Inside a Covid-19 community assessment hub

‘We will probably get more cases as restrictions lift’, clinical co-ordinator says

 Clare Fehin, Speach and Language, Joe Keena, GP, Martina Nolan, Physiotherapist, Siobhan Harnett, GP Registrar, Premnath Margabandhu, Senior Physiotherapist, Phillip Sheeran Purcell, GP Lead, Catherine Whitty, Hub Clinical Coordinator, Oonagh Murphy Asst. Dir of Public Health Nursing, Geraldine Nolan, Public Health Nurse, Meadhbh Larkin, Speach and Language Therapist at the Wicklow Community Assessment Hub in Wicklow town.  Photograph: Alan Betson

Clare Fehin, Speach and Language, Joe Keena, GP, Martina Nolan, Physiotherapist, Siobhan Harnett, GP Registrar, Premnath Margabandhu, Senior Physiotherapist, Phillip Sheeran Purcell, GP Lead, Catherine Whitty, Hub Clinical Coordinator, Oonagh Murphy Asst. Dir of Public Health Nursing, Geraldine Nolan, Public Health Nurse, Meadhbh Larkin, Speach and Language Therapist at the Wicklow Community Assessment Hub in Wicklow town. Photograph: Alan Betson

 

Thomas, a healthcare worker in a Dublin long-stay hospital, tested positive for Covid-19 four weeks ago and stayed off work for two weeks. When he returned to work, he felt better, but, the following day, he felt very tired with chest tightness and his cough had returned. “I talked to my GP who couldn’t bring me into his surgery because he has a lot of vulnerable patients so he got me a same-day appointment at the Covid-19 community hub in Wicklow town,” explains Thomas lives in Bray.

On arrival, he was checked out by the medical team. “Thankfully, I was fine and it was all done in a few minutes. My GP has put me on antibiotics because maybe I’ve a secondary infection after the virus. I can’t go back to work until I have another test so I’m off work for another two weeks,” he explains.

Adele, who had a bad cough for three weeks, attended the same community hub. “My GP gave me an appointment at the hub. I was assessed and told I was okay to go back home.” She had previously tested negative for Covid-19 in mid-March. “At that stage, I stayed in hospital for one and a half days. I came home and the cough went away, but two weeks later it came back.”

Meanwhile, her husband is gone back to work after two weeks of self-isolating due to his wife’s symptoms. “There are six people in my house and no one else is sick, but I’m in limbo (because she hasn’t got her results yet). I feel everyone is so concerned about Covid-19 that every other issue is put aside. You almost want to have Covid-19 to justify being sick. Still, I’m not brave enough to go out and do the shopping because it’s scary for other people to hear me coughing.”

The medical staff at the Wicklow town Covid-19 community assessment hub says there isn’t a typical patient since the hub opened in mid-April.

On the afternoon when I visit, there aren’t any patients at all. “The hubs were set up to get ahead of a problem perceived to be coming down the line,” explains Dr Phillip Sheeran-Purcell, the GP-lead of the Wicklow Covid-19 community hub. “We’ve flattened the curve so there aren’t so many sick people in the community. We have still seen four or five patients who were scarily unwell – but weren’t aware of it –- who we had to send to hospital by ambulance.”

The Wicklow Community Assessment Hub in Wicklow town. Photograph: Alan Betson
The Wicklow community assessment hub in Wicklow town. Photograph: Alan Betson

Infection control is a high priority for staff and patients who attend the community hubs. “We get the patient’s details from their GP and ask them any extra questions by phone before they come into the assessment hub to minimize the contact time,” explains Dr Sheeran-Purcell. Patients are then given a mask at the door and asked to sanitize their hands. “We check their breathing, oxygen levels, blood pressure, pulse, temperature and general alertness. Appointments are kept strictly to 10 minutes to minimize infection spread and staff members speak to patients at a distance when not examining them”.

All medical staff wear full PPE (with an extra set of gloves and a disposable apron for each new patient) when seeing patients in one of three assessment rooms. Rooms are rotated for use and disinfected after each patient. All re-usable equipment is decontaminated and put in sterile bags for re-use on subsequent patients.

The medical staff I meet say they aren’t worried about picking up the virus themselves while on duty. One says it’s probably more likely they would pick it up in a supermarket than at an assessment hub. The staff at the Wicklow hub have their temperature checked twice a day and self-report if they have any symptoms at the beginning of a shift.

“Some patients are very anxious but relieved and happy to have a thorough assessment. Most of them go back home and are able to manage,” says Premnath Margabamdhu, a senior physiotherapist who works alongside the doctor on duty. Patients are given healthcare advice and a self-care leaflet after their appointment.

