Research Spotlight: COVID-19 Clinical and Research Studies at North York General Hospital

NYGH has launched several COVID-19 clinical and research studies, involving multiple frontline physicians and staff members from different programs across the hospital to advance our understanding and ability to treat this virus. Dr. Monika Kastner, Research Chair in Knowledge Translation and Implementation, Dr. Katie Dainty, Research Chair in Patient-Centred Outcomes, and Dr. Rohit Mohindra, a physician in the Charlotte & Lewis Steinberg Emergency provide a snapshot of their COVID-19 studies, as well as their thoughts on the future of this disease.

Dr. Monika Kastner – Social frailty interventions that can best support vulnerable older adults during the COVID-19 pandemic: A rapid review

This study was recently awarded a Canadian Institutes of Health Research (CIHR) COVID-19 Rapid Research Funding.

• Could you tell us a bit about the COVID-19 study you are performing?

Social vulnerability represents some of the greatest challenges to the care of older adults and the health care system today. Imagine an older adult with a history of stroke and recent hip fracture who needs help with transportation and heavy housework but doesn’t have any family supports or adequate financial resources to carry out these activities of daily living; they become socially isolated or unable to leave their home. Now imagine how this older adult might cope with public health emergencies such as the COVID-19 pandemic (or other infectious disease outbreaks such as the flu) that may require isolating and distancing measures. Such policies could have important negative consequences for socially frail older adults, particularly if in place for an extended period of time. Our work will address the urgent need to support socially frail older adults in our community. Via a rapid scoping review and a realist review we will generate knowledge for decision makers about which intervention can help reduce, reverse or prevent social frailty during difficult and stressful situations such as the COVID-19 pandemic.

• What is the importance of your COVID-19 study within our community/hospital setting?

Our proposal and anticipated findings have the potential to: (i) inform clinical and policy decision makers of social frailty interventions that can reduce, reverse or prevent social frailty in vulnerable older adults and how they can be adapted to difficult situations such as the COVID-19 pandemic or other disease outbreaks requiring similar public health restrictions; (ii) elucidate our understanding of social frailty and how it intersects with physical and psychological frailty, currently not well understood and studied; and (iii) advance the methods of conducting combined reviews/rapid reviews to more quickly address public health questions and challenges.

Drs. Katie Dainty and Rohit Mohindra – Understanding Patient Experience of a Follow-up Clinic for High-Risk Patients with COVID-19

This study was recently awarded an Exploration Fund grant with funds from the North York General Foundation’s North York General Emergency Response Fund for the COVID-19 Pandemic.

• Could you tell us a bit about the COVID-19 study you are performing?

Access to follow-up care during the pandemic can be challenging because of unavailability of physicians, childcare constraints, employment obligations, difficulty using public transport or fear of exposure. Given the increased risk of loss-to-follow-up during the pandemic and the uncertain prognosis of the disease, North York General Hospital (NYGH) developed a telephone follow-up program for high-risk patients who present to the Emergency Department or Branson COVID Assessment Centre. Patients who do not have access to primary care follow-up, have multiple coexisting medical conditions, are highly symptomatic but did not meet admission criteria, or are from a vulnerable population are identified by clinicians or nurses for referral. Telephone follow-up is then conducted by the clinic team, consisting of members of the NYGH Family Health Team. The objective of this qualitative pilot study is to evaluate this program from the perspective of patients in order to understand if the program had a meaningful impact on their experience of care and disease course.

• What is the importance of your COVID-19 study within our community/hospital setting?

Even before the COVID-19 pandemic, arranging follow-up care after emergency department visits for certain populations could be difficult. Follow-up care is typically done by the patient’s family doctor or a specialist if necessary. The results of this study will help us to develop quality improvement tools and compare our telephone follow-up program to others around the city. Most importantly, we can ensure we are meeting the needs of our most vulnerable patients during this challenging time.  There has yet to be a published description, from the perspective of the patients, of the impact of such a follow-up clinic. As we move to the future and prepare for a possible second wave of COVID-19 patients, it will be important to understand the patient experience of this new type of clinic in order to ensure it meets their needs and improves their care.

• How do you see the future of COVID-19?

COVID-19 and the threat of future pandemics is our new reality and as such we need do adapt and build resilient systems so that we can continue to serve our patients and their families with the best care possible.  Coronavirus, like climate change, is partly a problem of our existing structures and so to tackle Coronavirus we must step back and be willing to reset those structures in a major way.