Expectation versus reality: the impact of a COVID outbreak on subacute inpatient Aged Care Allied Health service delivery

Ms Jacqueline Kay1, Rose Goonan1, Michelle Middlewick1, Alana Jacob1

1Melbourne Health, Parkville, Australia

Describe the difference between anticipated and actual service delivery during the COVID-19 pandemic.

Retrospective audit of clinical preparation strategies for COVID-19, with analysis of positive cases during an outbreak in a subacute setting of a tertiary health service in metropolitan Melbourne. A multimodal approach was taken to plan, respond and mitigate risks associated with COVID-19, including the development of clinical practice guidelines for Physiotherapy, Occupational Therapy and Social Work (focussing on the rehabilitation and recovery from an acute COVID-19 infection). Retrospective analysis was completed for the outbreak with positive cases and associated outcomes reported descriptively. The differences between clinical preparation and outcomes was then explored.

In July/August 2020, patients (n=106) were acutely diagnosed with COVID-19 with 31 transferred from Residential Aged Care Facilities (RACF) following multiple outbreaks. Four wards (104 beds) were closed due to environmental constraints and two wards remained ‘hot’ (covid-positive wards). Analysis was completed for 89.6% (95/106) of the positive patients. 89.5% (85/95) were symptomatic including: 46.3% (44/95) respiratory, 16.8% (16/95) fever, 16.8% (16/95) neurological and 9.4% (9/95) gastrointestinal symptoms. Mortality: Aged Care 36.8%, Transition Care 25.7% and RACF 32.3%. Despite clinical preparation for COVID-19, the presentation of symptoms and mortality during an outbreak in older patients significantly impacted Allied Health clinician’s ability to provide rehabilitation and discharge planning.

Allied Health clinicians were required to change their initial planned approach to meet the unique clinical demand of acute COVID-19 in older inpatients in a subacute setting. A palliative approach to patient-centred care was required as opposed to the rehabilitation focus initially planned for, with higher cohort rates of symptoms and mortality than community.


Jacqui Kay is the Grade 4 Clinical Lead Physiotherapist for Aged Care at the Royal Melbourne Hospital (RMH) subacute campus. Jacqui has a passion for Physiotherapy management for those with chronic diseases and vulnerable populations, and team culture amongst Physiotherapists, and has completed extensive work in these fields during her career both in Australia and the United Kingdom.

Jacqui has completed a Master in Health Services Management, an Advanced Practice Physiotherapy in Diabetes role, presented at national and international conferences, and most recently has been successful in a grant to evaluate increased Allied Health staffing on a newly established Acute Care of the Elderly unit.

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