Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

Research Article

Phys Med Rehabil Int. 2021; 8(1): 1175.

Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

Cosgrove T1 and Salawu A1,2*

1Department of Rehabilitation Medicine, Hull University Teaching Hospitals NHS Trust (HUTH), UK

2Hull York Medical School (HYMS), UK

*Corresponding author: Salawu A, Department of Rehabilitation Medicine, Hull University Teaching Hospitals NHS Trust (HYMS), UK

Received: January 14, 2021; Accepted: February 27, 2021; Published: March 06, 2021


As part of the UK National Health Service (NHS) preparations to manage the impact of the COVID-19 pandemic on hospital services, clinical guidelines that emphasized the expansion of the acute care capacity in managing the anticipated surge in COVID-19 cases were implemented. Clinical wards were reconfigured and routine face-to-face outpatient clinics were suspended. Some of the changes include workforce and facilities reorganization. One of the changes implemented at the Hull University Teaching Hospitals NHS Trust (HUTHT), was the relocation of the Complex Rehabilitation Ward from its 15- bed base in the Queen’s Centre for Oncology to a repurposed 12-bed surgical ward within the main Castle Hill Hospital (CHH) building in March 2020.

Methods: A comparative review of the admissions and outcome measures data (admission diagnosis; referral source; PCAT: Patient Categorization Tool; LOS: Length of Stay; Bed occupancy and discharge destinations) over a 4-month period (March-June 2020) was undertaken and compared to retrospective data from a corresponding 4-month (March-June 2019) period in the previous year to determine the impact of the ward relocation on the delivery of specialist rehabilitation to patients with complex needs during the pandemic episode.

Results: A reduction in total number of admitted patients (n=28 in 2019; n=18 in 2020) with reduced bed occupancy from 99% in 2019 to 72% in 2020 despite a reduction in bed base was noted following the ward relocation. A shorter length of stay with a mean of 29 days was noted following relocation of the ward while an increase in patient complexity as demonstrated by the PCAT scores was observed. The proportion of patients achieving a home discharge destination as opposed to other residential care facilities increased, accounting for 89% among discharged patients.

Conclusion: This review demonstrated some of the impact of the measures implemented to combat the 1st wave of the coronavirus pandemic, specifically the relocation of the specialist inpatient rehabilitation ward in a tertiary hospital setting. Though a higher proportion of the admitted patients had increased complexity, a shorter length of stay with a significant proportion of the patients achieving a home discharge destination were observed following ward-relocation in 2020 compared to a similar quarter in 2019. The findings also reflected a reduction in bed occupancy despite reduced bed base capacity. Though there is a noted reduction in duration of stay in hospital and a greater proportion the patients achieved a home discharge destination, this was achieved with a compromise on the rehabilitation process due to the constraints of the new ward environment. Significant impact in the quality of the therapy programmes delivered was observed. The longer-term impact of this will need to be monitored. This review highlights the need for consideration of specialist rehabilitation as part of the acute response planning process in pandemic and mass casualty events.

Keywords: COVID-19; Complex Rehabilitation; Hospital service reconfiguration; Patient discharge; Acute Rehabilitation


Cases of a novel respiratory infection caused by a newly identified virus, SARS-COV-2 belonging to the coronavirus family were first reported in the Wuhan district of China and notified to the WHO on the 31st of December 2019 [1]. The disease caused by this virus was labelled COVID-19 by the WHO on 11 February 2020. A majority (81%) of those infected with the virus have a mild/asymptomatic infection whilst 14% develop moderate to severe illness that requires hospitalization. Roughly, 5% go on to develop critical illness requiring ventilatory support and management in the intensive care unit [2]. Certain health conditions increase the susceptibility to developing severe/critical illness following infection with the virus. These conditions include obesity, insulin resistance and diabetes mellitus, cancer, chronic obstructive pulmonary disease, chronic kidney disease, sickle cell disease, heart failure and immunocompromised state [3].

The first reported UK cases were identified in York within our region on the 31st January 2020 in 2 members of the same family who were visiting the UK from China [4]. Subsequently UK infection and mortality figures have increased exponentially to 284,900 confirmed cases and 44,198 reported deaths as of the 4th of July 2020 [4]. As the number of cases increase, the government introduced a range of measures to limit the spread of the infection and to ensure that health care service capacity is not overwhelmed culminating in a lockdown on the 23rd of March 2020 [4].

