A Return to Well Being ~ The Post-COVID Assessment and Recovery Clinic at Penn Medicine

Figure 1: Radiograph of the right proximal femur showing high-grade osteosarcoma.
Figure 1: Radiograph of the right proximal femur showing high-grade osteosarcoma.

 

Rehabilitation specialists at Penn Medicine have created a Post-COVID Recovery Clinic to address the unique needs of patients with a history of COVID-19.

Certain individuals who have recovered from active COVID-19 infection continue to have difficulties in physical, emotional and cognitive functioning.1 This includes multifaceted lingering health effects and an overall worsened quality of life. Given the novelty of COVID-19, the exact nature of these ongoing health effects remains uncertain.

Given the novelty of COVID-19 and the heterogeneity of its effects, the character of these ongoing deficits have yet to be fully characterized. What is better understood is that cohesion of care becomes critical to continued patient recovery.

To address these issues, Penn Medicine has created a multidisciplinary Post-COVID Assessment and Recovery Clinic to screen, assess, treat, and provide referrals and resources for patients recovering from COVID-19.

This initiative is led by specialists from Penn Physical Medicine & Rehabilitation (PM&R), whose experience with coordinating care for patients with complex medical illnesses allows a position of experience and oversight for the seamless management of COVID-19 patients’ many needs.

Case Study

Ms. D, a 57-year-old female with a previous medical history of asthma and diabetes, woke up on 5/2/20 with high fever and cough. She presented to her local hospital where she was admitted after testing positive for COVID-19. She temporarily needed supplemental oxygen and was observed in the hospital for 5 days, then discharged back home.

On 5/11/20, Ms. D returned to the emergency room with worsening dyspnea, and was admitted and treated for bacterial pneumonia. She was discharged back home again one week later with home health services.

More than six weeks later (06/22/20), Ms. D presented to the Post-COVID Assessment and Recovery Clinic with profuse sweating, orthostatic hypoxemia, poor endurance, insomnia and brain fog. She also had dyspnea on exertion to the point that it limited her return to work, and reported oxygen desaturation to 94% at home.

Because Ms. D was tested for COVID-19 during her initial hospitalization, there was no need for additional testing at this time. She was screened for cardiac, pulmonary, psychological, cognitive, pain, and functional issues.

Based on her screening, she was referred to a pulmonologist and physical therapist associated with the Post-COVID Clinic to begin a structured pulmonary and physical rehabilitation program. She was also trained in sleep hygiene, prescribed a gentle sleep medication, and given a follow-up appointment to reassess her function.

At her on-month follow-up visit, Ms. D reported improvement in her functional symptoms. She remains under the care and observation of her primary care provider.

The Assessment Process

The Clinic is open to all patients post-COVID whether or not their symptoms are a clear and direct manifestation of COVID. On entry, patients are evaluated to determine their personal, health and rehabilitation needs, including, but not limited to, the frequently reported issues noted below:

  • Autonomic function
  • Pain
  • Hypercoagulability
  • Weakness and poor endurance
  • Impaired renal function
  • Critical illness myopathy/polyneuropathy
  • Residual pulmonary manifestations
  • Psychological issues: PTSD, insomnia, anxiety and depression
  • Cognitive impairment
  • Myocardial injury
  • Progression of chronic issues
  • Impaired daily function and mobility

Upon completion of assessment, clinical needs are identified and PM&R will:

  • Recommend or provide rehabilitation management
  • Consult patient’s PCP to coordinate care
  • Triage patients to appropriate partner specialists based as needed and coordinate same day appointments when possible

Penn Post-COVID Recovery Clinic patients will be followed over time in order to address new needs as they emerge. In addition, this clinic will serve to create a registry to accurately track important clinical data for a disease about which little is known.

How to Refer

For clinical questions, referral, and scheduling, please contact the Clinic at 215.893.2668 or by FAX at 215.893.2686.

Access

Penn Institute for Rehabilitation Medicine
Penn Medicine Rittenhouse
1800 Lombard Street Philadelphia, PA

Penn Medicine Cherry Hill
1865 E Route 70 Cherry Hill, NJ

Penn Medicine Radnor
145 King of Prussia Road Radnor, PA 

Download PDF

References

1. Carfì A, Bernabei R, Landi F, et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-605.

About the Post-COVID Assessment and Recovery Clinic at Penn Medicine

The multidisciplinary Penn Post-COVID Assessment and Recovery Clinic was created to screen, assess, treat, and provide referrals and resources for patients recovering from COVID-19. These patients will be followed over time in order to address new needs as they emerge. In addition, this clinic will serve to create a registry to accurately track important clinical data for a disease about which little is known.

Penn Faculty Team

Benjamin Abramoff, MD, MS
Director of Spinal Cord Injury Program
Assistant Professor of Clinical Physical Medicine and Rehabilitation

Franklin Caldera, DO
Associate Professor of Clinical Physical Medicine and Rehabilitation

Joel L. Deitz, MD
Medical Director, Medical Intensive Care Unit
Clinical Associate Professor of Medicine

C. Jessica Dine, MD, MHSP
Associate Dean for Faculty Development
Director, Section of Advance Pulmonary Consultation
Associate Professor of Medicine at the Hospital of the University of Pennsylvania

Denis Hadjiliadis, MD
Program Director, Adult Cystic Fibrosis
Physician Leader, Advanced Lung Disease Research Group
Paul F. Harron, Jr. Associate Professor

Janae K. Heath, MD, MSCE
Associate Program Director, Internal Medicine Residency Program
Assistant Professor of Medicine at the Hospital of the University of Pennsylvania

Matthew Craig Hyman, MD, PHD
Assistant Professor of Medicine at the Hospital of the University of Pennsylvania

Robert M. Kotloff, MD
Director, Harron Lung Center
Craig and Elaine Dobbin/Nancy P. Blumenthal Professor of Advanced Lung Disease

Jason Pan, MD
Assistant Professor of Clinical Physical Medicine and Rehabilitation