ROLE OF REHABILITATION DEPARTMENT FOR ADULT COVID-19 PATIENTS: THE EXPERIENCE OF THE SAN RAFFAELE HOSPITAL OF MILAN

Iannaccone, Sandro; Castellazzi, Paola; Tettamanti, Andrea; Houdayer, Elise; Brugliera, Luigia; de Blasio, Francesco; Cimino, Paolo; Ripa, Marco; Meloni, Carlo; Alemanno, Federica; Scarpellini, Paolo

Abstract The rapid evolution of the health emergency linked to the spread of SARS-CoV-2 requires specifications for the rehabilitative management of COVID-19 patients. The symptomatic evolution of COVID-19 patients is characterized by two phases: an acute phase in which respiratory symptoms prevail, and a post-acute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions as well as cognitive and emotional disorders. There is thus the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan (Italy) and recommends the set-up of specialized clinical pathways for the rehabilitation of COVID-19 patients. In this hospital, between February 1st and March 2nd 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (Intensive Care/Infectious Diseases). In the following 30 days, from March 2nd to mid-April, despite the presence of 60 daily arrivals to the ER, the organization of patient flow between different wards was modified and several different units were created based on a more accurate integration of patients’ needs. According to this new organization, patients were admitted first to acute care COVID-19 units, and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists and nutritionists.