Recovery from COVID-19 can be a long process that requires extensive rehabilitation for patients to regain endurance and strength. In Philadelphia, leaders at association member Einstein Healthcare Network recognized a need to provide post-acute care for COVID-19 patients, who often were turned away from rehabilitation facilities because of their positive diagnoses. So, the health system’s MossRehab facility created a dedicated unit for COVID-19 patients. The 12-bed COVID-19 rehab unit, called CORE+, opened in April and quickly filled to capacity.
“In speaking to colleagues … in Japan and in Korea and in Europe, one of the things that was quite apparent was that they were having all these patients that needed to have a place to reduce the significant pressure that acute care hospitals had, and, at the same time, allows the opportunity to provide better care,” says Alberto Esquenazi, MD, chief medical officer of MossRehab.
The CORE+ unit is geographically isolated from other units, in a separate wing with its own elevators. Patients stay in single rooms. A dedicated staff includes four attending physicians working two weeks on and two weeks off in the unit, providing some services via telehealth.
“By having separate units for these patients, we’re better able to track and educate people about how to use [personal protective equipment (PPE)], what PPE they need … how to don and doff it so they don’t become cross-contaminated, so I think those were good benefits to a specific COVID unit,” says Thomas Smith, MossRehab’s chief operating officer.
The CORE+ unit already has enabled some emotional patient reunions. After two weeks in rehab, a neurology patient who contracted COVID-19 was able to go home to his pregnant wife. The unit also reunited a husband and wife, who both had COVID-19 and who had been separated for weeks in another facility.
Esquenazi and Smith hope the rehabilitation model can serve as a framework for other hospitals worldwide. Esquenazi recently co-authored a letter to the editor of the Annals of Physical and Rehabilitative Medicine outlining the role of physician and rehabilitative medicine in the COVID-19 pandemic. This international collaboration includes considerations for admitting COVID-19 patients to physical medicine and rehabilitative (PMR) units. Recognizing that patients with severe and critical COVID-19 are potentially unstable and have low exercise tolerance, the letter discourages direct transfer to PMR from the intensive care unit and recommends admission criteria to PMR include:
- seven or more days from diagnosis of COVID-19;
- at least 72 hours without fever and fever-reducing medication;
- stable respiratory rate and arterial oxygen saturation; and
- clinical or radiological evidence of stability via computerized tomography scan or lung ultrasonography.
MossRehab leaders look to continue this framework during a predicted COVID-19 second wave, as well as the upcoming flu season.
“You really can, in a very short period of time, rethink what you’re doing and turn to a different way of addressing day-to-day operations and response — in this case, to an emergency, but really, in response to a need,” Esquenazi says.