Respiratory teams stepping up to the COVID-19 challenge in Essex

Wednesday, October 21, 2020

Respiratory Futures spoke to Vanessa Wakefield, Clinical Team Manager for Community Respiratory & Cardiac Services at the Essex Partnership University NHS Foundation Trust about how respiratory teams in their trusts adapted quickly to care for old and new patients during the pandemic.

Respiratory is a passion in the West Essex Community Respiratory Team and how deep it runs shone through when the pandemic hit the Essex Partnership University NHS Foundation Trust (EPUT), where we are based, and the rest of the NHS across the UK, culminating in the need to change working practices for patients now and for the future.

We were able to adapt promptly to the new challenges brought by the pandemic, and by the end of March, we stepped up to assist our GP’s and other colleagues in primary care, we took up the task of contacting over 2000 high risk patients in the area, identified through the GOLD classification, and including those on the NHS shielding list, to ensure they felt there was support for them, locally, and provided them with advice and onward referral to services such as pulmonary rehabilitation, community agents and other healthcare teams. Within six weeks we reached all patients.

To ensure we had extra support during the peak of the pandemic, we started an upskilling programme for more than 45 physiotherapists across physical and mental health, enhancing their skill sets so that they felt enabled and confident in undertaking respiratory assessments with their patients, even if it wasn’t their main area of work.

During this period, the team made more than 100 referrals to pulmonary rehabilitation, and issued more than 250 MyCOPD licences (an app that helps patients managing their COPD symptoms) that were both used to support the physical and mental wellbeing of our patients.

We quickly embraced new technologies, not only for staff meetings but also for the upskilling and training sessions we held, and for remote patient assessments, for which we used MS Teams and AccuRX. This enabled us to be interactive with our colleagues as well as with our patients, giving staff a suitable platform to seek further support or advice from other professionals and support workers. This benefitted us as much as our patients, as it enabled us to monitor one another’s mental health during times of lone working and isolation. As a team we felt that it definitely brought the working colleagues at EPUT closer.

From face-to-face to virtual

Due to social distancing and self-isolation within our patient groups, our Pulmonary Rehabilitation (PR) service needed to adapt too. This was achieved throughout the pandemic as we were quickly able to set-up and offer an exercise programme to all patients that could now be used at home. Patients were assessed using online platforms or over the telephone, and were provided a menu-based system of exercise and education using “Space for COPD”, an online interactive platform providing exercise and education, a paper based booklet that provided structured interval training and education for use at home, and the MyCOPD application. The latter provided visual interactive information for patients on how to exercise, adjust their inhaler techniques and again understand more about their condition.

Patients that were deemed high risk based on co-morbidities and MRC score, were offer a seated exercise programme or referred onward to a more appropriate option. They were monitored throughout their exercise programmes and given contact details to approach their clinicians for any ongoing support and advice during their rehabilitation.

Chest Physiotherapy clinics also continued via telephone or video consultations providing the necessary breathing and sputum clearance techniques that would be able to help those requiring further guidance and support with their breathlessness.

We collected feedback on our initiatives with a ”friends and family “questionnaire, and received so much positive comments from our patients, who have welcomed the chance to exercise while being restricted to home during shielding.

The Community Respiratory team was also prompt to adapt to the needs of the wider EPUT staff, by providing-trust wide FIT Mask testing, rising to the call from Mid to West Essex, helping to ensure that all staff members were safely kitted-up to attend any patients in the community that were suspected to be at risk from COVID 19.

Looking at the future

We have now begun to develop services further, by piloting an education session for patients that are newly diagnosed with COPD or awaiting a definitive diagnosis. This seeks to provide the patients with a link to the Community Respiratory Team and provide valuable information that will help them understand and manage their condition in the future. Running alongside this will be a Virtual Pulmonary Rehabilitation service using MS Teams to engage patients into exercise and education based rehabilitation that will be on offer to patients with respiratory conditions and patients recovering from COVID-19.

Overall we are proud to say that we feel we definitely rose to the challenge and will continue to use the newest technologies and best practice to be able to reach out to all those that need our services now and in the future.