COVID-19 has affected not just hospitals and acute services treating infected patients, but the entire Italian healthcare system. In the recent HIMSS webinar ‘Italian non-acute facilities facing COVID-19 emergency,’ chair Nevio Boscariol, head of finance, services and management at ARIS, opened up the discussion to those in rehabilitative and residential care. They spoke of their experience of national virus containment measures and the use of non-hospital facilities as isolation areas for COVID-19 patients.

WHY IT MATTERS

As discussed by Maria Gigliola Rosignoli, CMO at Istituti Clinici Scientifici Maugeri, the impact of the crisis varied significantly between regions. After the virus spread amongst hospitalised patients, particularly in Lombardy, Piedmont and Liguria, it was imperative to segregate confirmed and negative cases in rehabilitation facilities to ‘clean’ and ‘dirty’ areas while simultaneously implementing new care measures at pace. In the region of Marche, this necessitated the limitation of staff to discrete areas or departments, incurring extra costs and postponement of non-urgent treatments. The increased need for rehabilitative care post-peak meant reactivating pre-crisis rehabilitation structures, particularly for lung and respiratory health. Reopening services put on hold due to COVID-19 while maintaining the elevated safety and sanitation standards necessitated by the crisis is also currently a key consideration.

Aside from the reorganisation of care structures, health organisations across the country had to provide staff with digitally-coordinated training on the new measures, such as appropriate use of PPE and correct care procedures. Patrizia Potente, Marche regional directorate at KOS, noted that this coincided with the challenge of acquiring sufficient PPE, impacted by non-delivery of suppliers. One of the main difficulties across non-acute sectors, identified both by Rosignoli and Massimo Molteni, central medical directorate at La Nostra Famiglia, was coordinating a singular response across regions with different needs and directives. Potente pointed out that the national directive to place negative patients in rehabilitation facilities was difficult to coordinate with private facilities.

The response in residential care facilities was very different. Both Andreina Rovescala, MD of Torre della Rocchetta – GVM, and Sandro Elisei, CMO of Istituto serafico di Assisi, highlighted how their facilities initiated lockdown early, before any cases were confirmed. These preventative decisions, along with rigorous internal precautionary measures, training initiatives and thorough testing, successfully curtailed any positive cases from developing in the facilities. “The most complicated phase for us was managing the relationships between our patients and their family members,” stated Rovescala. “In this phase, our team of psychologists played a central role, working a lot with the help of video calls, group chat between patients and family members.”

Similar actions were taken for patients already hospitalised, such as those with severe disabilities. Patient access was severely limited and outpatient rehabilitation activities were stopped altogether, relying heavily on telehealth tools to bridge the gap. Although these measures have been effective, there is concern about how sustainable these containment methods are for hospitalised patients.

THE LARGER PICTURE

Maurizio Dal Maso, executive consultant at Istituto serafico di Assisi, highlighted the heterogeneity of the response across the non-acute sector, indicating that “the central government, regions and health trusts are not very coordinated and do not have a real chain of command defined on who does what in an emergency situation.” In response, he proposed more coherent governance structures moving forward, investment and adoption of digital care and telehealth platforms, in addition to an improved reliability of data flow.

The speakers unanimously agreed that there needed to be increased testing capabilities as well as more telehealth services and PPE availability.

ON THE RECORD

Rosignoli said: “The emergency has passed but now there is a greater need for rehabilitation follow-up. At present we have many patients recovered, therefore we are organising many post-COVID-19 rehabilitation plans, reactivating many rehabilitation structures, especially lung rehabilitation and studying specific care pathways for respiratory rehabilitation.”

Potente said: “Positive patients are currently being cared for in our rehabilitation facilities. We are practicing greater sanitisation of rooms and common spaces, as well as inpatient rooms. The use of lifts and common areas has been limited, and access to visitors has been inhibited with great effort.”

Molteni added: “Our greatest efforts were concentrated on activating and strengthening telehealth tools. We immediately understood that in order to avoid the complete lockdown of our young and complex patients (disabled, autistic, with emotional and behavioural problems) it was necessary to build a small team in charge of supporting video-conferencing with family members and remote rehabilitation services.”

Dal Maso concluded: “Let’s take advantage of what happened: redefining the procedures of our health trusts, remapping processes and digitising them. Let’s better train our staff and let’s try to be more prepared for a possible next time.”

The webinar is available here.