The Impact of Covid-19 on a Disability Service – Part Two

Our first Blog described our experience of navigating the early stages of the pandemic and the critical work streams that needed to be established to enable us to begin responding to the challenges of COVID-19.

Now, as we move from the initial response into the phase of longer-term accommodation and slow easing of restrictions, our focus is moving to recovery and planning for the safe and gradual re-opening of day, school and clinical services and of residential houses for visitors.

We are also conscious of the need to remain vigilant and flexible, should there be a resurgence of Covid-19 during the reopening phases, which would require expedient and appropriate adjustment of our service response.

Work is underway to recommence essential face-to-face clinical supports, in line with public health guidance. Clinics, assessments and reviews are being arranged for those who most urgently need these.

It is clear that a multi-faceted approach to clinical services delivery will be required for the foreseeable future, in order for safe and effective clinical supports to be delivered to the children and adults who use our services.

That approach will need to incorporate a mixture of phone contact, video calls, face-to-face interventions and online training modules and other remote approaches.

Alongside the resumption of clinical services, the day support services that have been stalled are now also in a process of phased reintroduction. Outdoor and remote supports are expanding throughout the summer and planning is underway for a gradual increase in face-to-face and in-building day support hours as we move into the autumn.    

The realities of the longer-term effects of and learning from the pandemic mean that some of the ways we have ‘always done things’ will need to change. Some of the lessons we have learnt during this time and the new ways we have begun to work will be worth holding onto and developing into the future.

In other cases, we will need to find a way back to providing the much-needed supports that are currently on hold for the people we serve and their families. There will be a requirement for ongoing review, audit, research and learning.

New children are being born every week who will need our services and others are growing up, ready to make the transition from school to adult life.  

Now, more than ever, quality services are needed that promote the well-being of people with disabilities and support them to live fulfilling lives.

At St. Michael’s House, we remain committed to that work.

This Blog was written by Eilín de Paor, Clinical Manager for Adult Services & Caroline Howorth, Speech and Language Therapy Manager, St. Michael’s House, Dublin

E-mail: eilin.depaor@smh.ie & caroline.howorth@smh.ie

Twitter: @de_eilin & @HoworthCaroline

The Impact of Covid-19 on a Disability Service – Part One

The past four months have seen inordinate change for the people with disabilities and families who use the services of St. Michael’s House. Widespread closure of schools, adult day and training services and respite have placed huge pressures on individuals and families.

Clinical supports have been altered or ceased. Routines have been disturbed, much needed programmes suspended and contacts with familiar staff and peers restricted and in many cases, stopped altogether.

For the children and adults with intellectual disabilities who we work with, the reasons for these changes are not always understood. This has led to confusing and perplexing times for many.

For those living in our residential houses, the lack of contact with family and friends has brought particular sadness and challenges. For some, it hasn’t been easy to spend so much extra time with housemates when they usually all have other outlets outside the home.

Others are enjoying the extra time in their homes and as providers of day services, this gives us cause to pause and reflect on what these individuals are telling us and whether day service models may need to change into the future.

For the Organisation, keeping our core residential services running has involved reorganising our services and locations, managing the challenges of physical distancing restrictions in our small disperse facilities and being flexible and responsive to the changing needs of those we support, as well as to the impact of Covid-19 on our staff teams.

Staff and management have worked hard to be flexible and have tried to respond to the needs of those we support and their families. However, there have been limitations in terms of what we have been able to achieve and certainly in the level of contact and supports we have been able to maintain for those who normally use our schools and day services.

