By Kate Hunger
Research has shown that turning COVID-19 patients onto their stomachs for a number of hours can help improve lung function and decrease mortality — but the process requires a specially trained team and a significant amount of time.
To help meet the need locally, School of Health Professions students are participating in patient positioning, or proning, teams for COVID-19 patients in intensive care at University Hospital. About 45 students from the Departments of Physician Assistant Studies, Occupational Therapy, Physical Therapy and the Division of Respiratory Care have joined in the effort, which began mid-January.
Properly positioning patients, many of whom are on ventilators, is a delicate process that takes a team at least 30 minutes to perform, said Tiffani Burgin, MPAS, PA-C, assistant professor and clinical coordinator in the Department of Physician Assistant Studies. Burgin is coordinating student participation and training. She previously supervised second-year physician assistant studies students who assisted with positioning COVID-19 patients last summer.
“They have Foley catheters, five to 10 IV lines, just tons of stuff connected to them,” Burgin said of patients. “Some of these patients, if you move them at all their oxygen levels fall way down. You have to be very careful. You have to watch the monitors for everything going on with the patient. You have to have six people in the room to be able to turn the patient and not lose any important lines.”
Elizabeth Scherer, MD, MPH, a trauma surgeon who directs the Surgical Intensive Care Unit at University Hospital, recognized the value of having additional support positioning teams last summer and requested additional trained student support to meet the current surge.
“Now we have multiple patients in an ICU who are being proned throughout the day and night, and having people who are good at it and know what they are doing is much safer for the patients,” said Dr. Scherer, who explained that having trained teams gives nurses more time to focus on the care of other patients who don’t require positioning as part of their treatment.
Participating students from physician assistant studies are taking shifts from 2 a.m. to 10 a.m. Other health professions students are taking four-hour shifts, and in addition to positioning patients, some respiratory care students, called RT extenders, assist respiratory therapists who are caring for COVID-19 patients in the ICU.
“Both the proning team and RT extenders make valuable contributions to the community and the welfare of our patients,” said Rick Wettstein, MEd, RRT, FAARC, associate professor and respiratory care program director.
Cas Thompson, PA, a 2020 physician assistant studies graduate, has helped train students for the current effort, showing them how to properly don and doff their personal protective equipment, how to apply pads to patient’s knees and other body parts to prevent pressure sores, and how to turn patients as part of team while working around the many lines and tubes connected to patients. He participated on the patient positioning team in July, an experience that convinced him to specialize as an intensivist.
“It was very rewarding, but also working with many different specialists and health care professionals, they really appreciated us,” he said. “Sometimes it was really challenging for one nurse to be pulled from their location to help another nurse [position] a patient.”
One of the students Thompson trained is second-year physician assistant studies student Brittani Orme.
“There is a lot of prep work that goes into it,” said Orme, who helped position a patient during her first shift. “The whole team has to be there. It’s quite a long process.”
The ICU setting “can be a very frightening environment” for physical therapy students who have not yet experienced it, said Department of Physical Therapy Chair and Associate Professor Greg Ernst, PhD, ECS. “This will give them great experience working with patients in the ICU. It’s a great opportunity that’s hard to simulate in the classroom.”
The opportunity for students to work with nurses, attending physicians and respiratory therapists in the ICU setting is invaluable, said School of Health Professions Dean David Shelledy, PhD, RRT, FAARC, FASAHP.
“They will take this interprofessional experience with them as they move forward in their own careers and work as part of a health care team to provide the best care for their patients,” Dr. Shelledy said.
The Department of Physician Assistant Studies sought to have its students integrated into the hospital wherever medical students would be, noted Paul B. Allen Sr., DSc, MPAS, PA-C, FAAPA, associate professor, program director, and department chair.
“Being able to participate in the care of these patients is a once-in-a-lifetime experience for them to give back to the community and help with this emergency situation,” he said.