This project involved multiple disciplines: Nursing, Physical Therapy and Occupational Therapy. The goals of the project were to improve the functional independence of Sub Acute Rehabilitation patients; maximize the monthly percentage of Sub Acute Rehab patients who return home or to their prior level of residence; improve communications among the rehabilitation team members and increase their efficiency in working together, and to educate patients’ families and caregivers to ensure that a safe discharge plan is established and implemented.

We collected data from June 2013 until December 2015 and chose to score each sub acute patient upon admission and discharge. We divided our Sub Acute Rehabilitation patients’ diagnoses into three categories:

• Orthopedic (common diagnoses: partial/total joint replacements, hip fractures, Open Reduction Internal Fixation, amputation and ankle fractures)
• Neurological (common diagnoses: Cerebrovascular Accident and Upper Motor Neuron Disease)
• Deconditioned (common diagnoses: congestive heart failure exacerbation, chronic obstructive pulmonary disease exacerbation, dementia, wound care and cancer)

We implemented weekly Physical Therapy/Occupational Therapy re-evaluations and assigned designated Physical Therapy assistants to the Sub Acute Rehabilitation unit. We also trained our Physical Therapy staff to utilize Standardized Functional Assessment tools, such as Timed Up and Go and Gait Velocity.

By implementing the Barthel Index at admission and discharge with each Sub Acute Rehabilitation patient, we had marked objective, quantifiable data to document patient improvements in functional independence:

• Improved clinical outcomes, reduced cost to system by avoiding skilled nursing home placement: 18% increase for Orthopedic patients who returned to prior level of residence from 2014-2015.
• Improved clinical outcomes and quality of care: 13% improvement in the Barthel Index from Admission to Discharge from 2014-2015 for all three categories.
• Improved interdisciplinary teamwork: Using the Barthel Index provides a multidisciplinary overlap of care for each Sub Acute Rehabilitation patient.
• Improved patient safety and potential decrease in re-admissions: Using the Barthel Index in family meetings offers objective, quantifiable information about how much additional care will be required to ensure the safest discharge plan for a patient returning to their home.

More patients are being safely discharged to their prior level of residence: We have improved clinical quality and decreased the need for skilled nursing facility care. In 2016, we had an 80.2% return to home rate overall. In the sub-category of Orthopedic patients, we had an 89.3% return to home rate.

Our Sub Acute Rehabilitation Program has had a direct, positive effect on safe discharges. With delegating certain domains of the Barthel Index to the specialized discipline, we created a stronger multidisciplinary approach to services for each of our Sub Acute Rehabilitation patients. These functional domains are discussed at our weekly Interdisciplinary Care Plan meetings, which improved teamwork and patient outcomes. Utilizing the Barthel Index system has significantly enhanced the education of our family and patients to ensure a safe discharge, ideally to their prior level of residence. This system significantly decreases patient harm by ensuring enough care will be provided when returning home.

We will continue to develop and offer such remarkable projects to help our patients. Ellenville Regional Hospital is leading the way forward to improve healthcare—close to home in our community and beyond.