Helping acute care patients take steps toward rehabilitation

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By Michael Oreskovich

Runnymede Healthcare Centre’s low tolerance long duration rehabilitation program (LTLD Rehab) focuses on restoring independence for patients who have reduced mobility after an injury or surgery and helps bridge the gap between acute care and home. At the start of their recovery journey, patients often feel uncertain about how they will be able to resume their lives upon returning to the community. Runnymede’s patient flow department provides support to patients like these by ensuring their concerns are addressed before they enter LTLD Rehab, and that their admission to the hospital from acute care is seamless.

Runnymede’s close integration with its healthcare partners makes patient flow’s role in the hospital essential. The department collaborates closely with referring acute care centres to admit patients who need Runnymede’s specialized level of care and meet the LTLD Rehab program’s criteria. They coordinate the flow of information about new patients between referring organizations and the hospital’s interprofessional team.

The department also works to enhance the patient experience before admission by providing support to patients and their families. “When patients are being transferred from acute care to a rehabilitation hospital like ours, it can be overwhelming,” said Runnymede’s Vice President of Strategy, Quality and Clinical Programs, Sharleen Ahmed. “Our hospital’s patient flow team uses an innovative approach for guiding families through this process by assigning one contact person – our admissions coordinator – to each patient before their admission to answer questions and address their concerns.”

Unique to Runnymede, the admissions coordinator role strengthens the hospital’s delivery of client-centred care. When reaching out to patients or family members, the coordinator lays out a vision for what rehabilitation at Runnymede will look like – how long it is expected to take, and the clinical outcomes they can anticipate. They also frequently raise awareness about existing community resources that are in place to ensure the patient continues to thrive after discharge from Runnymede back into the community.

These pre-admission conversations with patients and families give the patient flow team an opportunity to learn about what the patient wants to get out of their rehabilitation at Runnymede. They communicate these treatment goals to the clinical team along with a summary of the patient’s medical history and any special needs they have. From that initial touchpoint with patient flow, the clinical team can prepare for the patient’s arrival.

The single point of contact that patients and families have through patient flow’s admissions coordinator doesn’t just simplify communications, it also builds trust. This is particularly important if patients are anxious about transferring to a rehabilitation hospital like Runnymede because they feel their immediate needs are being met in an acute care setting.

A recent example of this involved a patient who suffered a fall at home. After two months in an acute care hospital, his injuries improved but he was unable to move independently and couldn’t safely return to his house. “Staff at the acute care hospital informed the patient and his family that admission to LTLD Rehab was what he needed to recover and return to the community,” recalled Lisa Dreher, Runnymede’s patient flow manager. A bed was available within days, but the patient’s family refused the offer. “Because of his limited abilities, his family didn’t feel he was prepared to resume his life at home.”

After patient flow discussed the rehabilitation process and helped the patient’s family understand the supports that would be available after discharge, they were inspired with confidence to proceed with rehabilitation. “He was admitted to Runnymede in 2016 and after two months in LTLD Rehab, the patient’s strength and independence progressed rapidly and he was able to return home,” said Dreher. Since his discharge, the patient’s family has successfully worked with community agencies to ensure that supports are in place to help the patient live at home independently and safely.

One of patient flow’s goals is to help patients navigate the healthcare system – which can at times seem complicated – to ensure they get the right care, in the right place, at the right time. But according to Ahmed, the department is also vital for putting patients at the centre of their own decision making, by addressing their needs before admission. “We never lose sight of the fact that every patient that comes through our doors is someone who has questions about their health and wants to get better,” she said. “Our patient flow team is an example of how we always do our best to find new ways of addressing patients’ concerns and empower them to continue their recovery journey even after they’ve completed their rehab at our hospital and have been discharged to the community.”

Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre.

 

 

 

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