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Executive Summary of "Rehabilitation in the wake of Covid-19: A phoenix from the ashes"

Posted 23rd July 2020

This is an executive summary of the key points of Rehabilitation in the wake of Covid-19: A phoenix from the ashes. This document was published by the British Society of Rehabilitation Medicine (BSRM) on 27 April 2020 (Issue 1) and prepared on behalf of behalf of BSRM by:

  • Dr Margaret Phillips
  • Prof Lynne Turner-Stokes
  • Prof Derick Wade
  • Dr Krystyna Walton

The focus of the document is on adults aged 16 years and over.

Some of the secondary effects of the Covid-19 pandemic include:

  • Inability to deliver normal rehabilitation services
  • Separation of families
  • Choice
  • Difficult decision making 
  • Socio-economic effects
  • Education
  • Relationships
  • Emotional wellbeing

Covid-19 has already led to a marked increase in the burden of disease and disability and will continue to do so.

It has produced many new challenges.

As NHS services “reboot “ in the wake of the pandemic there is an important opportunity to work collaboratively to rebuild services on a better, more cooperative model – a phoenix from the ashes.

The BSRM document sets out the recommendations for rehabilitation services for adults 16 years and over, in particular the role of specialist rehabilitation to support patients with more complex rehabilitation needs.

 

Key Elements:

 

Recovery Pathways

Rehabilitation should start early.

On the step down from intensive care, rapid access to acute rehabilitation programmes can triage into post acute pathway in the network.

The majority of patients are on a fast recovery track and their needs may be met by level 3 rehabilitation services, but these need expansion.

A small number of patients will require level 1 or 2 service for longer periods.

Hyperacute specialist units provide rehabilitation to patients who continue to be medically unstable.

There are currently 75 specialist rehabilitation units catering for 2500 admissions per year.

 

Infection Control

Some post Covid-19 patients will still be shedding virus as they enter rehabilitation, especially in the early stages, so both Covid-positive and Covid-negative services are required. Face-to-face rehabilitation should ensure that all staff have access to PPE to manage this safely.

 

Rehabilitation Assessment & Prescription

The rehabilitation prescription is used to record the rehabilitation needs and make recommendations for how these should be met as patients leave the acute wards. Consultants in Rehabilitation Medicine have particular skills in the diagnosis and management and prognostication of complex disability.

 

Community Reintegration & Rehabilitation

In specialist rehabilitation services, patients with complex rehabilitation needs have access to a range of specialist skills, facilities and equipment. Rehabilitation is delivered by a coordinated MDT, led by a Consultant in Rehabilitation Medicine.

 

Integrated Care Planning for those with Long Term Needs

With the above in place, the majority of patients will make a good recovery. For the patients that continue to present with symptoms, multiagency care is essential. This includes joined-up health and social care in the community, working in association with input from the third sector independent and charitable organisations, as appropriate. Patients with lifelong complex disability may require specialist nursing home care with input from specialist outreach rehabilitation teams for the rest of their lives. Best interest decision-making may be required to determine their likely wishes for continued life sustaining treatment and, where appropriate, neuro-palliative and end-of-life care.

 

Service Provision Proposal:

  1. Close networking links between Level 1, 2 and 3 services

  2. Covid-positive and Covid-negative streams for rehab delivery

  3. Close integration of hospital and community services with collaborative commissioning arrangements

  4. MDT rehabilitation teams

  5. Facilities that include specialist equipment

  6. Coorindated planning of health and social services provision in collaboration with 3rd sector services where appropriat

Within each network there should be an identified Consultant in Rehabilitation Medicine who should be an integral part of the acute care pathway team.

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