Redefining Rehabilitation in the COVID-19 Pandemic

During last summer’s fast-developing pandemic scenario, TIRR Memorial Hermann participated in a national virtual meeting sponsored by the American Medical Rehabilitation Providers Association (AMRPA), entitled “COVID-19 and the Rehabilitation Hospital Impact: Perspectives from Texas.” Three hundred participants were on the line for calls, as TIRR Memorial Hermann leaders were paired with Hackensack Meridian Health in Edison, New Jersey, to share their knowledge of and experience with COVID-19.

“The two locations were chosen to give a contrasting representation of the pandemic. Last July, COVID-19 was surging in Texas, while cases in New Jersey were decreasing,” says Rhonda Abbott, PT, FTPTA, CEO of TIRR Memorial Hermann. “We were fortunate early in the pandemic to be able to learn from rehabilitation professionals in the Northeast who had more experience with COVID-19 than we did. Their understanding added value and depth to our inpatient and outpatient experience as we have moved through the different phases of the pandemic.”

Both hospitals presented their response plan to the surge in cases. “At TIRR, we went through an acute alertness phase where we closed our treatment gyms, which has never occurred in our history,” Abbott says. “At that time, we were still learning how the virus spread and how best to use personal protective equipment. As time and data revealed additional evidence, we reopened and created new treatment zones and placed Plexiglas dividers throughout our campus in high-traffic, high-contact areas. Because our natural habit as humans is to keep doing what we’ve always done, we had to create alternate spaces. We have one chair per table in the cafeteria, for instance, and all meetings are on Zoom.”

Abbott says the patient-family component has been challenging. “We wanted to make TIRR a safe environment for people to start or continue their rehabilitation without fear of being exposed to the virus, so like other hospitals in Houston we instituted a no-visitor policy,” she says. “In our outpatient facilities, no visitors are allowed. For inpatients, we allow very limited visitation with special permission only. Family and friends play a tremendous role in recovery during rehabilitation, so we have issued iPads to all locations to ensure that patients can stay connected with family members via Zoom calls. In some ways our communication with families is even more frequent now, but we miss the personal contact.”

Gerard Francisco, MD, chief medical officer at TIRR Memorial Hermann and professor and chair of the department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth, gives credit to medical professionals around the world. “Our colleagues in New York, China, Italy, France and Spain – those who managed COVID-19 early on – shared good medical and clinical information and set an outstanding example for those of us who followed,” he says. “That experience allowed me to encourage our physicians. If they can do it in New York City, we can do it here.”

Since then, the medical community has learned that the virus affects many systems in the body. “We still don’t know everything about the body’s response to COVID-19, but we know there are often neurological effects similar to the issues we see in patients with stroke and brain injury, which may not be obvious immediately or may occur later. We are evaluating these problems and creating rehabilitation plans,” Dr. Francisco says.

TIRR Memorial Hermann’s post-COVID-19 therapy program for patients who no longer test positive opened in May. Built on the hospital’s strong program of respiratory support, the program is evolving as more information about what the virus does to the body becomes available.

Nicole Harrison, MBA, BSN, RN, NEA-BC, vice president and chief nursing officer at TIRR Memorial Hermann, talks about the importance of putting plans into place to ensure that patients coming into the hospital are not positive for COVID-19. “Our work as nurses is very hands-on and in close proximity to patients,” she says. “Our respiratory team helped us to create processes, algorithms and treatment pathways to that end. Our message to our nurses is that we’re in this together, and we’re making sure you’re practicing in a safe environment.”

Harrison admits it has been physically and emotionally challenging, although more so in the beginning when testing was less readily available and knowledge of COVID-19 was minimal. “Once testing kits were available, it gave us a huge sense of relief,” she says. “We huddle every week and ask managers to have frequent huddles on the units. You can never over-communicate, and that’s especially true now. Our nurses have been amazing, and the work we’ve done is immense. People have discovered vast emotional and skill reserves they didn’t know they had. They know we’re making history and setting standards for future pandemics.”