Many staff have taken on new roles and we have been called on to develop new procedures and services within tight timescales. Some of our main focuses have been:

  • Supporting our frontline staff in their crucial 24/7 work in our residential houses, keeping them and the people who use our services safe and well
  • Facilitating people to understand and ask questions about the changes in their lives – by preparing easy read information, social stories and other communication supports
  • Preparing guidance for staff regarding ethical decision-making during the pandemic. People with disabilities are being asked to have swabs, to self-isolate, to cocoon and accept other restrictions on their daily lives. All of these require our staff to carefully reflect on what we are asking people to do, what their will and preferences are and what other options may be available to them and us
  • Maintaining contact with individuals and families who are at home without day services and schools, through a system of key contacts
  • Ensuring teamwork continues and is enhanced across clinical services, frontline services and management
  • Piloting the provision of single discipline and team-based clinical supports in new ways whilst preserving physical distance e.g. telepractice, online training portals, virtual team meetings and even garden/window visits
  • Supporting staff to take on new roles with appropriate training and induction –  swabbing team, clinicians’ residential relief panel, day to residential frontline staff re-deployment, Covid-19 treatment and rehabilitation roles etc.
  • Upgrading our ICT systems to enable safe and effective remote-working
  • Procuring and managing a stock of appropriate PPE to enable our staff to work safely with the people we support
  • Establishment of an appropriate environment, systems and contingency plans for isolation, treatment and rehabilitation of those we support who contract Covid-19
  • Developing an in-house Covid-19 testing service for those in our residential houses
  • Working with HSE to ensure all our frontline staff are tested and with occupational health regarding contact tracing and managing self-isolation and cocooning requirements for those staff who need to.

This Blog was written by Eilín de Paor, Clinical Manager for Adult Services & Caroline Howorth, Speech and Language Therapy Manager, St. Michael’s House, Dublin

E-mail: eilin.depaor@smh.ie & caroline.howorth@smh.ie

Jack Charlton’s Amazing Act of Kindness

Sitting on board an Aer Lingus flight in January 1996, I noticed Jack Charlton across the aisle from me.

This was a significant flight for Jack, his final, emotional farewell voyage following his retirement as Manager of the Ireland team after nine great years in charge and three unforgettable major tournaments. I resisted the temptation to join the queue for his autograph but was delighted to have a brief encounter when he commented that he liked my hat!

I wasn’t to know then that four years later, I would be privileged to be involved in an amazing and moving act of kindness by Jack towards a patient of mine.

As a young Occupational Therapist working in a Yorkshire hospital, I was treating a man named Frank* who had suffered a brain stem stroke and had an incredibly rare condition called Locked-in Syndrome.

People with locked-in syndrome are conscious and can think and reason but are unable to speak or move. Frank was left with complete paralysis of nearly all voluntary muscles, with the exception of vertical eye movements and blinking. It was necessary to establish whether this eye movement could be used to enable Frank to communicate.

After some experimentation, a light-touch switch was positioned above Frank’s left eyebrow and when this switch was activated by his vertical eye movement, a sound was heard.

To try to create words, the speech therapist and I moved a finger along each letter on an alphabet board and to select his required letter, Frank used his eye movement.

Communication was painstakingly slow and exhausting for him but on one unforgettable day, a very determined Frank succeeded, for the first time, in creating words. He spelled out ILOVEYOU to his wife. It was an incredible and emotional breakthrough.

In the months that followed, Frank experienced many setbacks. He had ongoing medical complications, and during these periods, was unable to engage in therapy.

Over these many months, I got to know Frank so much better … his love of the great Leeds United, Jack Charlton, Ireland and especially fishing in Ireland. And being an Irish lass, he and I formed a great connection.

In that time, I wondered how we could motivate Frank in his efforts to communicate. I thought about Jack Charlton, a Geordie treasure and Frank’s hero, and what it might be like for Frank to communicate with Jack.

I googled Jack Charlton but of course I didn’t find a contact number. I called on my mother in Dublin who somehow managed to contact a senior figure in the Football Association of Ireland who, in the circumstances, was kindly willing to provide Jack’s number on the condition of confidentiality.

Somewhat petrified about the reaction I might get, I called the number. But I needn’t have worried. Jack listened to my unusual request for a visit and without hesitation, agreed to visit Frank on one condition: No press could be involved. I gave him my word and a date was set.

