Meeting Patient Needs with Runnymede’s LTLD Rehabilitation Program

May 14, 2013, will mark the one year anniversary of the opening of the Low Tolerance Long Duration (LTLD) Rehabilitation program at Runnymede Healthcare Centre. The LTLD program has enabled the hospital to create job opportunities for over 60 employees and provide a much-needed, specialized rehabilitation program in the local community.

Sometimes referred to as slow-stream rehab, LTLD rehabilitation is a low to moderate intensity program for patients who need slower paced rehabilitation for a longer period of time, to maximize their potential of regaining functional skills and returning home.

The LTLD program is beneficial for patients like 94-year-old Mabel Kitson, who has rheumatoid arthritis and fractured her pelvis after a recent fall in her apartment. After a one-week stay at St. Joseph’s Health Centre Toronto, she was transferred to Runnymede where she was expected to benefit from 24-hour hospital care and LTLD rehabilitation provided by an interprofessional team consisting of physicians, nurses, physiotherapists, occupational therapists, social workers, speech-language pathologists, pharmacists, and clinical dietitians.

Rehabilitation provided in the LTLD program is designed to cater to each patient’s unique needs and home environment. Since Kitson will return to an independent lifestyle where she likes to attend monthly luncheons at her church, spend time on her computer sending emails and volunteer at the Salvation Army Church, her physiotherapists worked with her to regain her ability to walk on her own using a cane and a rollator. In group therapy, she worked on balance and standing exercises and in her spare time she continued to practice skills of daily living, such as dressing and getting in and out of bed, with the assistance of nurses.

“This rehabilitation program ensures patients that require a slower pace less intensive rehabilitation will receive the right care in the right place,” says President & Chief Executive Officer Connie Dejak. “RHC has built a reputation for excellence and as we set our strategy to move forward in our hospital we embrace opportunities for growth and expansion to better serve our communities.”

After seven weeks in the program, Kitson is scheduled to return home. “I just can’t wait to go home,” says Kitson, “but since I had to be in hospital, I’m glad it was Runnymede. I couldn’t be more pleased with the nurses who were all very kind and the therapists who helped me regain my balance and walking ability.”

Helping patients return to the community is the primary goal of the LTLD program and thus far has been a key area of success. Over 190 patients have been admitted to the program since it opened in May 2012. With many acute care beds in the Toronto Central LHIN being tied up with alternate level of care patients, Runnymede’s LTLD program is able to alleviate system pressures by transitioning patients to a more appropriate setting.

At Runnymede, Kitson has also been able to learn strategies to improve her safety at home and prevent future falls through the hospital’s
Falls Prevention program. Led by an interdisciplinary committee, the program ensures that best practices are used in identifying patients at risk for falls. Clinical staff implement fall prevention interventions and educate patients and staff about risk assessment and risk minimization. Moreover, the committee monitors and evaluates the program on a regular basis to ensure ongoing quality improvement and safety, and to eliminate barriers to compliance.

Effective fall prevention strategies that have been implemented at Runnymede include:

  • Using a cheat sheet to assist in identifying the cause of falls and the actions taken.
  • Consulting a falls protocol checklist to ensure 100% compliance with post fall documentation.
  • Enhancing the availability of equipment such as bed mats, chair alarms and bed alarms.
  • Continually monitoring and adjusting a patient’s environment to reduce risks, such as putting the bed in a lower position and freeing spaces of clutter.
  • Labeling patients’ mobility aids with colour tape to indicate the level of falls risk, thereby helping clinical staff identify immediately, the degree of assistance a patient requires with ambulation and transfers.

“Educating patients on how they can continue to reduce risks and prevent future falls is a crucial component of the program,” says Manager, Pharmacy and Allied Health Luba Kelebay. “As we are increasingly positioned to provide rehabilitative services in the journey between acute care and the return to the community, we want to ensure that we can maximize not only our patients’ potential to regain their activities of daily living, but also their potential to enhance their quality of life for as long as possible.”