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

The Frontline as a Radiographer during COVID-19

I can distinctly recall the date of the first Covid-19 patient that was admitted to St. Luke’s Hospital in Kilkenny. Ironically, it was on Friday, the 13th March, 2020.

It was so rehearsed, systematic, an ideal scenario in fact – the patient was calmly examined in a dedicated isolation room. ‘Recent travel from China’ read the clinical indications on the X-ray order.

We have come a long way since then. Now we are led by daily algorithms and HPSC updates have dictated new work-flow operational practices for Primary Care centres, ED staff and in turn, radiographers.  

Referral criteria for chest X-rays and CT scans have been modified in line with best international practise. Operational workflow arrangements to deal with both COVID and non-COVID work streams have been organised so that the care streams never meet, in order to minimise infection crossover risk.  

Digital mobile radiography is the new standard to reduce the transfer of infection. Strict infection control measures are adhered to – “donning and doffing” are the new buzz words for radiographers. We have also introduced a Buddy system to minimise cross infection whilst X-raying COVID patients.

Many patients, either intubated or on admission to the Medical Assessment Unit, appear agitated as the infection takes hold. This makes the whole event of performing a mobile X-ray tense as conversation with the patient is limited. These conditions make it difficult to empathise with the patient.

I am a well-seasoned radiographer and I have found it heart-breaking to work in these circumstances, only to find that, in some cases, the patient has unfortunately passed some days later.

I’m now an expert in PPE. I can discern the quality of good PPE from a mile off. I spend much of my day in a whole white body suit that was not so long ago commonplace on media images we saw from Italy and Spain. Where initially there was one patient, now there are often four to five portables to be performed in a COVID ward.

The suits are hot and difficult to move in but a necessary evil. I keep telling myself that I will never take another free dessert from the canteen again, but my willpower is shocking.

It has been six life-changing weeks since the crisis took hold and there is no sign of it abating any time soon. My physical and mental well-being is tested on every shift. Equally though, valuable lessons have been learned and strong work friendships formed in the face of hourly adversity and crisis.

There have been many days and nights since this crisis started that I have questioned why I ever become a Radiographer. I lost a good friend just last week and discovered this awful news by casually looking up RIP.ie whilst I was on call.

I was not able to attend her funeral or pass my condolences to her family. There is no longer a vent to express the normal phases of grief. I have lost work colleagues and the realisation that I too may succumb to COVID 19 is never far from my mind.

I am not a great cook or champion organiser but since the crisis has begun, Nigella, Kevin Dundun and Nevin Maguire are strewn across the kitchen table. Blobs of flour and egg shells mark my attempts at becoming the next Nigella.

My teenage children can sleep for Ireland but they have, on a couple of occasions, acknowledged what I do for them on the frontline … and that has brought a tear to my eye. I realise I am a radiographer because I worked hard to be one and that example is what I want to impart onto them.

The weeks do pass and I have a diary noting the dates that Occupational Health have phoned to say I was either a close or casual contact. Little else goes into it. My social diary is clear. However, the weather outside is getting better and with that brings hope …

This blog was written by Kate Murphy, Radiation Protection Officer, St. Luke’s Hospital, Kilkenny with support from all the Radiography team in St. Luke’s Hospital.

COVID-RUARY: Clinical Reflections on the Month Gone by

This has been the most challenging 4 weeks in my 20 years of practice for many reasons.

Looking for certainty at a time of complete and utter uncertainty has led us to reach out and make meaningful connections locally, nationally and internationally which has been a double edged sword. It has brought a lot of meaningful discussion but has also given us a thirst for knowledge and evidence that is emerging but may take months to be conclusive.

In the meantime, we question ourselves relentlessly; trying to reduce our clinical worth to what is deemed essential and non-essential has been exhausting and, at times, a little degrading.

