BY PAMELA FAYERMAN
Since the pandemic began, well over 100 patients have survived COVID-19 after being treated in the Surrey Memorial Hospital intensive care unit.
Many of them have ongoing medical problems and will require hospital readmission within a month – 30% at three months, 40% at six months and 50% within a year if statistics on survivors of other critical illnesses apply.
Dr. Greg Haljan, head of the SMH critical care unit (CCU) is spearheading research delving into the role of virtual health care for pulmonary and other rehabilitation aimed at discharged patients. Researchers want to learn what types of interventions might reduce the number of rehospitalizations and improve the quality of life and overall health of patients who were discharged. Haljan, who is also the Regional Medical Director of Research for Fraser Health, intends to examine whether a virtual recovery program providing pulmonary rehabilitation for COVID-19 survivors reduces the rate of repeated hospitalizations, patient quality of life and health outcomes.
Patients who don’t have primary care physicians, he said, have the greatest need for follow-up care.
Haljan and his research team have received more than $300,000 to do the Virtual Health Care Rehab Clinic feasibility study.
Early in the pandemic, Haljan anticipated the need for home monitoring so he loaded up on instruments like blood pressure and heart rate monitors, weight scales and pulse oximeters for patients to use.
“I got them in February, all on Amazon before they started selling out,” he said in an interiew.
Haljan led a collaborative project with the SMH emergency department which involved following discharged patients at home. They were phoned daily and urged to return to the hospital if their health deteriorated. The feasibility study helped researchers understand more about the needs of people who’ve survived a critical illness and been on a ventilator.
“These ICU followup clinics – critical care survivors clinics – are hard to do since we are hospital doctors, not docs in the community,” he said.
Getting discharged from an ICU is tough on patients and their families. Many experience depression, anxiety and post-traumatic stress disorder as patients are left with physical and cognitive disabilities.
“There’s growing recognition of care and complications of the disease, what we call post-ICU syndrome, and that includes COVID-19 patients we’ve seen, even those who didn’t require life support. We aren’t a COVID long haul program, we are an ICU survivorship program, to be clear.”
For COVID long-haulers – those who suffer symptoms and effects of the virus for many months after they ere first infected – there is a great need for clinics where they can seek help. So far, there are clinics at Vancouver General Hospital, St. Paul’s Hospital, and soon, Surrey and Abbotsford hospitals.
Shortness of breath is often a problem with patients who’ve been on ventilators and so is muscle weakness and blood oxygen levels. Said Haljan:
“You can liken being on a ventilator to being in a cast for a broken bone. You lose muscle mass every day, and that includes breathing muscles. So standing up, turning your head, even just breathing is hard. The intubation has caused a direct injury so the voice and breathing is all part of that physical reconditioning,
“Shortness of breath causes a lot of anxiety so there’s a psychological component to this. People start to breathe fast and end up using more oxygen. They may experience joint problems, arthritis, inflammation, brain fog like what we call chemo brain in those on cancer therapy.”
Post ICU rehabilitation for COVID and all other patients has been a missing element in health care and Haljan said that needs to change.
“Like all patients who’ve had life-threatening pneumonia, we know COVID inflames blood vessels and causes injuries. Different diseases have similar issues that require long term rehab support. Most rehab has been focused on what we can measure – sit to stand exercises that measure strength, for example.
While the program is still being designed, Haljan said he thinks it will use a coaching approach because that seems to actively engage people. “They can set some personal goals and we can come up with a program that helps achieves goals, just like what is done in cardiac rehab after heart attacks.
“Pulmonary rehab, however, had s traditionally been harder to get patients to stick with. I don’t know if an exercise prescription is right, it may require layers of various approaches.”
The program is still under development but it’s expected the base will be the Jim Pattison cardiac care unit. The health professionals will be there but they will offer virtual care to patients in their homes. The $300,000 is funding the research infrastructure space, and for various health professionals – a lab, pharmacy research coordinator, and nurse.
“We are making our own virtual platform. a sort of Zoom or Facetime type. The initial engagement will be with a nurse or doctor to see how the discharged patients are doing. We can make referrals to medical specialists and then offer a functional assessment by a physiotherapist, then a coaching process that shows patients what to do, give them pointers, and track their progress. Their abilities and out capacity may dictate how many sessions are offered – maybe it’s two or three times a week or once over three months,” he said.
The Surrey Hospitals Foundation is funding COVID-19 medical research through an investment of $150,000, and a $150,000 matching grant from the Michael Smith Foundation for Health Research (MSFHR). Seed funding of $25,000 came from the TELUS Friendly Future Foundation.
“We are facing a healthcare crisis with COVID-19 and it is absolutely critical for us to invest in COVID-19 research to improve the health outcomes of patients,” said Jane Adams, President and CEO of the Surrey Hospitals Foundation. (Adams is in the photo on left).
“We are so grateful to the Michael Smith Foundation for Health Research for this timely grant and we are proud to support COVID-19 research initiatives and the establishment of this COVID clinical research team in Surrey.”
Established evidence shows that mobility and rehabilitation, after being discharged from the hospital, (can) reduce mortality and acute care utilization in patients who survive hospitalizations for critical illnesses.