On the morning of Jack’s visit, the hospital was abuzz with excitement and tension, a local idol was on the way. I met Jack, a towering man at the hospital entrance. I must admit I felt more than a little intimidated looking up at him but his warmth and presence soon left me feeling at home with him. It took some time to get through the hospital as people stopped Jack for a word …

I remember bringing him into a quiet room to prepare him for the meeting with Frank. I described how Frank would be sitting in a specialised seating system, with a tracheostomy tube, and that communication would be slow and difficult using an eye switch and an alphabet board system.

But Jack needed no preparation. He told me, in his straight-talking Geordie way, that he was used to visiting patients with motor neurone disease and that there would be no problem.

When we walked into the quiet room on Ward 2, Jack, straight away, lowered his head to ensure his eyes met Frank’s. He then settled into the chair next to Frank where he sat for the following two hours. We facilitated Frank’s communication and together, they covered great ground – soccer, Yorkshire, Ireland, fishing, family.

Jack was inspirational in how he motivated Frank to keep going. And the emotion in Frank’s eyes showed how much the visit meant to him.

My overriding memory of that day was Jack’s generosity of spirit, his genuine interest in Frank, his wife and their lives. As they said their goodbyes, Jack promised to send his autobiography which his wife could read to Frank.

What a true privilege it was to witness Jack’s extraordinary gesture of kindness and to see the love, joy and hope it brought to Frank’s life – one good day, at a time when the good days were few.

You’ll always be remembered Jack. Rest in peace.

*Frank’s name has been changed for confidentiality.

This Blog was written by Alison Enright, Health and Social Care Professions Development Manager, National HSCP Office.

Transitioning to a Virtual Campus

The Experience of the RCSI School of Physiotherapy during the COVID-19 Pandemic

In this blog, we want to share our experience of dealing with COVID-19 in the teaching, learning and assessment of our physiotherapy students.

As a University of Medicine and Health Sciences, RCSI is well known for its international footprint. This, alongside our world-leading expertise in infectious diseases, were significant contributing factors in our rapid response to the unfolding COVID-19 pandemic.

In early February, our infectious disease experts and senior management in RCSI Dublin flagged the potential impact of COVID-19 – as our Bahrain Campus had experienced the effects of COVID-19 some weeks before it became a reality in Ireland.

A Business Continuity Team was established in RCSI Dublin to identify requirements for the college to move to a ‘virtual campus’ as soon as practically possible. IT solutions were put in place at pace, including Blackboard Collaborate for delivering ‘live’ interactive student lectures and tutorials, Speedwell for online assessment, Microsoft (MS) Teams for staff and student meetings, and Office 365 to allow remote access to files for all staff. The IT department provided intensive training for all staff on use of these systems.

As a School, we held numerous meetings to plan and implement RCSI’s strategy of moving to a virtual campus. Our focus was on virtual academic teaching, preparing contingency plans if clinical placements were cancelled, and ensuring clear, consistent student engagement and ongoing personal tutor support.

On Thursday, 12th March, when the government announced that universities were closing from that day, we were well placed to switch to our virtual campus. Students on clinical placement had to discontinue their placements, although placements were already being affected as COVID cases appeared in various hospitals. The remaining practical/clinical skills teaching could no longer be delivered and we had to ramp up our contingency plans for alternative methods of assessment.

Those first couple of weeks felt long and mentally draining as we all moved out of our comfort zone in using Blackboard Collaborate for teaching, coupled with back-to-back remote staff and student meetings.

The students really engaged with the ‘live’ lectures and attendance was excellent across all years. The ‘breakout group’ feature of Collaborate provides an opportunity for student interaction in small groups, whilst the educator moves between the groups to facilitate discussion.

Over the next few weeks, we became more proficient and innovative with this technology. This sketch note summarises well our experience of transitioning to remote learning – thanks to Dr. Ailish Malone who put it together.

