By Dr Hina Iftikhar, Dr Warren Doherty, Dr Charlie Sharp

Background and problem

The COVID-19 pandemic has put a strain on the National Health Service secondary to the unprecedent number of acute admissions requiring high dependency (HDU) and intensive care (ITU) support due to respiratory failure

and sequela of hypercoagulability.

The long-term complications of COVID-19 pneumonia are also beginning to emerge with growing clinical experience directing us to focus on integrating disease severity with the likelihood of long-term multiorgan complications alongside the psychosocial holistic care support requirements in these patients.[1-3]

We describe our multidisciplinary (MDT) observational experience at Gloucestershire Hospitals NHS Foundation Trust of delivering personalised holistic multicomponent interventions for all patients discharged from a HDU/ITU using a unified follow up pathway to address multi-organ complications and psychological trauma by setting rehabilitation goals and GP action plan to improve long term outcome of these patients.


The MDT follow up consisted of an interprofessional carousal with review from intensive care, respiratory, therapy, psychology, pharmacy, dietician and community well-being colleagues using a unified proforma adapted to address individual patient needs.

37 patients were followed up over a 4 week period using this approach and long term complications of COVID-19 were identified and addressed by relaying the subsequent action plan to primary care


The proportion of ongoing biopsychosocial complications identified from the MDT follow up of COVID-19 patients are summarised (Image 2 - Table 1).

Onward referrals for subspecialist input were made from clinic and action plans relayed to primary care in all patients.