Outpatient Rehabilitation in a Hospital Setting

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Several years ago hospitals in Ontario began reducing outpatient rehabilitation services for outpatients, but a few have initiated an innovative approach to fill a perceived gap in health-care services.

In 1998 St. Joseph’s Healthcare Hamilton became one of less than a dozen hospitals in the province to incorporate a business within the hospital setting. The Centre for Acute Injury Rehabilitation offers patients the advantage of private physiotherapy treatment in the hospital environment as an alternative to a community based physiotherapy clinic.

“The idea was to offer our services to types of patients, such as motor vehicle accident patients, who had never been treated within the hospital setting in the past,” says centre manager and physiotherapist Brad Balsor. “As well, the Centre for Acute Injury Rehabilitation is self-supporting and provides a source of revenue for the hospital.”

The centre sees as many as 400 patients a year, 85 per cent of whom have suffered either work related injuries or injuries acquired in a motor vehicle accident.

Balsor says St. Joseph’s Acute Injury Rehab centre offers more than physiotherapy. “We have an arm to our program that gets patients fast- tracked access to specialists and subsequently to diagnostic investigations. For instance, I’m able to arrange a consult with an orthopedic surgeon or a physiatrist within the week rather than waiting months. We get that done for the family doctor, and from a service point of view, physicians find it very helpful as a one stop shop.”

The centre has a number of physicians who consult including an orthopedic surgeon, a neurosurgeon, a neurologist and a physiatrist. Dr. Dinesh Kumbhare is medical director for the centre, specializing in physical medicine.

St. Joseph’s Centre for Acute Injury Rehabilitation has doubled its staff in two years, but their focus remains on the patient. They don’t want to grow so big that they loose the individual in the larger picture. Currently the centre is available at two of St. Joseph’s campuses – both at the acute hospital site and St. Joseph’s stand-alone Centre for Ambulatory Health Services. In the future, services may be extended to the third campus at the Centre for Mountain Health Services.

Weekly meetings with staff physiotherapists and centre physicians provide quick access to further services. “We work as a team to consult immediately on the needs of the patient. That’s one of the advantages of being in a hospital setting. And also at St. Joe’s, the patient can choose which site is more convenient for them to attend,” says Balsor.

St. Joseph’s Acute Injury Rehab Centre offers patients an active approach to treatment, involving them in learning about what has gone wrong and what they can do to improve. Patients participate in an aerobic program of strengthening and conditioning that is specific for their problem. The centre also offers manipulative therapy as an adjunct to other services. Prevention and education are also important parts of the program.

As part of a teaching hospital, centre staff and physicians are also involved with the physiotherapy and medicine programs at McMaster University, as well as having a number of research projects on the go.

Balsor says, “Many hospitals have discontinued physiotherapy care for outpatients. This venture for St. Joseph’s Healthcare has allowed us to remain a leader in outpatient rehab services in Hamilton, and at the same time continue our commitment and involvement in education and research in the field of rehabilitation.”