With clinical placements no longer possible, students participated in a programme of placement-related activities overseen by the Practice Education Co-ordination team. These included on-line Covid-19 modules and case studies, which focused on placement learning outcomes.

With practical and clinical skills assessment no longer feasible for our end-of-semester assessments, we planned for remote assessment for all years.

We also wanted to expedite our final years’ exams to allow students to register with CORU and enter the workforce as soon as possible. As they had already completed their final clinical placement, all that remained was their final year research protocol and a viva exam, which could be administered remotely.

Our final years successfully completed their exams and received their results on Friday 1st May, five weeks earlier than planned. With the help of our Communications Department, we were delighted to put together this video to celebrate results day.

In this period, we have certainly up-skilled in using technology to enhance the learning experience for our students. While it cannot replace the face-to-face interaction, we see technology playing a significant role in achieving a more blended learning experience in our post COVID environment.

We are very proud of how our students embraced this unprecedented transition to a ‘virtual campus’ and we are now planning for how our programmes can be delivered safely and effectively for the 2020-2021 academic year.

We would like to thank all those who contributed to the successful delivery of our undergraduate and post graduate programmes including academic staff, practice education co-ordinators, clinical tutors and educators, administrative staff, external lecturers, external examiner and our student, academic and regulatory affairs staff.

The biggest thanks to our students for staying engaged throughout despite missing out on so many other aspects of college life. We hope that when the academic year resumes in September, they will return to some degree of a traditional student experience.

This Blog was written by Dr Helen French, Senior Lecturer in Physiotherapy, RCSI University of Medicine and Health Sciences and Professor Suzanne McDonough, Head of School of Physiotherapy, RCSI University of Medicine and Health Sciences.

Staff Self-Care in the Context of COVID

Many disciplines contribute to the delivery of our Health Services, from primary care to acute hospital care. These include medicine, nursing, health and social care professions and pharmacy.

As a hospital psychologist, I’m acutely aware of the additional ancillary disciplines, such as administrators, cleaners, caterers, porters, IT-experts, and security-personnel that also make invaluable contributions to the effective running of the health service.

Each profession has its own challenges, and rewards, and all of them have been impacted by COVID-19.

In this Blog, I aim to speak to three things: the general well-being of healthcare staff, added stress due to COVID-19 and how we might cope with these demands.

How ‘well’ are we, anyway?

Most of the available data is limited to the well-being of doctors and nurses (not all healthcare disciplines), from other jurisdictions (not Ireland specifically). I’m part of a research group looking to change that.

Nevertheless, the data signals some stark warnings. Doctors and nurses are at higher risk of developing mental health problems, relative to the general population1,2. They are also at an increased risk of developing ‘burnout symptoms’1,3, and are more susceptible to sickness-related work-absences, particularly if working in public sector roles, large organizations, or being in a more junior role4.

Most alarmingly, they’re also at increased risk of suicide, which must say something about the demands of working in healthcare. These issues signal a need to increase support for healthcare workers, and remedy any ‘systemic’ issues that may be contributing.

Is COVID-19 adding additional stress?

Past pandemics have taught us that healthcare staff experience increased distress. What differentiates COVID-19 from other pandemics is its scale and the risk of the ‘system’ becoming overwhelmed.

It has led to unprecedented societal measures, such as lockdown, and public health measures, which have become ‘normal’. Bearing in mind that 30% of all Irish infections have been healthcare workers, we are one of the most affected groups.

Whilst we’ve all been affected to some extent, it’s clear that select subgroups of the health-force have experienced increased levels of anxiety, depressed mood and trauma.

More specifically, approximately 10-15% of healthcare workers report clinically significant distress, particularly those exposed to the frontline, and those at the earlier stages of their careers5.

However, one very interesting study is at pains to point out that baseline rates of poor mental-health are already very high within these healthcare worker cohorts and COVID-19 is only likely to be adding marginally to this6. Food for thought.

