How did your service operate before COVID-19?
Prior to the COVID-19 pandemic, the East Cornwall integrated respiratory team delivered pulmonary rehabilitation in four village halls and one small community hospital site with minimal exercise equipment.
The team consists of physiotherapists, respiratory nurses, an occupational therapist and a speech and language therapist.
How did the pandemic affect your service?All patients on our waiting lists were contacted at the start of the first lock down and it very quickly became evident that most of them either could not or did not want to engage with anything digitally and they were also very honest at admitting that home programmes might not be adhered to!
When did you re-start your face to face contact with patients?Since August 2020. We have been running face to face programmes at the Royal Cornwall Show Ground and we have recently started using the largest of our village halls.
Restarting face to face PR is no small task. What advice would you give to other teams working to re-start services?There have certainly been some challenges and we have put together some top tips that may hopefully help other teams as they restart their face-to-face services.
People
Involve the right people at the very beginning. Our team has a great working relationship with the Infection Prevention and Control governance team (IPCT) and the legal team now. This was key to getting the robust risk assessment and standard operating procedures (SOPs) signed off by the trust.
Locations
Use local knowledge to negotiate larger venues. We managed to secure the use of cattle sheds and the use of the whole of the outside space of show ground for £15/hr plus VAT.
Other considerations for working with new venues include:
- Obtain copies of the venue’s own risk assessments and their public liability insurance.
- Share copies of your own risk assessments.
- Negotiate wipeable chairs.
- Plan for post group cleaning of venue, including toilets.
- Check mobile phone coverage in more rural locations.
Pre-appointment screening
This was all completed over the telephone or via Attend Anywhere. Some patients did prefer paper copies of the questionnaires, so these were sent out in the post prior to the assessment day. one-two days before each assessment/rehab session the patients were contacted for COVID-19 screening.
Assessment/reassessment days
Staggered times and patients wait in their cars until their time slot. Due to the size of the venue, we are now able to meet the 6MWT standard of a 30m circuit. The acoustics of the cattle sheds are not great, so we chose not to use the incremental shuttle walk test (ISWT) as patients were struggling to hear the beeps.
The programme
Our programme is six weeks long, consisting of six face to face sessions and six telephone sessions.
The programme was changed from circuits to 20-30 mins cardiovascular work inside or outside and then strength work, sets and reps with theraband (individual piece and options to increase resistance).
Patients were “bubbled” into socially distanced groups of four maximum plus a member of staff and worked with this group for the whole six weeks. Education was delivered in paper format with socially distanced question and answer session the following week and a final week “pub quiz” to establish increased knowledge.
Regularly review the government guidelines
The government guidelines, especially when using the tier system, were sometimes difficult to navigate. We also had issues with the county line- some patients lived in Devon but had a Cornwall GP. The guidelines were regularly reviewed with the members of the Respiratory Oversight Group- this group includes primary care, secondary care, community care, commissioning and volunteer Cornwall.
Have you been able to evaluate the project and find out how patients have found being back in person?
The feedback from our patients has been overwhelmingly positive. We were worried about using larger venues with outdoor space because of the poor weather Cornwall can throw at you, but they felt the experience was more like real life, with uneven surfaces, slopes, hills, wind, drizzle and cold air (if it was raining hard, we used the cattle sheds). We were also concerned that only our patients on grade 2 of the Modified Medical Research Council Dyspnoea Scale (mMRC 2) would attend but this was not the case.
Our drop out rate has reduced drastically – only 5 people so far and some of them were having to undertake a 100 mile round trip to attend. Our patients have really loved the blended approach, face to face with a telephone session and felt they were able to commit to this more easily. They also report they are more engaged to join local exercise groups as they are not afraid of exercising outside anymore.
Do you plan to keep this model of working?We are planning to continue this format for the future, investing in headsets and speakers as we all had rather hoarse voices after each session! We are also looking in to a video linked hub and spoke model so we can start using some of our smaller venues again, and this will enable us to deliver care closer to home for our patients.