Background
The COVID-19 pandemic has put a strain on the NHS secondary to the unprecedented number of acute admissions requiring high-dependency unit (HDU) and intensive care unit (ITU) support due to respiratory failure and sequela of hypercoagulability. The long-term complications of COVID-19 pneumonia are also beginning to emerge, with growing clinical experience directing us to focus on integrating disease severity with the likelihood of long-term multi-organ complications alongside the psychosocial holistic care required by these patients.1–3 We describe our multidisciplinary team (MDT) observational experience at Gloucestershire Hospitals NHS Foundation Trust of delivering personalised holistic multicomponent interventions for all patients discharged from a HDU/ITU. Our intervention used a unified follow-up pathway to address multi-organ complications and psychological trauma, setting rehabilitation goals and using a GP action plan to improve the long-term outcomes of these patients.
Method
The MDT follow-up consisted of an interprofessional carousel, incorporating review from colleagues in intensive care, respiratory, therapy, psychology, pharmacy, dietetics and community wellbeing and using a unified pro forma adapted to address individual patient needs. 37 patients were followed up over a 4-week period using this approach. Long-term complications of COVID-19 were identified and addressed by relaying the subsequent action plan to primary care (Fig 1).
GP action plan.
Results
The ongoing biopsychosocial complications identified from the MDT follow-up of COVID-19 patients are summarised in Table 1. Fatigue was the prevalent complaint, followed by breathlessness, decline in functional and mental health and hair loss. Onward referrals for subspecialist input were made from clinic and action plans relayed to primary care in all patients.
Multidisciplinary follow-up clinic findings in COVID-19
Discussion
The extent and severity of long-term complications secondary to COVID-19 may cause substantial morbidity, and further studies are required to evaluate the long-term effects of COVID-19 in at-risk groups and determine how to manage them optimally.
Our observational study of the HDU/ITU COVID-19 follow-up cohort demonstrates a range of perplexing clinical sequalae and emphasises the need to utilise the available resources to deliver high-quality patient care and to develop a better understanding of this condition in order to minimise the long-term costs that will be incurred by failing to address COVID-19-related complications.
We advocate a multidisciplinary approach to following up COVID-19 patients. This approach will allow personalised holistic multicomponent interventions with early identification of potentially life-limiting complications, without over-investigating patients making a full recovery, while ensuring primary care colleagues have an action plan to pragmatically manage these patients upon discharge.
Conflicts of interest
None declared.
- © Royal College of Physicians 2021. All rights reserved.
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