The goal of Burke’s Cardiopulmonary Rehabilitation Program is to help you achieve the most active and productive life possible, despite physical limitations. It is divided into two parts: the cardiac program and the pulmonary program. The cardiac program is tailored for individuals with heart disease and the post-operative cardiac patient. The pulmonary program serves young adult through elderly patients, with diagnoses such as COPD - emphysema, bronchitis, bronchiectasis, chronic and acute respiratory failure, and pulmonary fibrosis.
Whether you are living with a chronic lung disease or have suffered an acute lung condition, we assist your recovery with intensive therapy (five to six times a week), and we teach you strategies to help you manage your condition. Rehabilitation nursing and access to a physician are available 24 hours a day, seven days a week.
The interdisciplinary rehabilitation team consists of you, your family or caregiver, physician, nurses, social worker/case manager, occupational therapist, physical therapist, recreation therapist and dietician. Led by Richard Novitch, M.D., a pulmonologist, the professionals on the team will assess your medical and rehabilitation needs and work with you to establish your individual goals. In close collaboration, the team designs and implements your treatment program. Throughout your treatment, the entire team meets formally once per week to discuss your progress, and Dr. Novitch monitors the overall team process and outcome.
Family members and caregivers are encouraged to attend and participate in treatment sessions and care as appropriate. Comprehensive education for you and your family or caregiver is essential to reaching your goals. Team members provide a series of lectures and discussions on pulmonary wellness daily.
Scope of Services
The cardiopulmonary program provides care to all patients admitted secondary to cardiopulmonary dysfunction leading to limitations in functional capabilities. The population served ranges from young adult to elderly. These patients present post surgically or following an exacerbation of a chronic cardiopulmonary condition and require the level of care provided by an acute rehabilitation hospital. Patients present with various levels of medical acuity which is diagnosis and/or exacerbation based. The patient must be medically stable to be able to be medically managed in the acute rehabilitation environment and to tolerate approximately 3 hours of therapy/day. Each cardiac and/or pulmonary patient will receive a minimum of 3 hours of therapy a day, 5 days per week, generally Monday through Friday, and a sixth day of therapy, generally Saturday, for 1-2 hours. Skilled therapy will be provided in a combination of physical therapy and occupational therapy and/or speech therapy if needed.
The Cardiopulmonary Team is committed to ensuring that each individual’s needs are addressed by:
- Providing rehabilitation through an interdisciplinary approach that emphasizes communication, collaboration and cooperation
- Lessening limitations of activities by focusing on the individual’s capabilities and utilizing compensatory strategies and devices
- Providing the highest quality, patient focused rehabilitation
- Removing or lessening restrictions to participation in life situations to the extent possible
- Providing counseling to the individual and family and/or caregiver on alternative possibilities for life participation when necessary
- Preparing the individual, family and/or caregiver to make the transition to the next stage of the rehabilitation process
Cultural and religious needs are respected for each patient by the entire team. Accommodations to the patient’s schedule, dietary needs and requests, and the provision of appropriate equipment are provided to enhance the patient’s experience and support full participation in the rehabilitation program. All staff members participate in annual cultural diversity and sensitivity training.
The diagnoses commonly served include but are note limited to:
- COPD: emphysema, bronchitis, asthma, bronchiectasis
- Idiopathic Pulmonary Fibrosis
- Restrictive Lung Diseases
- Post operative Thoracotomy s/p Pneumonectomy, Lobectomy or wedge resection.
- Status Post Lung Volume Reduction Surgery
- Congestive Heart Failure
- Status Post Coronary Artery Bypass Graft
- Status Post Valve Replacement (mitral, aortic)
- Medical debility
In 2014, the Cardiopulmonary Program:
- Served 115 patients with cardiac conditions and 141 patients with pulmonary conditions ranging in age from 32 to 93 years old.
- Discharged patients to the following:
- 85% of our patients with cardiac conditions and 84% of our patients with pulmonary conditions returned home with home care, outpatient, or no further services because services were no longer needed.
- 2% of our patients with cardiac conditions and 3% of our patients with pulmonary conditions went to a sub-acute facility to continue their inpatient rehabilitation.
- 13% of our patients with cardiac conditions and 13% of our patients with pulmonary conditions were transferred to an acute hospital.
- 0% of our patients entered a long-term care facility.
Within the scope of the Cardiopulmonary Program, patient evaluation and care planning are designed around traditional medical disablement models. These models assess three levels of dysfunction which stem from the patient’s admitting diagnosis (pathology).
Impairments: Weakening, damage, or deterioration of function within a specific component of the cardiopulmonary and/or musculoskeletal system resulting from injury or disease.
Examples: decrease in exercise tolerance, decrease in balance, limitations in pulmonary hygiene, decreased cardiac output, decreased ventilatory capacity, decrease in strength, decrease in active and/or passive ROM.
Activity Limitations: The inability to perform a specific task (i.e. dressing or stair climbing) as a consequence of the aforementioned impairments.
Examples: Difficulty with ambulation, stair negotiation, dressing, grooming, or self-care.
Participation Restrictions: The cumulative effect of impairments and activity limitations on the ability of a person to participate in life roles.
Examples: Inability to perform duties as a parent, caregiver, employee, or participant in social and leisure activities.
In addition to these medical characteristics identified through the utilization of the disablement model, social barriers to discharge must also be assessed. These factors are societal and environmental by nature and often times they impact the determination of services rendered upon discharge.
These barriers can include but are not limited to:
- Limited transportation
- Inaccessible living environment
- Limited caregiver support
- Financial resources/Insurance benefits
The initial assessment performed by each discipline should capture the patient’s most accurate burden of care via Functional Independence Measure (FIM) scoring as well as functional endurance which is measured via 6 minute walk test. Based upon the results of the initial evaluation, each interdisciplinary team member will create a patient specific plan of care designed to meet each patient’s specific goals. The team will formally meet twice weekly to discuss discharge planning and treatment progress.