How can we cope?

Healthcare workers are capable, resilient, caring individuals with an ability to adapt to challenging environments. It’s possible you are already coping well. What follows is intended to remind us what’s recommended at times of crisis, viral pandemics included.

At an individual level, the aim is to stabilise and mitigate acute distress. One recommendation is to be attuned to your own emotional thermometer and responsive to it when it becomes at risk of getting ‘overheated’, so to speak. Practice relaxation. If you need to, seek the support of someone who’ll listen. Remember, not all problems need to be fixed, some just need to be heard and understood.

One of the most frequently offered pieces of advice by my colleagues was to ‘control the controllables’ and also to ‘switch off’ after one’s shift was completed. Having outside interests is invaluable in this regard.

One practical piece of advice is to remain informed but limit the extent to which you’re attending to news, which generally has a negative slant. If people are working on teams, regular ‘debrief’ sessions are considered helpful, where the focus is on communal support, not forced disclosure.

Some teams also introduced ‘buddy systems’, especially for junior colleagues.  

With word limits against me, I’d finally suggest that framing one’s efforts in a meaningful way is another helpful psychological tactic. Sometimes it’s through adversity and sacrifice that we achieve something greatly significant. This is one of those times.

For those with an interest in additional resources, I’ve provided a couple of useful links below:

www.beatcovid.co.uk

https://www.psychologicalsociety.ie/footer/COVID19-Resources).

References

  1. Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: the way forward.  JAMA 2017;317:901-2
  2. Schernhammer ES, & Colditz GA. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). The American Journal of Psychiatry.(2004) Dec;161(12):2295-302. https://doi.org/10.1176/appi.ajp.161.12.2295
  3. Ribeiro VF, Filho CF, Valenti VE, Ferreira M et al. Prevalence of burnout syndrome in clinical nurses at a hospital of excellence. Int Arch Med. 2014; 7-22.
  4. Leaker D, & Nigg W. Sickness absence in the UK labour market: Sickness absence rates of workers in the UK labour market, including number of days lost and reasons for absence. Office for National Statistics. (2018). Available online (June 4th 2020): https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2018
  5. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 2020 Mar 2;3(3):e203976-.
  6. Bell & Wade. Live meta-analysis: Mental Health of Clinical Staff Working in High Exposure Compared to Low Exposure Roles in High-Risk Epidemic and Pandemic Health Emergencies (last updated 2020.05.27). Online open software meta-analysis. Accessed 4.6.20 https://osf.io/knhs3/.

This Blog was written by Dr Damien Lowry, Chartered Member of the Psychological Society of Ireland and Senior Counselling Psychologist in the Mater Misericordiae University Hospital’s Psychology Department.

ESD: Our Virtual Transformation

The Early Supported Discharge (ESD) team in Cork provides specialised domiciliary stroke rehabilitation.

As an integrated stroke service, ESD constitutes a vital rehabilitation pathway for stroke survivors facilitating patient flow through acute stroke units in Cork University Hospital, the Mercy University Hospital and St Finbarr’s Stroke rehabilitation unit since starting in 2018.

Continue reading “ESD: Our Virtual Transformation”

Major Surgery is Like Running a Marathon – Both Require Training

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Prehabilitation is the concept of increasing an individual’s exercise capacity to physically prepare them for their upcoming surgery. The OpFit prehabilitation programme is a pre-operative exercise programme for patients who are scheduled for cancer surgery in St. James’ Hospital. We have based our programme on the current research on pre-operative rehabilitation, and also the Macmillan “Principles and Guidance for Prehabilitation within the Management and Support of People with Cancer” (2019).

Continue reading “Major Surgery is Like Running a Marathon – Both Require Training”

COVID-19: Changing Contexts for Health and Social Care Professionals in Palliative Care

Palliative care is an interdisciplinary approach to care of people with active, progressive, far-advanced disease, for whom the focus of care is the relief or prevention of suffering.

