UOHI Cardiovascular Rehabilitation During The COVID-19 Pandemic: Using Virtual Models to Provide Best Practice Care
Bonnie Quinlan, Director, Prevention & Rehabilitation
Dr. Thais Coutinho, Cardiologist, Chief, Cardiac Prevention & Rehabilitation, Chair, Canadian Women’s Heart Health Centre
Jennifer Harris, Manager, Out-Patient Cardiovascular Rehabilitation and Regional Outreach Programs
The COVID-19 pandemic has impacted the physical, mental and emotional health of all UOHI patients, families and staff. Despite this impact, cardiovascular disease remains the leading cause of death in Canada and around the world. Cardiovascular rehabilitation (CR) helps prevent recurrent heart events and is known as an effective strategy to reduce death and hospital re-admissions. Importantly, CR also improves quality of life of our patients. During the COVID-19 pandemic, CR programs across Canada suspended in-person, on-site services due to required infection control measures to reduce disease transmission, and also because of CR staff re-deployment to cover other hospital areas. These changes had implications for significant negative effects on patient’s cardiac recovery and health outcomes. After a heart event, patients need the multi-disciplinary support that CR provides as soon as possible – even more so during times of uncertainly. To ensure our patients access to CR care was not impacted, the University of Ottawa Heart Institute’s Cardiac Prevention and Rehabilitation Program quickly moved to providing all patients with access to state of the art, best practice virtual CR care.
Virtual Program Challenges
UOHI has a long history (20 + years) of providing virtual CR care, but even for the much smaller number of patients who accessed this type of rehabilitation, a part of the program remained in-person such as obtaining physical measurements (blood pressure, heart rate) and physical baseline assessments. With the announcement of the COVID-19 pandemic, we were forced to quickly shift to a full virtual CR practice. With this change, came the question: could we do all this as effectively from home, for all patients? The team also had to consider the impact of providing virtual care to some patients who were already facing health inequities, such as those without access to mobile devices or the internet, patients requiring an interpreter, and marginalized populations. In addition, did staff have the digital literacy required to provide this care so quickly? The answer to all these questions is – yes! With a determined and motivated CR team, amazing support from our IT department and strong senior management leadership, the team moved to providing a comprehensive virtual cardiac rehab program almost overnight!
New Virtual Cardiac Rehabilitation Program
All patients referred to CR, even during the lockdown periods, continued to be contacted and provided with a virtual (phone/ video) visit with the CR team. They also identified patients who still required to be seen on-site, as the benefit to this in-person visit outweighed the potential risks. CR leaders worked closely with infection control practitioners to ensure that patients and staff were safe during the on-site visit. The team developed two new Virtual Education Series (Cardiovascular and Heart Failure) using the technology provided with our new electronic health record (EPIC). This allowed patients with access to their MyChart record to attend their CR education and exercise sessions from the comfort of their homes. Patients also had the opportunity to bring along a partner or caregiver to the sessions. To ensure that patients without devices or technology could access these sessions, patients were provided with a tele-conference option as well. Every patient continued to have access to individualized care as well with their primary case manager or mentor.
The team held patient focus groups to provide input into the content developed for every session, as well as providing a patient survey upon completion of CR to further understand how the program can be improved.
Due to the new efficiencies identified by our team in the implementation of virtual CR during the pandemic, not only was our CR program the only one in the entire province of Ontario that never stopped taking patients, but we were also able to grow our CR patient volumes by over 25% and CR enrollment rates by 11%. At this time, we are providing CR services to more patients than ever before!
As life gets back to our ‘new normal’ we are offering patient education and exercise classes back at the Heart Institute, while continuing to ensure patient and staff safety. The virtual program options continue to be a very popular options for our patients and often they combine with on-site classes, using a hybrid approach to CR care.
What is most important of course, is the patient feedback received from these new virtual programs:
“ Very well thought out program, informative, and comprehensive.”
“ I feel that everyone really cared, it wasn’t just a job”
“ It changed me in so many ways. The weekly exercise gave me confidence as well as the education sessions. I can do more for myself and it was helpful to see others(on zoom) that were in the same boat. “
“ No need to use the awful parking, that was one of the best things”
As difficult as the COVID-19 pandemic has been to the healthcare system and its providers, the silver lining was the pandemic’s ability to catalyze positive changes in healthcare. The growth of our virtual CR program in the face of adversity is a testament to the commitment and adaptability of our CR team, and the trust and support of our patients.