Discharge planning has the potential to begin on the first day of the patient stay with the discussion of outpatient follow up services, patient goals, and patient support base being initiated by social work. The combination of the patient’s medical, physical and social circumstances will dictate the most appropriate discharge environment from the services available.
Upon admission, each patient will be evaluated and cared for by members of the interdisciplinary team. The interdisciplinary team make up is determined by patient assessment, medical needs, rehabilitation needs and predicted outcomes. Based upon individual patient needs, the team may be comprised of individuals from, but not limited to the following disciplines:
The patient is an integral part of this team and is informed of the interdisciplinary team members’ findings, and expected outcomes by individual team members as plan of care is determined.
Support Services Available include:
- Medical consultation (Psychiatry, ENT, Dermatology, Podiatry)
- Pastoral Care services
- Complimentary therapy
- Laboratory services
- Pharmacy services
- Driver assessment and education
- Medical nutrition
The overall function of this team is to create the most appropriate patient centered plan of care. The team’s goal is to help the patient achieve the highest level of independence and education while establishing a discharge plan that keeps the patient progressing within the healthcare continuum. In doing so, the team aims to minimize impairments, reduce activity limitations, lessen participation restrictions and achieve predicted outcomes. The ideal outcome is an independent discharge to the community with follow up out patient services concurrently arranged.
- Diagnosis: as outlined in “scope of services,” diagnoses are cardiopulmonary in nature as the primary rehabilitation diagnosis
- Prognosis: patient is expected to demonstrate the potential, from a medical standpoint as well as a rehabilitation standpoint, to improve functionally through exposure to the acute rehabilitation environment
- Medical Stability: patients will be deemed medically stable by admitting physicians of the cardiopulmonary program in conjunction with nurse screeners
- Co-Morbidity: Co-morbidities are expected to be consistent and medically manageable with the primary rehabilitation diagnosis but not a hinderance to positive patient outcomes in the acute rehabilitation environment
- Pre-Morbid Function: is considered in terms of establishing team goals to return the patient to pre-morbid status and/or surpass pre-morbid status
- Support System: is considered for prognosis in achievement of optimal benefits of acute rehabilitation program, however, it is not a strict admission criteria
- Mental Status: Ability to tolerate the intensity of care-patient must be projected to be able to tolerate 3 hours of therapy per day to benefit from the acute rehabilitation environment
The appropriate disposition following discharge requires planned preparation and counseling by the interdisciplinary team from the date of admission until return to the community. Upon first contact, social work initiates discussion of follow up services. The patient is provided general information regarding length of stay for their specific diagnosis as well as the preferred venue for follow up services upon discharge. The following are the intended discharge environments in order of preference.
- Home with out patient services (cardiac/pulmonary/general rehab. services)
- Home with home care services
- Sub-acute (short-term) rehab in a skilled nursing facility
- Long term placement in a skilled nursing facility
Following the evaluation by each discipline, team conferences are held in which each patient is discussed. All members of the interdisciplinary team for that patient are to be present. Following collaborative discussion, the date of discharge and disposition recommended by the team are conveyed to the patient via social work. The patient and the family have the right to participate in all discussions regarding discharge. The goal is for all disciplines is to be educating each patient/family on their specific projected discharge needs and how they will best be met (in the continuum of care). Once the plan is set, the patient is asked to select a provider for follow up services. The patient is provided the names of agencies along with all necessary contact information.
Prior to discharge, patients will be informed of the durable medical equipment (DME) required for discharge. If the patient owns the required equipment, they are encouraged to bring it to therapy for adjustment and evaluation. If not, patients are to be educated regarding insurance coverage for DME and all necessary equipment should be ordered. This equipment should be received by therapy, evaluated and adjusted appropriately prior to discharge.
Prior to discharge, a re-evaluation will be performed and will capture the patient’s functional status and burden of care again via the FIM instrument and 6 minute walk test. If the patient is to be discharged home and is not independent with the performance of a necessary task, family and/or caregiver training will be performed. This should yield an end result of the patient in combination with caregiver support being independent with all necessary functional tasks.
Outcome Management and Performance Improvement
Core Outcomes to be monitored by all Programs:
- Community D/C
- Patient Satisfaction
- FIM Scores
Program Specific Outcomes for Cardiopulmonary
- Change in 6 min. walk distance
- Change in total ambulation distance
Continuous Quality Improvement Initiatives
To the patient and caregiver:
All cardiac and pulmonary patients will attend daily patient education classes, which are delivered by the interdisciplinary team. This education is open for family and caregiver attendance as well as patient participation. Educational objectives of the patient education classes are based on self care and disease management, resource utilization as well as community re-entry following discharge.
The clinical staff will be educated via ongoing orientation in-services provided by the program director, team leader and advanced clinician. The format for clinical education for physical therapy and occupational therapy staff will be the completion of an orientation to the program/service in addition to completion of diagnostic specific clinical competencies. These competencies will be reflective of skills and knowledge base required by all clinicians on this service to properly identify and address the needs of the cardiopulmonary acute rehabilitation population. The nursing staff will complete general nursing competencies with regards to their competency requirements for the facility. All members of the cardiopulmonary service/team will be invited to attend weekly in-services which will address considerations in caring for this patient population.
The clinical staff will be encouraged to attend continuing education courses to address the needs of the cardiopulmonary patient population. Annual requirements for outside courses will be identified for staff completion while on this service.
- Initial Evaluation
- Daily Treatment Session Charting
- Weekly Re-evaluation
- Discharge Evaluation
- Integrated Electronic Medical Record