Continue reading “COVID-19: Changing Contexts for Health and Social Care Professionals in Palliative Care”

COVID-19: From Zero to 6,000 in Eight Weeks

Hidden Health Workers

Medical scientists are unique healthcare professionals. We play a pivotal role in the diagnosis of disease and treatment of patients. Yet, we never meet them, in fact, most don’t even know we exist.

Although we don’t see the faces behind the samples, the patients are in the forefront of our minds in every step of our testing procedure. This remains the case during this pandemic where we must ensure we can stand over and trace every aspect of the process, from sample collection through analysis and results.

Starting from Scratch

When we made the decision to introduce in-house testing for SARS-CoV-2, we didn’t have the existing equipment required or enough staff to maintain the service. Thankfully, close links to UCD provided us with both equipment and scientists to help get us off the ground. Our medical scientists welcomed that assistance and worked round-the-clock to validate all the necessary components. 

The procedure for SARS-CoV-2 involves a number of different steps. When samples are received, as with all samples, they are checked to ensure identifiers on swab and form match. A lysis step is next, where buffer is added to some of the liquid media from the patient’s swab. This lyses cells and inactivates the virus making the sample safe for further processing. 

An extraction procedure follows, to isolate and purify the viral RNA (genetic material), if present, from the patient sample/lysis buffer mix. The final step in the pathway is RT-PCR. Viral RNA, is converted to DNA and this DNA is amplified and measured by the PCR instrument. 

All procedures along the way need to be validated and internal controls are included in every step, in every run. Despite the enormity of the task, less than a week after the decision to start testing, we reported our first results.  

Dealing with Rapid Change

The first few weeks went by in a blur. Everyday brought new challenges and as soon as one issue was resolved, another arose; reagent shortages, consumable shortages, equipment issues.

Throughout this eight-week period we have used four different lysis buffers, four different extraction methods and four different Real-time PCR methods, each needing validation before tests results can be released. Results were sometimes delayed as we battled uncooperative equipment or technical issues. I stumbled out of work in tears after some very late nights.

Challenges during Challenging Times

I expected the validation of a brand new test to be challenging. A challenge that I hadn’t anticipated was the public perception of medical scientists. From being a largely unknown profession outside of hospitals, suddenly we were in the spotlight.  Sampling and testing were commonly confused. 

Everyone was demanding to know what was taking us so long. Why couldn’t we just make reagents/get analysers/test faster? After working countless hours to validate new systems to ensure quality of results, it sometimes felt like a personal attack, even though the situation was out of our control. 

Currently our supply chains seem robust and our orders are maintained through a centralised HSE network where reagents/consumables are allocated depending on test capacity.

Teamwork in a time of crisis

A whole new section in our department was created in a week, and we still had to process all our normal microbiology specimens. We had to divide staff into teams to allow social distancing and limit contacts. 

Staff also had to contend with the same issues that face front-line workers throughout the country including childcare and worry of possibly infecting family members at home. Despite these difficulties, the laboratory staff came together to make it work.

As a team, both in St. Vincent’s University hospital and in the Medical Scientist community as a whole, we have grown closer and stronger. A network, between hospitals and departments, which luckily always existed, was now called upon more than ever to share experience and loan/swap reagents. 

Staff members have driven reagents to different hospitals and another hospital allowed us to use their equipment when one of ours broke down. Staff at the National Virus Reference Lab (NVRL) have helped provide materials to use for validation and have shared validation procedures, despite being incredibly busy.

Amazing Achievement

Less than two months after that first test, we have now tested over 6,000 samples. We have the capacity to test 200 samples/day seven days a week and our turnaround time for results after receipt of samples into the laboratory is between 8 and 30 hours. 

We also have a one-hour RT-PCR assay for urgent samples. We have come a long way in eight weeks and we are aware that there is a long way to go but we will continue to test, test, test; always remembering that behind every sample is a patient.

