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Sub Acute Rehabilitation / Swing Bed Patient Care with the Barthel Index

Sub Acute Rehabilitation / Swing Bed Patient Care is inpatient Sub Acute rehabilitation performed at Critical Access Hospitals. Currently there is no standard system in use to measure functional outcomes for these patients. In 2013, we identified the need to quantify our patients’ functional improvements from admission to discharge.

Following research, we implemented the Barthel Index of Activities of Daily Living (A.D.L.) to assess our Sub Acute Rehabilitation patients’ functional levels in 10 quantifiable self-care activities of daily living. These included:

  • Feeding
  • Bathing
  • Grooming
  • Dressing
  • Bowels
  • Bladder
  • Toilet Use
  • Transfers (bed to chair and back)
  • Mobility (on level surfaces) Stairs

 

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.

How Our Program is Designed to Help Sub Acute Rehabilitation Patients

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.

Our Innovative Program Creates Objective Patient Improvements and Safe Discharges

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.

Back Home and Feeling Stronger Every Day: One Sub Acute Rehabilitation Patient’s Story

John P. was an LVAD patient at Ellenville Regional Hospital who benefited from the Sub Acute Rehabilitation program. Before his surgery, he would just lie in bed from a weak heart and other healthcare professionals didn’t think he would make it. He shared with us that our hospital was the best he had been to in all his life. He was treated exceptionally well, the food was delicious and, if he didn’t like something, the nurse would get him something else. Treatment and services by the nurses were at a very high level; he said they were always there for him. He also raved about the therapy work. Even now, after discharge, when he runs into those who gave him therapy here, he shares with them how they are the best and what a great experience it was. John was released from the Sub Acute Rehabilitation program and returned home on July 28th, 2017 and, while he uses a walker, he says he feels like he could get up and run. He learned a great exercise program while at Ellenville Regional Hospital, and he is improving each day with his exercises at home.

What's Next for Our Sub Acute Rehabilitation Program?

Our Sub Acute Rehabilitation project is becoming a statewide model and is now poised to go national.

In 2016, we presented the Sub Acute Rehab Outcomes Improvement Project as a statewide initiative to other New York Critical Access Hospitals. Eight out of 18 of them agreed to use this Barthel Index tool and administer it on Sub Acute Rehabilitation admission and discharge. We were able to benchmark and collect data with the eight hospitals that participated over the past year. We have received many accolades for implementing this tool and improving patient outcomes.

You Can Help Support Our Innovative Sub Acute Rehabilitation Program

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.

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