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Rehab Hospitals Retooling

Joe Cantlupe, for HealthLeaders Media, April 25, 2011
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“The information on best practices that we learned from participating in the EQUADR network played a major role helping us choose which fall prevention strategies to pilot and eventually adopt,” Harrington says. “Perhaps the strongest drivers in reducing falls were hardwiring the use of bed alarms on all patients and implementing the use of chair alarms on selected patients.

“These were interventions that we had considered, but were not convinced that the effectiveness would be worth the hassle,” she concedes. “But after discussing with our peer EQUADR facilities that use these devices, we
felt comfortable trying them out. It turned out to be incredibly successful,” Harrington says. “Hearing how successful other rehab hospitals were in fall rates, we knew what kind of results were achievable.”

In acute care facilities, “you don’t expect your patients to fall very much because they are not getting up very much,” Harrington says. “They may be sick in bed for two days; while in rehab they might be there for two weeks.”

“Falls are something we are always trying to improve on,” Harrington adds. “There are so many different causes behind them, [so] to prevent them, you have to have a comprehensive plan of attack.”

In addition, the hospital intensified its education program for patients, making them aware of the potential for falls. “We teach patients fundamental boundaries so they know when they need to call for help and [when] they can do something on their own,” Harrington says.

“At Carolinas Rehabilitation, reviewing the benchmark data from EQUADR has become a standard part of our internal performance improvement plan, as well as an integral part of our annual quality goal setting,” says Harrington.

Falls are a constant concern for rehabilitation hospitals, according to Charles Pu, MD, chief medical officer for Spaulding North Shore. Addressing falls is challenging and “requires an organizational commitment” and “rigorous systematic approach,” Pu says.

Success Key No. 3: Real-world environment

New Hanover Regional Medical Center in Wilmington, NC, has three hospital campuses and is licensed for 855 beds. Its 60-bed rehabilitation facility focuses on the needs of patients who will face the adjustment from their hospital beds to their homes. To help patients make that transition, New Hanover Regional provides a real-world environment within the hospital, complete with beach sand, a makeshift apartment, and a grocery store.

Besides patients suffering from a spinal cord injury or with a traumatic brain injury, the patients also have chronic conditions such as arthritis and multiple sclerosis.

By making transitions easier for patients, the hospital has hastened the patients’ ability to go home following treatment, says Leslie Kesler, director of the New Hanover Rehabilitation Hospital. Within the past year, the hospital has had 78% of its patients go home within two weeks, above the 71% national average for rehabilitation hospitals.

As rehabilitation centers work more for reducing the LOS, it is increasingly important to prepare patients
for day-to-day life outside the hospital, Kesler says.

At New Hanover’s simulated convenience store, for example, there are artificial fruits and vegetables, but they weigh the same as the real things. Rehab patients use scales and calculate price, and practice how to get out money and count money, and how to write a check.

There is an apartment with a functioning bathroom and a kitchen where patients can prepare meals. A donated car enables patients to practice getting in and out of vehicles. And there is a golfing area and a small beach “so people can walk on the sand, which is totally different” from concrete or wooden walking areas, Kesler says.

“It is very functionally oriented,” she says. “It gives [patients] an opportunity to practice in a safe environment before they go out, with all the distractions in the real world out there. It gives people an opportunity to practice their skills in a controlled environment, and they have more confidence in the community.”

The rehabilitation facility’s relationship with the acute care hospital allows for shared services, such as CT scans or laboratory services, and that reduces duplication of efforts and saves money, which is “certainly an advantage,” says Kesler. “We have made some great gains with patient improvement over time.”

Success Key 4: Combining acute and rehab care

The WakeMed Health System has worked to improve collaboration between the acute care and rehabilitation systems by combining strategic planning through varied committee assignments with specific leadership structures, especially in spinal cord injury rehab cases, says Rohlik, the hospital’s executive director for rehab and trauma.

An interdisciplinary team approach is the foundation of the system, she says. The team consists of physical, respiratory, occupational, and speech therapists, as well as a neuropsychologist, physician, nurse, dietitian, infection control nurse, and clinical case manager, which allows patients to see a wide variety of spinal cord specialists.

With the trauma and acute care collaboration, there have been improved outcomes for patients with spinal cord injuries. Skin breakdowns are common and considered a devastating medical complication of spinal cord injuries because of the lack of movement and changes in circulation. Those breakdowns can occur within weeks of hospitalization. The WakeMed team approach, which entails monitoring of each patient’s skin condition, resulted in a reduction of a skin breakdown among patients over a six-month period in 2009.

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