By Denise Williams
In the face of a public health crisis, pulmonary rehabilitation programs across the country have spent the last year working around the “new normal.” What PR looked like pre-pandemic and what it looks like now is starkly different, and it hasn’t been easy on patients or providers. Perhaps the hardest part for Anne M. Gavic-Ott, MPA, RCEP, MAACVPR and her crew at Northwest Community Healthcare (NCH) was the four months the Arlington Heights, IL program had to shut down. “We’ve talked to and seen patients who were in Ph III and have not been able to return,” she recalls, “and it has deeply affected their physical and mental health.” Gavic-Ott, who manages the unit, says the staff not only missed patients but also each other and working together as a team.
Although the program didn’t let COVID-19 keep it out of commission for long, it’s operating with only about a third of the patients it normally treats. Still, notes Renee Ahrens, BS, CCRP, RCEP, “we have pivoted greatly over the past year and have implemented so many different ways of caring for our patients.” The latest strategy is NCH’s home-based or virtual rehab class, which she says has worked especially well for participants who felt that it was too risky for them to attend traditional classes. Based on the level of success that has been seen with the virtual offering, she expects that NCH likely will maintain the programming even post-pandemic.
Ahrens says the practice will also continue to do whatever it can to make rehab fun for participants, whether there is just one patient or 100. That includes celebrating observances such as PR Week, even if in a somewhat muted fashion. Having to tone down the festivities was tough for the group, which she admits generally loves to celebrate everything. Gone were the parties of yore, but Ahrens says staff conducted fun educational quizzes and handed out small prizes to liven things up.
The high point of the week, however, was when NCH walked away with top honors in AACVPR’s PR Week video contest. Gavic-Ott says the winning video, a team effort led by Ahrens, was a perfect opportunity to focus on the positive in what is shaping up to be another challenging year. “It was a way to use creative energy and an opportunity to tell our story, especially to those who had little understanding of what we do each day,” she explains. “As noted in the video, it reminded us of why we’re here and what an important mission we have.” To the delight of the team, the win came just one week after the program snagged first place in the parallel CR Week video competition! And that, according to Cecilia Tancun, MSN, RN, CCRP, who took the lead on developing that project, is “a testament to how much we enjoy our jobs and the overall collaborative nature of our staff.”
Other Programs, Like Experiences
Lifting each other up also carries a lot of weight at the Cardio & Pulmonary Wellness Center at El Camino Health in Mountain View, CA. Missy Von Luehrte, RN, BSN, says she and her colleagues took the opportunity during PR Week to highlight both the program’s services and the benefits of PR on a bulletin board created especially for the event. The team and the program’s accomplishments over the past year were also recognized, not least of all an exciting telehealth program.
Modeled after the existing Center-Based Rehab Program (CBRP), the 8-week telehealth offering launched in November and is now on its third round of participants. Working with the Pulmonary Medicine Department and an outside contractor, the practice also developed an 18-month interactive follow-up program that graduates of the 8-week program can complete online.
The new additions top a list of achievements made necessary after the emerging pandemic forced the practice to shut down services abruptly in March. At the time, a “rolling” CBRP was providing care to 20-25 patients at once. The facility reopened in June, with changes in place to keep patients and staff alike safe. The practice now features two “fixed” 8-week programs servicing no more than 12 patients at a time. To further accommodate social distancing, the configuration of exercise chairs was adjusted, only every other piece of aerobic equipment is used at the same time, and each participant sits at his or her own education table with a 6-foot buffer zone. Maintenance, previously offered as a single, one-hour session, has been expanded to include two one-hour sessions in order to allow for reduced volume and social distancing.
In addition, initial consultations and 30-day Medical Director visits are conducted via virtual video. Meanwhile, both of the program’s center-based support groups, which met monthly or bi-monthly before the pandemic, are now held by virtual video as well. Surprisingly, Von Luehrte says, patients love it!
Other precautions now in place include continued use of face coverings by patients, mask wearing and eye safety for staff, thorough cleaning of all equipment, tables, and chairs before and after use, and COVID screening with each session.
The Pulmonary Rehabilitation Program at University of California Davis Health, for its part, was fortunate to avoid any closures throughout the course of the COVID-19 pandemic. Doing so was possible, says program supervisor Aimee Kizziar, MHAL, BA, RRT-NPS, RCP, thanks to early adoption of virtual PR for enrolled patients. At the same time, the Sacramento practice stayed connected to Maintenance members via weekly Zoom meetings. Increased infection-control measures have allowed staff to resume center-base pulmonary rehab (CBPR) at 50% capacity, with virtual interaction continuing with patients for whom this service is appropriate.
UC Davis’s CBPR program, though still subject to limited occupancy, has come back stronger than before, according to Kizziar, who considers the new hybrid format one of the “silver linings” to come out of the pandemic. “The exercise component is center-based (meeting twice weekly),” she explains, “while the educational series is via Zoom (once weekly).” Feedback from patients and the PR team overall has been overwhelmingly positive, Kizziar is proud to report.
She says her facility celebrated PR Week with two informative presentations—one covering “Strategies to Break the Cycle of Severe COPD Exacerbations” and another on “Implementation of a Telehealth Pulmonary Rehabilitation Program at a Non-Profit Acute Care Hospital.” Additionally, time was taken each day to recognize the PR team and reflect on the effectiveness and impact that PR has on patients who undergo treatment.
COVID-19 didn’t stop the PR community from observing PR Week and it hasn’t dampened the enthusiasm of professionals in the field. Quite the opposite, Kizziar believes the public health emergency has brought the community closer together, through mutual support, encouraging words, and shared ideas. And pivoting to virtual care where possible has allowed many practices to, as El Camino Health’s Von Luehrte puts it, both “survive and thrive” despite the current hardships.