SYRACUSE, N.Y. (WSYR-TV) — Upstate University Hospital has created a COVID Transitions Clinic program to provide additional, ongoing support services for COVID-19 positive patients who are now recovering at home.
The COVID Transitions Clinic is virtual, but has a wide range of resources for COVID-19 positive patients who were treated and released from Upstate, an Upstate emergency department or tested positive at the Upstate testing site.
“There’s a lot of anxiety around this, there’s a lot of unknowns so just patients and families knowing that this would be followed through the outpatient world is really great,” says Dianne Nanno, Director of Transitional Care at Upstate University Hospital.
It starts before they’re ever even discharged. Nanno says, “Do they have access to food, do they have housing, do they have someone to take care of them, do they understand their medications, just a whole person assessment.”
Transitions Clinic staff will connect the patient to a primary care doctor and schedule daily telehealth conferences with an Upstate physician to assess his or her symptoms and also connect with the patient’s primary care physician.
Dr. Elizabeth Asiago-Reddy is an infectious disease specialist at Upstate University Hospital. She tells NewsChannel 9, “You can see a lot about a patient by how they’re talking, how they’re communicating with you when you’re having a conversation and get a sense for whether they’re short of breath, how short of breath they are.”
Nanno and her team also created COVID Comfort kits, which she described as a “virtual hug” to let patients know Upstate is thinking of their needs as they recover at home.
The kits include a cloth mask, teaching materials, a thermometer, a homemade greeting card and a sleep kit complete with an eye mask.
Nanno recently acquired a small number of bracelet oximeters, which will be offered to select COVID-19 positive patients who are at a higher risk for disease progression.
“One of them looks like a fit-bit, like a watch, one of them that’s a little less complex is an oximeter that just goes right on their finger, you’ve probably seen this,” Nanno tells NewsChannel 9.
Asiago-Reddy adds, “We’ve really been able to address multiple issues from the psychosocial to the medical to the spiritual that are going on for the patients and offer them care that will hopefully really successfully transition them to wellness.”
The COVID Transitions Clinic has a 24-hour hotline that patients may call with questions or if their symptoms get worse. The hotline and telehealth visits also allow Upstate doctors to fast-track a patient’s readmission to the hospital if necessary.
That process creates a streamlined pathway for the patient and can relieve the emergency departments, Nanno and Dhamoon said.
Many of the patients the clinic is reaching out to do not have a primary care physician and do not speak English, Nanno said. Clinic staff are using Upstate’s Interpreter Services to ensure those patients are receiving the care they need.
If the patient does have a primary care physician, the clinic’s interactions with the patient are also relayed to his or her regular doctor.
Upstate physicians will follow COVID-19 positive patients through the clinic until their symptoms are gone.
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