This Blog was written by Deirdre Keating  (dkeating@svhg.ie), Specialist Medical Scientist, St. Vincent’s University Hospital.

Cardiac Physiologists – Coping and Adapting as a Team during COVID-19

Over the weekend, I reflected on the effect, dynamics and response of our team of 16 Cardiac Physiologists to these unprecedented COVID weeks.

Anxiety, Communication and Self-care

Given we perform and report cardiac tests on patients, there has been anxiety of contracting or passing COVID to patients, particularly during cardiac ultrasound, a close contact procedure. 

There was the uncertainty of the situation, possible redeployment and how the health service would cope. There were also individual concerns regarding family, particularly older relatives.

We had an initial meeting where all concerns and thoughts were raised in an open way.  Questions were answered honestly, where information was available, but there were also a number of “I don’t knows”. 

We hold daily huddles, to update on rapidly changing work practices and set-up a COVID Info group in addition to our longstanding work WhatsApp group, so everyone had relevant information on their device.  Our team was directed to information sources, such as the WHO and HSE.  As a team, we feel these daily huddles reduced anxiety and improved communication.

Our mantra is to “get through this with our health and relationships intact”.  To aid this, infographics about stress management and self care from @whw_HR have been shared.  This weekend, I shared “Hold onto your red thread” an article from the BMJ – mine are cycling, home life and minding our team.

New Protocols

30% of COVID patients develop cardiac issues, with a number requiring cardiac ultrasounds. Protocols reflecting international guidance were rapidly adopted. Twitter has been great at keeping us updated on guidance and also showing how other centres and leaders in the field have been dealing with this. 

Within one week, we developed processes for safely treating patients with COVID, who were also suffering from heart attacks. This involved the 24/7/365 Heart Attack (CODESTEMI) team, nurses, doctors, radiographers and ourselves.

Although non-time critical diagnostics were cancelled, our long-standing use of remote monitoring technology, where implanted devices can be checked from patients’ homes, has allowed us to continue to provide follow-up for these patients. 

We have noticed over the last number of weeks, after cocooning was instituted, that phone calls with these patients takes longer as they seem to enjoy the chat.  We also observed that chatting with inpatients who require tests was even more important than usual. They are missing their visitors – the suggestion is to ask at least one non-clinical question. 

We also rapidly, with support of IT, integrated reports from all of our testing equipment onto the hospitals Electronic Health Record.

Split teams – challenges and benefits

Cardiology split into two teams, working different shifts on alternate weeks.  This was designed to protect the service from being wiped out by infection.  Within three days, through open discussion, we had managed to work out shifts which aligned to medical and nursing colleagues and provided extended hours diagnostics, six days a week, to support a non-COVID Emergency Department in the Acute Medicine Unit.

New extended hours are quite tiring for staff and people are missing colleagues who are not on their team. However, there have been a number of benefits; the smaller teams provide opportunity for staff to take on more responsibility and colleagues have got to know each other better. Both teams have tried to keep spirits up, lots of baking, some laughs, minding each other, and goodies being left for the team taking over.

I was concerned about not meeting the other team but am having a number of WhatsApp video calls to keep in touch, although I might benefit from them most.

Pride

There is a huge sense of pride in our own team, how they have adapted, grown, got stronger and minded each other.  Pride in our HSCP colleagues, Radiographers – performing tests on COVID patients, Med Lab Scientists – responding amazingly to ramp up testing in difficult global conditions, Medical Physics staff – procuring, commissioning and checking huge amounts of equipment to get us ready, Physiotherapists, Dieticians, Speech and Language Therapists, to mention a few – working in critical care areas and COVID wards. 

There is also pride in our leadership at national level; Simon Harris, Dr. Tony Holohan and his team and the Irish people whose adherence to restrictions has helped prevent the surge.

This Blog was written by Paul Nolan, Chief Cardiac Physiologist, University Hospital Galway. @pnolan99. paulg.nolan@hse.ie