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Expanding Access: Redefining Inpatient Rehab for Medically Complex Patients
Not long ago, a patient like Joseph would have faced a dilemma. After battling a life- threatening infection, he needed both intensive medical rehabilitation and regular hemodialysis for kidney failure—which were rarely available in free-standing rehabilitation hospital settings. But Burke Rehabilitation Hospital, committed to delivering seamless care to patients with complex medical needs, added onsite hemodialysis to its inpatient services three years ago.
"It is a significant development to have access to the full benefits of intensive rehabilitation-and at the same time provide other services for the medically complex," says Janet Herbold, PT, PhD, MPH, Senior Vice President of Burke Rehabilitation.
Burke has rapidly expanded—and continues to expand—onsite capabilities to ensure access across the continuum of care, no matter the complexity of a patient’s condition. In addition to onsite hemodialysis, those capabilities include a method of providing complete nutrition for medically fragile patients and a high-level CT imaging suite to test for complications such as second stroke or brain bleed.
Onsite Hemodialysis
As the first and only free-standing rehabilitation hospital in New York State to offer onsite hemodialysis, Burke is filling a critical gap in care for patients with kidney and late-stage renal disease who need intensive rehabilitation. Burke patients on hemodialysis now receive it without leaving the building. Patients can even use a robotic-assisted in-bed cycling trainer, a Bemo, to engage in aerobic exercise during dialysis sessions, improving their strength and endurance.
By keeping patients in a single setting for continuous care, Burke is achieving faster recovery times and better outcomes—leading the way in coordinated care that drives results. At discharge, our social work team also coordinate directly with a community dialysis center, so treatment continues without a gap. “That’s the continuum of care we address,” says Janet. “We’re closing the loop for all patients, even after discharge.”
Total Parenteral Nutrition (TPN)
TPN delivers nutrition directly into the bloodstream for patients who can’t get sufficient nutrition through eating or tube feeding, often due to cancer treatment, gastrointestinal disease, or other serious illness. Burke began admitting patients who need TPN this year. Now, patients can participate in three hours of intensive rehabilitation therapy daily while continuing to receive the levels of nutrition they need.
CT Scanner Suite
Previously, when an inpatient showed a sudden change in status—a possible second stroke, for instance—Burke sent them by ambulance to an outside hospital for imaging, which would interrupt their daily therapy schedule. But thanks to New York State funding and a commitment to expanding capabilities, Burke advanced its onsite diagnostic capabilities with a new CT Scanner Suite, a state-of-the-art 128-slice scanner that both reduces the disruption in patient care and speeds Burke clinicians’ results.
"The new suite allows our providers to have access to the results in a very timely manner so that they can take action on whatever the medical issue or concern is," Janet says. "It reduces transportation, it reduces disruption of care, and it increases timely access to what the patient's potential medical needs are." The CT scanner is also accessible to patients in the community as an outpatient diagnostic procedure.
These additions are part of a larger pattern reshaping the field of medical rehabilitation, to respond to and anticipate how people live and age in the community, today and into the future. "The whole industry is experiencing a shift in the level of medical complexity of the patients referred to Burke," Janet notes, adding that Burke is already preparing for what's next, training staff to provide additional care required by patients with disorders of consciousness, a medical condition. These patients, whose levels of wakefulness and awareness of their surroundings are severely impaired, are expected to arrive this fall.
Burke is well positioned for this kind of expansion as a hospital with 24-hour medical and nursing coverage and on-staff therapy, social work, and nutrition teams. The structure lets a patient with kidney failure, or a feeding need, or an uncertain diagnosis, get all their needs met in one place, starting but not ending with three hours of therapy a day. For Joseph, this meant he could seamlessly integrate hemodialysis three days a week with the intensive therapy that got him back on his feet and walking.
Burke is also part of an integrated hospital system, anchored by its relationship with the Montefiore Health System and a wider network of referring hospitals. "In fact, it's our acute care partners who really help us to identify the lack of rehabilitation services for certain patient populations," says Janet, noting how instrumental the partners were in Burke's expansion of capabilities to-date.
"We're constantly looking at additional capabilities, advanced technologies and specialized training that offer our patients a higher level of services and support while they are here," she says . "This is what the future of medical rehabilitation looks like."
