Mid-year update (Zoe vanWilligen, Rachel Devlin, Fi Hall):

What a year it has been since we received our Q award! While much learning has been undertaken and progress made towards the execution phase of our project, it has been significantly delayed for a number of very valid reasons:

1.      We are primarily a clinical team at University Hospital Southampton (UHS) with patient caseloads on ICU. As such the first few months of 2021 were all-consumed by the peak of the COVID pandemic.

2.      Our original project was for a gym-based programme. Despite our best efforts in the design and in engaging with relevant stakeholders (patients, relatives, clinicians and the UHS Trust Quality Committee), it became clear that a face-to-face class approach was not feasible in the current climate.

3.      We had to go back to the drawing board- we have since decided to run the programme virtually. We have made many links with teams nationally and internationally who deliver virtual rehabilitation classes for other health conditions. The learning from this has been hugely useful, but time consuming.

While this complete design change initially seemed like a setback, we now feel that it is actually a very positive step. Our bid for funding was based on a previous face-to face pilot class, pre-pandemic. If we now deliver the same class virtually, we will be able to compare the two to see what works best for our population of patients. Additionally, the design fits the principles within the NHS Long Term Plan for digital transformation. We have consulted our patients and their families during our virtual ICU peer support program, and they anticipate potential benefits for virtual classes; no transport/ parking issues and the convenience of being in their own home while still benefitting from ‘group’ support.

Our achievements to date:

1.      Patients are being ‘screened’ for entry into the EMPOWER programme, through our virtual ICU follow up clinic.

2.      We have made links with our trust’s digital team for the most appropriate online format and engaged with colleagues running virtual classes for other health conditions within UHS for their ‘top tips’.

3.      Social media and national conferences have been utilised to network with peers who have also made the leap to the virtual world.

4.      A suitable venue for online classes has been located, and safe numbers/ skill-mix of staff have been costed into the award fund.

5.      We have visited and observed a local virtual pulmonary rehabilitation class, who were kind enough to share their practice and resources with us.

6.      We are in regular contact with a successful international online health platform (BEAMfeelgood) who have also shared their wisdom around risk assessments and data collection/ evaluation for online exercise classes.

7.      The patient support hub- a voluntary service at UHS- have been in touch and are happy to help us address any digital inequalities- delivering devices, explaining use of technology and even accompanying patients while they exercise if they live alone. They are also willing to help patients complete our pre and post programme assessments, plus anything else that is required to ensure inclusivity.

8.      Some of the Q award fund has been used to purchase IPADs for patient use. We are also looking into the necessity for purchasing finger oxygen saturation probes too.

9.      We are in contact with national ICU support websites ‘criticalcarerecovery.com’ and ‘ICUsteps.org’. We already signpost patients towards these and hope to be able to collaborate more with them in the future.

10.  The EMPOWER programme has been included within the UHS NEW (nutrition, exercise and wellbeing) centre initiative, to ensure a coordinated approach to rehabilitation service improvement and research within our trust.

11.  The patient experience team at UHS have kindly redesigned our patient and relative questionnaires for before and after the EMPOWER programme.

12.  We have engaged with the National Rehabilitation Collaborative (NRC) working group of the Intensive Care Society, who have asked us to keep them posted on our progress.

Still to be completed prior to execution of the EMPOWER rehabilitation classes

1.      We would like to incorporate some GP education into this fund- the practicalities of this are still being discussed.

2.      The NRC have asked that we try to incorporate the screening tool ‘Post ICU presentation screen – PICUPS’ into our project. We are currently looking into the feasibility of this.

3.      Once the design and start date are finalised, we need to timetable and cost our key MDT speakers into the education sessions.

We have attended several of the Q evaluation and action learning sessions and have found these to be both inspiring and thought provoking. They have provided opportunity for shared learning which has stimulated problem solving within our own project. While it has been challenging designing a new service at the height of a pandemic, it has certainly been a unique and valuable learning opportunity for us all!