National guidelines were developed with the aim to create extra capacity for the anticipated surge in admissions at the peak of the pandemic. The guidelines required various bodies such as the UK National Health Service (NHS), Hospital Trusts, Clinical Commissioning Groups (CCG), and Social Services to work together in achieving this. Elective clinical activities including outpatient clinics and procedures were suspended and workforce reorganization with staff redeployment especially among clinical staff undertaken to ensure frontline services will not be overwhelmed. Additional measures include the implementation of virtual clinics with the use of telephone and video consultation facilities. Facilities reconfiguration included closure and relocation of some ward services based on the emerging evidence that some conditions increases the vulnerability to contracting and developing severe form of the COVID-19 disease.

Within HUTHT, implementation of this guidance influenced the Specialist Rehabilitation service that provides multidisciplinary rehabilitation to patients with complex clinical conditions and disabilities. The Complex Specialist Rehabilitation ward (C29) is a 15-bedded unit located within the Queens centre for Oncology and Hematology at Castle Hill Hospital (CHH). The Queens Centre for Oncology and Hematology is a self-contained detached building comprising of 5 wards, radiotherapy suites and outpatient facilities in addition to office accommodation for the oncology service. The rehabilitation ward C29 is served by a suitably equipped therapy gym located adjacent to it. This ward was vacated for the relocation of the Oncology Day Assessment Service to ward 29 while the Complex Specialist Rehabilitation ward was relocated to the Elective Orthopedic Surgical ward (C9a) within the same hospital. The aim was to ensure that patients on admission with oncological diagnosis are placed in a bubble within the Queens Centre mainly comprising of cancer-related services. Though it can be argued that the patient group served by the complex rehabilitation service fall within those vulnerable to the COVID-19 disease, a relocation to main hospital building on the Castle Hill Hospital site was non the less implemented.

A change in the rehab ward location brought drastic alterations to accommodation, with requirement on the Complex Rehabilitation Service to adapt patient rooming to satisfy the constraints of the environment. Bed numbers dropped from 15 to 12, and a 4-bedded bay converted into a makeshift ward gym. To compare the accommodation facilities between the wards, ward C29 offered 9 single occupancy cubicles, with 3 dual occupancy bays. All rooms were equipped with ensuite facilities & showers. In contrast, C9a provides 4 smaller sized single occupancy cubicles and 2 four-person bays. Within C9a there are two patient toilets in common areas, one shower room, and two cubicles equipped with ensuite toilets without showers.

This narrative aims to explore and to measure the impact of relocation of the Specialist Rehabilitation service through a review of routine outcome measures collected and submitted to the United Kingdom Rehabilitation Outcome Collaborative (UKROC). In addition, this review enabled a comparison of the length of stay and discharge destination for the periods covered. We aim to apply the findings to inform future deliberations on service reconfiguration and relocation decisions on provision of this essential service.


The UK Rehabilitation Outcomes Collaborative (UKROC) is a national database developed to collate inpatient case episodes for patients admitted to UK Rehabilitation services [5]. The HUTHT Complex Rehabilitation Service is a member of the collaborative and submit basic monthly data on admissions and outcome measures (PCAT, RCS and FIM/FAM) to the UKROC.


Patient Categorisation Tool (PCAT) is a clinical checklist document completed on admission to a rehabilitation service, detailing specific scoring criteria relating to the overall clinical impression of patient needs (ranked in order of reducing severity as A, B or C). This helps inform the level of rehabilitation service designated as levels1, 2 or 3 in order of decreasing specialization required based on the British Society of Rehabilitation Medicine (BSRM) service standards [6]. PCAT was originally designed to provide a descriptive measure of patient needs, it has since been refined for use as an ordinal tool in associating rehabilitation needs to patient pathology [7].

Materials and Methods

Admissions and outcomes data were collected in the first four months of the HUTHT Complex Rehabilitation Service relocation to C9a (March-June of 2020), a period coinciding with the 1st peak of coronavirus infections and hospital admissions for COVID-19 in the UK [4].

To contextualize this information, the C9a data was compared with retrospective data from the corresponding period in 2019 from C29 (previous ward). Direct comparison of patient discharge data allowed the team to examine length of stay and patient complexity in two equivalent periods.


Admissions data

Data was obtained from the records of a total of 47 patients (n=29 [21 males: 8 females] in the March-June 2019 cohort; n=18 patients [12 Males; 6 Females] admitted from March-June 2020) (Table 1).