Stepping up to rehab

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At Toronto’s Bridgepoint Hospital, the inspiration for a new service came when staff on the musculoskeletal rehab unit realized that an active rehab program wasn’t the right prescription for some of their patients.

“The unit was designed to provide high intensity therapy for a short duration, usually two to three weeks,” says Kim Sterling, Case Manager for the musculoskeletal (MSK) rehab unit. “We were seeing many patients who were not able to participate fully in rehab for different reasons – they might have had several weeks of non-weight bearing status, were of advanced age, or had any number of medical conditions. This impacted greatly on their level of participation in the unit’s rehab program.”

As a result, this patient population required a very different approach to rehabilitation, involving a low tolerance, longer duration activation service which the unit was not designed to offer. It meant longer stays on the MSK rehab unit for these patients, sometimes up to several months, and consequently, a longer external waiting list for the unit. In some cases, patients were not admitted to the unit at all because of the participation limitations they faced.

Bridgepoint endeavoured to come up with a solution that would address the key issues – goal-oriented programs for patients, shorter external waiting lists, and the efficiency of the unit.The result is Stepping Up to Rehab, a unique rehabilitation service. Developed by staff of Bridgepoint Health, the 24-bed unit focuses on patients who are not yet ready for a full intensive rehabilitation program.

“It’s unique because it admits complex care patients, those with high co-morbidities and mild cognitive impairments,” says Shahrani Mohamid, Program Director. “It’s an example of how Bridgepoint is at the helm as health care faces its newest frontier, complex care and complex rehabilitation.”

Complex care is one of the fastest growing patient categories in Canada. In fact, more than 70 per cent of all health care resources in Ontario go to caring for complex patients. In Toronto alone, there are more than 365,000 people affected by complex illness and disability, and 20,000 of them are in the advanced stages of their illness. Bridgepoint Health is a leader in the development of integrated health care services for complex care patients for this ever -increasing patient population.

Stepping Up to Rehab is part of the solution, admitting a large number of patients with high co-morbidities. The aging population has resulted in a rising number of patients who are recovering from bone fractures and joint replacements.

Stepping Up to Rehab patients participate in a less strenuous program than they would on the musculoskeletal rehab unit – lower intensity sessions are offered about three times a week instead of five, and for a longer overall duration, 12 to 14 weeks on average.

Once patients have built up their strength and mobility, they are ready to be discharged, often moving through the Bridgepoint Health continuum to the MSK rehab unit a few floors down.

“Since the program got off the ground, it has improved our flow-through and decreased our average length of stay. We’ve been able to take more patients who need rehab because there is more bed availability,” says Sterling. “If a patient is admitted to either the musculoskeletal unit or Stepping Up to Rehab, and can either use more or less rehab, or a longer stay, now we can better serve them by transferring them between the two units based on their individual needs.”

In some cases, patients are discharged home or to a long-term care centre. Some patients continue to visit Bridgepoint’s Day Treatment service for outpatient rehabilitation care.

The advantages of Stepping Up to Rehab go beyond the physical benefits to patients. Because the service admits individuals directly from emergency departments, it is helping to reduce the pressure on acute care facilities. Additionally, many patients would have previously been in beds in the MSK rehab unit for up toseveral months, leading to long external waiting lists for the rehabilitation service.

“Since the program began running a year ago, it has been consistently running at full capacity,” says Ann McLeish, Case Manager for Stepping Up to Rehab. “Our discharge rate reflects what an overwhelming success the program has been, and our patient outcomes speak to the positive impact of patient-centred care.”

Bridgepoint Hospital is part of Bridgepoint Health, an integrated health services organization focused on providing a continuum of care for patients in the Greater Toronto Area who require complex care and complex rehabilitation. Bridgepoint Health comprises Bridgepoint Hospital, Bridgepoint Health Research Institute, Bridgepoint Centre for Living (a soon-to-be-constructed complex care and long-term care centre), Bridgepoint Community Rehab (a not-for-profit community-based rehabilitation service), and Bridgepoint Health Foundation, which supports the programming and development goals of Bridgepoint Health.