The endless debate on PPE has allowed us to fear our patients. We fear the risk we pose to them. We fear the risk they pose to us. We have also been asked to question our worth to the patient’s care. Do you really need to do your job?

The reality is that rates of under-referring to the HSCP group was prevalent pre-COVID-19. This is not a time to exacerbate this situation. This is a time to come together to prove the integral role we all play in a comprehensive holistic pathway of care. 

For the first patient I went to see 4 weeks ago, I was so dysfluent in the process of donning and doffing the PPE, I arrived a little distracted. The discussions on how far to stand away from the patient made it harder to do what has always been a fundamental part of my assessment. To look someone in the eye and apologise that they are in Hospital, but reassure them that they are in the right place.

The second time I went in, it got easier. It has also become easier to offer constructive help to my colleagues; can I schedule my assessment at the same time as they need to be turned? I can help. When do they need oral hygiene done again? I can do this. Are they taking meds? I can assess whether they can manage these orally.

There is a debate raging that oral hygiene may no longer be part of our essential role. I cannot agree with this. Not when I have assessed and treated multiple patients in the last few weeks; some extubated after prolonged ventilation, some on NIV hoods, some on airvo, some self ventilating.

COVID-19 requires a very different approach to normal respiratory conditions. Humidification is not necessarily part of the treatment. Dehydration is common and sometimes life threatening. Oral xerostomia and risk of candida are common.

An essential part of my role has been to ensure that all patients are entitled to oral hygiene via suction toothbrush. It is more common practice to administer oral hygiene via small pink sponge swabs. I’m not sure how this ever became normal. An ex-patient likened it to Christ on the Cross and the sponges of vinegar!

It is undoubtedly more comfortable for a patient to have their mouth cleaned with a toothbrush, and when they are unable to manage their own saliva, the risk that this oral care poses to the lungs is significant and life threatening.

It is essential to raise insight into this and help people understand that the suction toothbrush not only saves the patient from aspiration but also protects the person completing the oral hygiene as it is a closed suction system. Being able to support the Nursing Team so that it can be provided every 2 or 3 hours prevents the build-up of candida on the tongue. This is vital to prevent another source of aspiration and pneumonia.

I have now completed an episode of care with a person who was admitted, although within the younger age category, with multiple comorbidities. He was intubated for 10 days, experienced seizures and delirium as a result of severe dehydration and had not been able to see or speak to his family for 35 days.

What did a week in that pathway of care look like?

  • Working with my Nursing colleagues to provide oral care, to commence cautiously on oral intake and to determine how to enable the person to communicate basic needs
  • Working with my Medical colleagues in Infectious Disease, Renal Medicine and Neurology to define delirium versus neuropathy, confusion versus cognitive change and to determine capacity to meaningfully participate in decisions on delivery of care. All of whom are interpreting the diagnostic results analysed and reported from my HSCP colleagues in Medical Science and Radiography.
  • Working with my Physiotherapy colleagues to minimise risk of aspiration from oral secretions and oral intake, and to enable the best expiratory flow for voice, cough and swallow.
  • Working with my colleagues in Clinical Nutrition and Dietetics to enable the best regime for nutrition and hydration in the context of a severe oro-phayrngeal Dysphagia.
  • Working with my colleagues in Pharmacy to ensure the right consistency of oral medication.
  • Working with my colleagues in Occupational Therapy to enable positioning for therapy and self-feeding.

Finally, the icing on the cake at the end of an intense week, was enabling my patient to have a cup of hot (modified) tea, while we whatsapp video-called his family as I interpreted, so they could understand his dysarthric speech. The joy in the reunion, after 23 days of not seeing each other, was immense.

All in all, not a bad week in the office.

This Blog was written by Aideen O’Riordan, Deputy Speech and Language Therapy Manager, Cork University Hospital

Pivoting, at Pace, to Virtual Patient Management, Communication and Education

Recent weeks have seen massive disruption to healthcare services as we grapple to meet service need in the context of the COVID-19 pandemic.

