Aim: To achieve a 25% reduction in senior clinical reviews from an average of 52 per month in Q1 2023 to a target of 39 in Q3 2023. A clinical audit was undertaken in December 2022 by the Advanced Consultant Clinical Practitioner in the UCR service; SQ1132 Urgent and Emergency Care Clinical Audit Toolkit. The audit highlighted significant discrepancies in the use of the UCR follow-up clinical review process, which allows UCR clinicians to keep patients on the acute medical caseload for up to 72 hours. Consequently, an improvement project was proposed to reduce the burden of clinical reviews with the UCR senior clinicians’ cohort. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagrams - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Project Impact: The average number of senior clinical reviews decreased from 52 in quarter 1 to 26 in quarter 3. A reduction of 50%. 780 minutes of senior clinician patient facing time were freed up each month - 156 hours per year. Cost savings of £290.68 per month and £3488.16 per year.

Aim: 90% of Reablement patients to be seen with in 48 hours of receiving the referral (Monday – Friday) 100% Urgent Community Response (UCR) Therapy patients to be seen with in 48 hours of receiving the referral (Monday-Sunday). Following the publication of Urgent Community Response (UCR) guidance by NHSE in July 2021 CWPT has responded with the development of their own UCR team. This in turn was predicted to change the utilisation of therapy within the urgent offer. Patients need to be seen within the timescale specified by triage which can be 4-6 hours / 24 hours / 48 hours. The therapy team that responds to the urgent referrals also provides the on-going up to 6 weeks Reablement service. Any changes to the urgent response roster will have a knock-on effect on the reablement offer. Therefore, we needed to explore how to maximise capacity to fulfil the requirements of both Urgent and Reablement Therapy using QI. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Waiting times for Reablement patients January 2022 = 3 weeks. Patient facing activity time during every working shift varied across the team from 42% to 99% against a target of 67%. Developed a way of measuring waiting times for UCR patients. Next Steps: Daily monitoring of: Waiting list /Capacity and demand / Patient flow. Scoping what capacity can be released from both clinical / non clinical perspective to support service improvements and patient flow, followed by, scoping funding for Patient Flow Coordinator to release further clinical capacity. Preparing for AHP job planning. Equitable workload across the services. Plan for future workload for the service e.g., trajectory of wait lists being cleared.

Objectives The primary objective is to determine which of two interventions: 1) an eight week, online, home-based, supervised, group rehabilitation programme (REGAIN); or 2) a single online session of advice (best-practice usual care); is the most clinically and cost-effective treatment for people with ongoing COVID-19 sequelae more than three months after hospital discharge. Trial design Multi-centre, 2-arm (1:1 ratio) parallel group, randomised controlled trial with embedded process evaluation and health economic evaluation. Participants Adults with ongoing COVID-19 sequelae more than three months after hospital discharge Inclusion criteria: 1) Adults ≥18 years; 2) ≥ 3 months after any hospital discharge related to COVID-19 infection, regardless of need for critical care or ventilatory support; 3) substantial (as defined by the participant) COVID-19 related physical and/or mental health problems; 4) access to, and able/supported to use email and internet audio/video; 4) able to provide informed consent; 5) able to understand spoken and written English, Bengali, Gujarati, Urdu, Punjabi or Mandarin, themselves or supported by family/friends. Exclusion criteria: 1) exercise contraindicated; 2) severe mental health problems preventing engagement; 3) previous randomisation in the present study; 4) already engaged in, or planning to engage in an alternative NHS rehabilitation programme in the next 12 weeks; 5) a member of the same household previously randomised in the present study. Intervention and comparator Intervention 1: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) programme: an eight week, online, home-based, supervised, group rehabilitation programme. Intervention 2: A thirty-minute, on-line, one-to-one consultation with a REGAIN practitioner (best-practice usual care). Main outcomes The primary outcome is health-related quality of life (HRQoL) – PROMIS® 29+2 Profile v2.1 (PROPr) – measured at three months post-randomisation. Secondary outcomes include dyspnoea, cognitive function, health utility, physical activity participation, post-traumatic stress disorder (PTSD) symptom severity, depressive and anxiety symptoms, work status, health and social care resource use, death - measured at three, six and 12 months post-randomisation. Randomisation Participants will be randomised to best practice usual care or the REGAIN programme on a 1:1.03 basis using a computer-generated randomisation sequence, performed by minimisation and stratified by age, level of hospital care, and case level mental health symptomatology. Once consent and baseline questionnaires have been completed by the participant online at home, randomisation will be performed automatically by a bespoke web-based system. Blinding (masking) To ensure allocation concealment from both participant and REGAIN practitioner at baseline, randomisation will be performed only after the baseline questionnaires have been completed online at home by the participant. After randomisation has been performed, participants and REGAIN practitioners cannot be blind to group allocation. Follow-up outcome assessments will be completed by participants online at home. Numbers to be randomised (sample size) A total of 535 participants will be randomised: 263 to the best-practice usual care arm, and 272 participants to the REGAIN programme arm. Trial Status Current protocol: Version 3.0 (27th October 2020) Recruitment will begin in December 2020 and is anticipated to complete by September 2021. Trial registration ISRCTN:11466448, 23rd November 2020