Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan

Abstract

The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.

Keywords: Coronavirus; Critical pathways; Neuropsychology; Physical therapy modalities; Rehabilitation; Telemedicine.

Fig 1

Hospitalization of patients with COVID-19 in phase 1. Figure 1 summarizes the clinical movement flow undertaken by patients with COVID-19 during phase 1, before the organization of specialized COVID-19 rehabilitation standard procedure flow. Patients entered the hospital through the ED and were admitted to either the ICU or the infectious disease, internal medicine, or respiratory high dependency care departments, according to their clinical status. The hospitalization stays were, on average, 15 days; 400 beds were created in 1 month. Abbreviation: avg, average.

Fig 2

Rehabilitation paths for patients with COVID-19 and patients post COVID-19 in phase 2. Figure 2 summarizes the clinical flow of patients with COVID-19, from acute wards until home return. Each transition between the different units is discussed and decided by the multidisciplinary team. Following the acute phase (for an average of 10d) and according to the swabs results as well as functional abilities of patients, patients should be admitted to COVID-19 rehabilitation wards (for an average duration of 10d), quarantine (for at least 14d), or post-COVID-19 rehabilitation wards (for an average of 10d) to undergo rehabilitation. Following quarantine or post-COVID rehabilitation, patients can return home and continue rehabilitation according to their needs under the supervision of hospital specialists using the telemedicine unit. Moreover, even during quarantine, patients and caregivers can benefit from remote supervision using the telemedicine unit. Abbreviation: avg, average.