Challenges and Lessons Learned for Acute Inpatient Rehabilitation of Persons With COVID-19

Abstract

Objective The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post–COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. Design For this clinical descriptive retrospective study, data were extracted from post–COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1–June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. Results The COVID-19 patients ( N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. Conclusions The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

Pressure injury prevalence and characteristics in patients with COVID-19 admitted to acute inpatient rehabilitation unit

“…This included changes to infection control policies, space allocation for therapy and staffing modifications ( 32 ). Patients in AIR were admitted for a wide range of physical and cognitive disabilities following COVID-19 infection, such as stroke, debility from respiratory failure, vascular complications such as amputation and peripheral neuropathy ( 2 ). In this study, patients admitted to AIR with pressure injury had a statistically significant longer length of stay in both the ICU (34 vs. 15 days, P < 0.0005) and in acute rehabilitation (22 vs. 17 days, P < 0.05) when compared to the group without pressure injury.…”

“…Patients who experience critical illness have a wide range of disabilities requiring intensive rehabilitation. COVID-19 patients incurred prolonged acute hospitalizations and ICU treatments with subsequent disability necessitating intensive inpatient rehabilitation ( 2 ). Between March 2020 and April 2020, out of the 5,700 patients admitted to a NY-based hospital system, 14% were admitted to the intensive care unit (ICU) ( 3 ).…”

Neurorecovery after Critical COVID-19 Illness

“…103 Rehabilitation hospitals and systems experienced substantial strain during the heights of the COVID-19 pandemic. 104 Given the multiorgan dysfunction often seen in COVID-19, the multidisciplinary rehabilitation team is critical for framing the ongoing impairments of recovering COVID-19 patients within the biopsychosocial rehabilitation model. The individualized rehabilitation formulation plan should not only target recovery of respiratory and cardiovascular conditioning but also mobility, functioning, and cognition.…”

Two years of COVID-19: Trends in rehabilitation

“…The surge in cases around the globe has stimulated easing administrative procedures to transfer hospitalised COVID-19 patients from acute COVID-19 hospitals to inpatient rehabilitation facilities producing positive effects on availability of beds. 12 In addition, rehabilitation has played a crucial role in facilitating patients’ activity and mobility, a timely discharge, and the possibility of being discharged home or to “Covid hotels” from acute hospitals. 13 Several studies of acute inpatient rehabilitation conducted during the first pandemic wave, have demonstrated that an early rehabilitative approach was effective at improving outcomes and facilitating discharge to home.…”