Life in the Time of COVID-19: Pulmonary Rehabilitation

 Published: December 16, 2020

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When COVID-19 shut the country down last spring hospitals continued to care for people not only with the virus but everyone else needing acute care as well. But many outpatients, including those attending pulmonary rehabilitation programs, weren’t so lucky. They suddenly found themselves without the care they needed to manage their conditions. What happened to those patients and the respiratory therapists dedicated to their care?  

Debbie Koehl, MS, RRT, RRT-NPS, AE-C, has been the program coordinator for pulmonary rehab and patient education at IU Health Methodist in Indianapolis, IN, since 1995She understands the dilemma these patients and their providers found themselves in.     

Maintaining contact

According to Koehl, programs that were forced to shut down – and some are still at that point even today – understandably felt frustrated by not being able to open back up.  

“Hopefully they worked on getting patients information on how to do some exercises at home,” she said. “I know while we were shut down we did that.” 

At IU Health, they also contacted their patients on a regular basis and asked specific questions designed to identify their needs – and not just their needs in terms of their respiratory condition. Koehl says they inquired about everything from their mental health to whether they were getting enough food to eat.  

“We needed to be able to give them an avenue to ask questions about their disease process or their concerns about COVID-19,” she said.  

Getting patients to keep up with the exercise regimens they began in PR, however, wasn’t easy, and despite their best efforts to encourage continued exercise, some patients couldn’t do it without the personal interaction they got in the program.  

“It’s not the same, and many patients need that one-on-one instruction,” she said.  

Back in business, with some caveats

Thankfully, many programs are now back in business, including the one at IU Health. But Koehl emphasizes it’s only partially business as usual. 

According to Koehl, many pulmonary programs were keeping enhanced cleaning routines a top priority when they first opened back up. “I know ours was due to seeing patients post and pre lung transplant as well as adult CF patients,” said Koehl. They always used masks for their CF and bronchiectasis patients, and they always cleaned equipment between patients.  

But COVID-19 demanded they do more.   

“What was unique to reopening is that we created exercise pods, so that the patient stays in their assigned pod from beginning to end of their exercise program,” she said. Exceptions may occasionally be made for specific equipment, but they are very deliberate about how they move patients around the space. Now everyone wears an isolation mask, and some use face shields as well. 

The program made a host of other changes too. Koehl says they limited class size and switched to more one-on-one education. They also they reworked their patient evaluation process to accommodate the patient safety demands of the virus. Now every patient who comes into the program is screened for COVID symptoms.  

Even the waiting room is no longer the same. Support staff had to be downsized to accommodate needs created by the pandemic.  

An evolving situation

Koehl sees more changes ahead for PR programs as the pandemic winds down. For one thing, many patients are having long-term problems stemming from the disease and may need rehab down the road.  

“Our hospital has a post COVID ICU clinic that works with patients in all aspects of post rehab care,” she said. “We are seeing some PR referrals as well.”  

She believes these patients may end up with treatment plans like those used for their interstitial lung disease patients now, considering their need for various levels of oxygen, nutritional advice, and exercises to increase their strength and endurance. The hardest part about incorporating them into their existing program may be their fellow patients.  

“I think our biggest worry is how other patients may feel interacting with a post-COVID patient, feeling a fear of the unknown,” says Koehl  

This long-time PR professional sees a possible role for PR programs in the dissemination of vaccines too, since all the patients who come to these programs fall into the high-risk category.  

“Programs could be a clinic site for the vaccines, as long as staffing allows,” she said. The key for programs is to stay up to date on the latest news and information about the vaccines 

“Our infection prevention department at IU Health is top notch and they are really providing us with great information,” Koehl said. “I think the vaccines with help not only the staff feel safer, but also the patients.” 

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