Following the assessment, the medical staff decides whether the patient needs to return home, go to a self-isolation facility or an acute hospital. “We see if they are stable or not and if they can self-isolate at home or not. If they are vulnerable, the self-isolation unit in the City West Hotel is an option although we haven’t sent anyone there yet,” explains Dr Sheeran-Purcell. If a patient is clearly sick, he/she is sent straight to St Vincent’s University Hospital by ambulance.

Catherine Whitty is the clinical co-ordinator at the Wicklow community assessment hub. She says the hub will stay open for at least another 15 weeks. “We will probably get more cases as restrictions lift and GPs get busier with other patients. It is important people know we are here so people don’t travel to hospital without being seen first. And it’s reassuring for non Covid-19 patients who want to attend their GPs,” she says.

Dr Sheeran-Purcell adds, “There are a lot of GPs working on their own who are at risk [of getting Covid-19] so we can give the physical check up to enable these GPs to function.”

Oonagh Murphy, deputy-clinical lead says that transport can be arranged for anyone who can’t get to an assessment hub.

The Wicklow community assessment hub has a clinical staff of 10 on duty at any one time. These include the GP on duty working with a nurse or physiotherapist, the clinical co-ordinator and deputy clinical lead and an administrative team of speech and language therapists/physiotherapists all seconded from routine work cancelled during the Covid-19 crisis.

Acknowledging that numbers attending the hub has been quite low so far, Dr Sheeran-Purcell draws an analogy to fire-fighting. “You don’t want all the fire brigades out at one time in case there is another fire. We just don’t know what will happen next in the community.”

Overall, Dr Sheeran-Purcell says that the Covid-19 pandemic is an opportunity to reassess our medical system and do things differently. “Maybe, there will never be waiting rooms in GP surgeries again – which might be a good thing. Also, there has been an accelerated adoption of video appointments at GP level which works very well for some things. And I hope there is a reset button on the health system so we don’t build up long waiting lists for outpatients appointments after this crisis is over.”

What exactly are Covid-19 community assessment hubs?

In mid- April, the HSE and the Irish College of General Practitioners set up 29 Covid-19 community assessment hubs across Ireland. Aimed at people who had tested positive for Covid-19 or were presumed to have Covid-19, the GP-led service offers free face-to-face appointments for those referred by their own GP on a same day or next day basis. By Wednesday, May 13th, 2,232 people were seen at the hubs.

The idea behind the service is to offer suspected or confirmed Covid-19 patients the support and reassurance on how to manage their illness at home - or pick up on cases where hospitalization is needed. Patients who attend the hubs are either asked to return home, to stay at a self-isolation facility if they can’t self-isolate successfully where they live or are sent to an acute hospital.

The City West Hotel is the self-isolation facility that most people are sent to if they don’t have a suitable place to self-isolate. Around 200 people have already completed their period of self-isolation and have returned to their own homes since mid-April.

From a health system perspective, the community assessment hubs allow GPs get back to seeing their normal cohort of patients - without the fear of patients picking up Covid-19 at their surgeries. The hubs also allow patients to be assessed face-to face to give GPs an alternative to sending patients to an acute hospital without seeing them in person.

Dr Nuala O’Connor, ICGP lead on Covid-19 says that initial plans were to open 40 community assessment hubs to prepare for a surge and stop Emergency Departments becoming overwhelmed but only 29 have been opened so far. “We didn’t get that surge but we could have mini-waves of Covid-19. Having the hubs also restores confidence in general practice and out of hours doctors services so people know it’s safe to go there with other health problems. The hubs will be needed in the next few months and are an important layer in the [pandemic response] even if we don’t need their full capacity yet.”

Coronavirus Assessment Hubs – where are they?

  1. Letterkenny       
  2. Ballinagh, Co. Cavan       
  3. Castleblaney, Co. Monaghan       
  4. Ballytivnan,  Co. Sligo       
  5. Galway City       
  6. Castlebar       
  7. Castlerea       
  8. Limerick City        
  9. Shannon       
  10. Roscrea       
  11. Cork City       
  12. Kilcreene, Co. Kilkenny       
  13. Waterford City        
  14. Wexford  Town       
  15. Dublin Cabinteely       
  16. Dublin Clonskeagh       
  17. Wicklow Town        
  18. Dublin Clondalkin       
  19. Dublin Tallaght       
  20. Dublin Rialto       
  21. Naas       
  22. Dublin 7       
  23. Athlone       
  24. Drogheda       
  25. Slane, Co. Meath       
  26. Longford  Town       
  27. Portlaoise       
  28. Dublin Glasnevin        
  29. Dublin Raheny    
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