Over the past six weeks, the SCOPe Directorate* in St. James’s Hospital has pivoted from primarily in person assessment and review to a teleHealth model. This Blog will set out the key enablers that made it possible to achieve this change at pace.

* The SCOPe Directorate is the HSCP clinical structure in St James’s Hospital consisting of the five departments of Medical Social Work, Speech & Language Therapy, Dietetics, Occupational Therapy and Physiotherapy.

Our SCOPe team is no stranger to digital developments having led the digital transition from paper to electronic patient records (EPR) with all documentation transitioned by end of 2016. This improvement project was highly structured and a SCOPe EPR QI team managed implementation and governance.

The vision has always been to progress patient engagement, teleHealth solutions, shared records, patient portal etc. in structured phases.

Looking back, our experience and vision laid the foundation for digital readiness in the HSCP workforce, giving us a big head start when news of COVID-19 emerged.  

Our Journey to a teleHealth Model

In early March, the SCOPe eHealth QI team had a brainstorming session to explore the potential of teleHealth to support patient care as the situation evolved.

Services identified as potentially suitable for transition varied as HSCP staff work across all episodes of care including ED, in-patients and outpatient clinics.

Over the course of the following week, the SCOPe directorate moved to provide urgent assessment and review to all OPD services using a generic teleHealth platform.

Electronic appointments and an EPR are already in situ in St. James’s Hospital so the immediate need was to provide a safe, secure substitute for the face-to-face component of the therapy assessment.

Colleagues in the IMS department provided invaluable support including:

  • organising app demonstration
  • enabling of infrastructure
  • provision of licences for staff

Concurrently, the SCOPe team worked to develop:

  • the processes
  • clinical guidance
  • flow around implementing the teleHealth application
  • mechanisms for measuring activity while supporting staff in the introduction of the teleHealth app

Our Learnings So Far …

Feedback has been positive as the teleHealth model allows ongoing contact with patients who require HSCP input.

There is an acknowledgement that it is not ideal for all patients. However, staff report that they are getting better at identifying those patients for whom a virtual teleHealth clinic will work best and at adjusting their communication style to aid rapport development.

In some cases, the teleHealth clinic exists alongside a telephone clinic depending on the patient’s technological abilities.

There have been teething problems with Wifi /4G availability on the patient side and clear instructions are required on how patients can best manage their device for camera visibility.

This use of digital solutions to facilitate ongoing patient management is happening in parallel to the use of virtual tools to facilitate department communication and training.

Where social distancing cannot be observed, significant value is added by the inclusion of virtual video conferencing for education sessions on clinical preparations for the COVID-19 emergency, in-services, journal clubs and meetings.

There is a learning curve with using this technology … a need for collective understanding that technology may fail, cameras may freeze and small visitors may make an appearance in the feed of those working from home!

While it is not always as successful as a group face-to-face meeting, it is a very acceptable alternative when staff can’t all be present in the same room, at this time.  

As well as this, a campus-wide staff communication tool has been implemented in the last two weeks. This has also proven very beneficial for urgent communication from the hospital leadership team and this secure confidential messaging service can also be used to support communication in relation to clinical information.

Most of all, it is clear that the well-plotted transition to EPR created the conditions for readiness amongst the HSCP workforce in the following crucial areas:

Final Thoughts

While teleHealth developments in St. James’s Hospital were already under development, COVID-19 greatly accelerated implementation! By far the greatest asset has been the staff who were required to be ‘early adopters’ of change, learning as part of the doing rather than ahead of implementation.

It has been a huge undertaking and SCOPe HSCP have adapted admirably, motivated by the fact that these changes would lead to effective alternatives to direct patient care for service users.

This Blog was written by Joanne Dowds on behalf of the eHealth HSCP Advisory Group. Joanne is a clinical specialist physiotherapist working in the ICU of St James’s Hospital.