PM&R News   •   March 18, 2020

Dear PM&R Colleagues,

These are challenging times indeed, but there is no better group than physiatrists to rise as leaders during the COVID-19 pandemic. We have a diverse understanding of medicine, debility, and rehabilitation. Due to our breadth of knowledge, we can help guide our hospitals in developing protocols for safety and recovery. While there are CDC guidelines being released multiple times throughout the day, there is a lack of clear guidance for protecting patients and staff in rehab units. As an inpatient rehabilitation medical director, current recommendations did not fully apply to inpatient rehabilitation in best preventing COVID-19 exposure in a high risk patient population. Therefore, we developed a protocol to prevent COVID-19 spread that is specific to inpatient rehabilitation. We felt this was important to share in order to give direction to our fellow units.

Covid-19 Inpatient Rehabilitation Safety Protocol

1. Screen new admissions for Covid-19 within 24 hours and prior to admission to the rehabilitation unit.
2. Check temperatures on every visitor, staff, and physician that enters the building.
   • If this cannot be achieved, we recommend checking every individual that enters the rehab unit immediately (physicians, residents, nurses, dietary, administration, etc).
   • Keep a log to include: date, time, name, temperature reading, symptoms (dry cough, sputum production, shortness of breath) and reason for visiting.
     • The Rehab Director files the log daily. Visitors with fever or symptoms may not enter the unit.
3. Only one visitor per patient.
   • Visitors allowed only for family training.
4. Anyone that goes into a patient room for treatment should wear level 1 mask and use hand sanitizer, then put on gloves.
   • When leaving, dispose of gloves in the room and use hand sanitizer/wash hands.
5. OT and SLP sessions are performed in the patient rooms. Utilize gym space for PT, but patient must follow at least the 6 foot rule.
   • Disinfection after use is imperative and should be kept in a log.
6. Keep patient room doors closed at all times.
   • Consider opening windows for ventilation if possible.
7. Consider any fever COVID-19 until workup complete.
   • Follow CDC recommendations for initial management.
   • Monitor regular labs
   • Check temperature every 6 hours
8. Level 1 masks for staff and patients to be worn at all times.
9. Expedite discharges home appropriately to keep post-acute care beds available and reduce strain on acute hospitals.

Please send us any feedback (see email/social links below) on what you may be doing in your PM&R program to help protect patients and staff from COVID-19 outbreak on the inpatient rehabilitation unit. Any additions we feel appropriate, we will add to the list and give you full credit for the suggestion.

Please stay safe.