A COVID Rehab Unit For All

When it comes to hospitalization of patients with COVID-19, much is heard about time in intensive care, but less about what happens after the ICU. In fact, coming back from COVID-19 can take weeks or months, and patients often need a tremendous amount of care and support along the way.

For the staff at UVM Health Network – Elizabethtown Community Hospital, a small, critical access hospital in the North Country that does not have an ICU, the need for this intense rehabilitation offered a way to “play their part” in helping the region’s hospitals respond to this pandemic.

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 affiliate hospitals in New York and Vermont as well as other nearby hospitals.

Dedicated Nurses

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. Elizabethtown Community Hospital 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 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.

Housekeeping’s Critical Role

With all of the intense cleaning and sanitizing processes necessary to prevent against any potential spread of infection, the housekeeping team helped design the COVID recovery unit. “We worked closely with the nursing unit to brainstorm and problem-solve,” says Environmental Services Leader Melissa Stoddard. Readying supplies for the unit -- such as face shields for cleaning staff and antibacterial wipes for 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 says 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 Savage, Stoddard says her experience this past year 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 Elizabethtown Community Hospital team members. During patients’ isolation period, Savage stresses 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.” The normal hustle and bustle on a floor of a hospital can be easily underestimated until it’s not there, says Savage.

“[Patients] are isolated, and I feel badly for them,” says Stoddard. “Our presence with the additional cleaning gives these patients another opportunity to interact with people,” she says.

Getting Up After Getting Knocked Down By COVID

A center of excellence within the UVM Health Network in terms of post-acute or rehab care, the highly seasoned Elizabethtown Community Hospital team still needed some outside-the-box thinking to configure the new unit to suit the particular needs of COVID patients.

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. “We developed bedside exercises, with portable bikes and portable pulse oximeters,” explains Physical 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, can take an emotional toll. “Many patients require a fair amount of guidance and reassurance initially,” says Mike Theeman, DPT, a physical therapist at Elizabethtown Community Hospital. It is challenging to motivate patients to participate when they are worn out, coughing and not feeling well. But still, “Many of the patients tell us they have been isolated for so long and really look forward to working with staff here,” says Dr. Theeman. “They are so thankful for the opportunity to recover and return home.”