Authors (including presenting author) :
Lau WLC(1), Chan YL(1), Kwan KK(1), Tsui TS(1), Ko WN(1), Lam WT(1)
Affiliation :
Occupational Therapy Department, Kowloon Hospital
Introduction :
During the 5th wave of COVID-19 pandemic, local in-patient COVID-19 service framework and post discharge case management approach by occupational therapist (OT) were adopted to enhance our services quality according to the needs of COVID-19 patients.
Objectives :
1. Review the outcomes of COVID-19 rehab service framework provided by OT during in-patient phase. 2. Explore the impact of long COVID symptoms on the discharged COVID-19 patients and future service direction according to their needs in community phase. 3. Evaluate the effectiveness of case management approach by OT under integrated care and discharge support(ICDS).
Methodology :
A total of 1054 COVID-19 patients were referred to OT in-patient service from March to April 2022 in Kowloon Hospital. 824 subjects were finally recruited for data analysis. Their demographic characteristics, discharge destination, OT interventions, functional outcomes, mortality & readmission rate were retrieved by Clinical Data Analysis & Reporting System (CDARS). Total 22 patients recovered from COVID-19 under OT case management in ICDS from March to May 2022 were recruited for review after discharged from hospital. The impact of long COVID symptoms, functional outcomes and readmission rate were assessed.
Result & Outcome :
OT service coverage for COVID-19 in-patient was over 80%. 33% were old aged home (OAH) cases, 67% were home cases. Their top 3 comorbidities were respiratory disease (32%), cardiac disease (12%) and neurological disease (12%). 23% of them were transferred back to acute hospital or isolation facilities. The mortality rate of OAH cases were 3.5 times higher than home cases. The top 3 OT interventions for COVID-19 in-patients were activities of daily living (ADL), cognitive functions and discharge planning. Their Modified Barthel Index (MBI) and Montreal Cognitive Assessment Hong Kong version (HK-MoCA) indicated improvements upon discharge. However, their overall readmission rate of the first 28 days after discharge was 23% and the major readmission reason was respiratory problems (47%). Therefore, post discharge support service was urged. 22 recovered COVID-19 patients were recruited to follow up by OT under ICDS after hospital discharge. Their most common long COVID symptoms were fatigue (52%), dyspnea (33%), decline in cognition (33%) and mood disturbance (29%). Around 50% of them have negative impact on their functional domains (ADL, leisure, mood, life role and cognition) due to the long COVID symptoms. Individualized case management approach was adopted according to their needs of functional domains. Finally, their MBI and functional independence measures (FIM) showed significant improvement and no readmission in the first 28 days after discharge from ICDS. In conclusion, a structured OT service framework and case management approach to facilitate timely & safe discharge as well as decrease the avoidable hospital readmission were suggested.
