Prone And Mobility Team Works To Improve COVID-19 Patient Outcomes

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A physical therapist by training, Kelly Rund is used to working in the outpatient world, without the lines, tubes and monitors that are fixtures of a hospital room.

The coronavirus (COVID-19) pandemic has changed things.

Rund is one of 36 physical therapists, physical therapy assistants, occupational therapists and rehabilitation aides redeployed to work with COVID-19 patients on Anne Arundel Medical Center’s (AAMC) medical/surgical units as part of the new Prone and Mobility team.

Six members of the team are working in AAMC’s intensive care unit.

The program has two components. Staff members are trained to “prone” patients, or place them on their stomachs. The process takes about an hour and helps mitigate COVID-19 symptoms and increase the amount of oxygen they are getting into their lungs. They are also trained to assist with patients’ mobility, helping them walk around their rooms and do other activities to keep them moving.

Rund, who normally is based at Anne Arundel Medical Group (AAMG) Physical Therapy’s Edgewater office, said the program has given her an opportunity to support patients emotionally as well as medically. It’s nice for them to see a friendly face, even if it’s hidden behind masks and face shields, she added.

“I feel very thankful just to be someone who can be in there and sit with them,” Rund said.

Christy Wu, AAMC’s inpatient physical therapy manager, said the program began at the start of the pandemic. Clinic staff members were originally redeployed to help patients with their mobility, which decreases their fall risk and the likelihood that they’ll have to return to the hospital. But there was a growing need to have clinical staff on hand to prone position patients.

Studies have shown that prone positioning could lead to improved outcomes for patients who are on ventilators. Doctors at hospitals in New York and Massachusetts have seen improvements when COVID-19 patients are placed in the prone position.

“You definitely see a difference when you get these patients off of their backs,” said Clarisse Labor, a physical therapist with AAMG Physical Therapy’s Bowie North office.

Each team member is trained to do both prone positioning and mobility – it just depends on what and where the need is. AAMC already had mobility training in place for nursing staff and has adapted prone positioning training from Massachusetts General Hospital.

“They have amazing clinical skills, and we are putting them where they are needed and helping to support the nursing units,” Wu said. “We’ve had really great feedback from the nursing directors.”

From the beginning to the middle of May, the team prone positioned 150 COVID-19 patients, Wu said.

Rund and Labor said their colleagues in the hospital have been supportive and eager to show them the ropes.

“It’s been several years since I worked in acute care, and it’s definitely different than outpatient,” Labor said. “But the nurses and therapists have been very helpful, and I definitely felt welcomed. I feel fortunate that I am still able to help in these times.”

Elizabeth Bailey, clinical supervisor on the observation unit, added that the team has gone above and beyond their assigned duties.

“Today I watched a special needs patient on our unit just beam with pride as they encouraged her, telling her how well she was doing,” she said on May 14. “They assisted other patients with ambulation to the commode, and even changed briefs and bed linens as they worked with the patients. This was not expected or even asked of them – they wanted to do it.”

Christie Thibeault, nursing manager on the observation unit, praised team members for providing an extra set of hands in an extremely busy time. Thanks to the team, nurses can stay focused on other aspects of care.

“They have just been phenomenal support for our nursing staff, and have improved the quality of patient care tremendously,” Thibeault said.

A former ICU and trauma nurse, Thibeault has long been familiar with the benefits of prone positioning and she’s eager to dive more deeply into how it’s improved COVID-19 patient outcomes post-pandemic.

“There’s so much that should come out of this,” she said. “Did it decrease their length of stay? Did it prevent them from going on a ventilator?”

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