom COVID-19 index case was declared on the 31st January, 2020. The ensuing pandemic peaked in April, requiring expansion of critical care capacity and redeployment of staff groups. Staff redeployment highlighted the need for rapid training responses.
Purpose: We captured the Physiotherapy service delivered to our critical care during the pandemic to determine incidence, frequency and intervention timing. This data may support future curricula, by identifying interventions which are employed early, compared to those which may be required following the peak.
Methods: This was a single center observation of the Adult Critical Care Unit (ACCU), the Royal London Hospital (RLH), United Kingdom. Data was collected from 1st April to 31st May 2020. The ACCU at RLH usually hosts 44 beds, occupied by medical, surgical and trauma patients. In response to COVID-19, critical care capacity was expanded to 90 beds for both COVID-19 positive and negative patients.
Forty-two Physiotherapists were available to provide a seven day ACCU service creating an average Physiotherapist to bed ratio of 1:5. Core services were delivered between 8am and 6pm, with overnight on-call from 6pm to 8am.
Physiotherapy interventions were delivered following therapy assessment. Interventions were classified as: Secretion management; Weaning (ventilator and tracheostomy); Rescue Therapies (proning) and Functional Rehabilitation. The Chelsea Physical Assessment (CPAx) score at critical care admission and discharge was recorded.
Forty-two Physiotherapists were available to provide a seven day ACCU service creating an average Physiotherapist to bed ratio of 1:5. Core services were delivered between 8am and 6pm, with overnight on-call from 6pm to 8am.
Physiotherapy interventions were delivered following therapy assessment. Interventions were classified as: Secretion management; Weaning (ventilator and tracheostomy); Rescue Therapies (proning) and Functional Rehabilitation. The Chelsea Physical Assessment (CPAx) score at critical care admission and discharge was recorded.
Results: 213 patients were included in the sample, 163 COVID-19 positive and 50 COVID-19 negative. 2248 interventions were delivered across the time period. The most common intervention was “physical assessment and limb care” (540 occasions).
The most frequent secretion management intervention was suctioning (430 occasions), followed by assisted cough (140 occasions), positioning (101 occasions), manual techniques (83 occasions) and ventilator hyperinflation (67 occasions).
Weaning interventions were completed on 271 occasions. There was an increase in Tracheostomy weaning over the third, fourth and fifth week, while ventilator weaning was delivered more consistently throughout the period. Rescue therapies were required on 82 occasions.
Functional rehabilitation (FR) was required on 534 occasions, representing 242 SOEOB, 169 SOOBIC and 123 mobility interventions. The mean weekly incidence of FR was 67 ± 11.8 occasions. The distribution of interventions was greatest in weeks four, five and six. The incidence of FR increased in parallel with Tracheostomy insertion.
48% of the sample (n=76) completed both an initial and discharge CPAx while in the ACCU. The mean CPAx on admission to ACCU was 9/45 points, and 25/45 points on discharge.
The most frequent secretion management intervention was suctioning (430 occasions), followed by assisted cough (140 occasions), positioning (101 occasions), manual techniques (83 occasions) and ventilator hyperinflation (67 occasions).
Weaning interventions were completed on 271 occasions. There was an increase in Tracheostomy weaning over the third, fourth and fifth week, while ventilator weaning was delivered more consistently throughout the period. Rescue therapies were required on 82 occasions.
Functional rehabilitation (FR) was required on 534 occasions, representing 242 SOEOB, 169 SOOBIC and 123 mobility interventions. The mean weekly incidence of FR was 67 ± 11.8 occasions. The distribution of interventions was greatest in weeks four, five and six. The incidence of FR increased in parallel with Tracheostomy insertion.
48% of the sample (n=76) completed both an initial and discharge CPAx while in the ACCU. The mean CPAx on admission to ACCU was 9/45 points, and 25/45 points on discharge.
Conclusion(s): During the peak of a respiratory pandemic response, the incidence and frequency of Physiotherapy intervention demonstrates a temporal pattern. Rescue and secretion management interventions were more likely to be required during the early clinical response, while weaning and FR were more likely to be required during the later response. Secondly, this data demonstrates intervention incidence when Physiotherapist to bed ratios are commensurate with national (UK) recommendations.
Implications: Training for re-deployed staff should focus on interventions required during the initial response, with subsequent training for interventions which are required at a later time point.
Funding, acknowledgements: This research received no specific grant from any funding agency in public, commercial or no/ for profit sectors.
Keywords: COVID-19, Physiotherapy, Critical Care
Topic: COVID-19
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Service evaluation by the clinical effectiveness unit at The Royal London Hospital (project 11153).
All authors, affiliations and abstracts have been published as submitted.
