In 1897, New York native and tuberculosis survivor Walter Jarvis Barlow, MD, made the trek to Los Angeles to begin a private practice specializing in internal medicine. Today, his humble vision has evolved into the only dedicated respiratory hospital in Southern California.
When Barlow contracted tuberculosis in 1895, he headed west in search of a dry, sunny climate and a cure; in 1902, he established the Barlow Sanatorium to treat patients who were also battling the disease. By 1922, a recreational facility and medical library were added to the facility’s grounds, built through gifts from local donors who also believed in the dedicated and specialized care the Barlow Sanatorium was providing the Los Angeles area.
Barlow’s momentum in Southern California soon began to build. With the additional buildings, as well as cottages donated by the American Red Cross in 1919 for World War I veterans, Barlow enjoyed an open campus. This open nature was well suited to beliefs in the early years that the best prescription for treating tuberculosis was fresh air and sunshine.
Barlow’s treatments of that day required many patients of the sanatorium to remain on bed rest, so they could expedite the strength and recovery process. Once patients began showing signs of improvement, they were moved from the infirmary to cottages on the Barlow Sanatorium grounds. While residing in cottages, patients were expected to help with the upkeep of Barlow’s campus and were encouraged to participate in social and recreational activities; some patients even tended to goats and other animals. The cottages continue to be maintained and utilized today, serving as prominent landmarks on campus.
Barlow Respiratory Hospital Today
Focused on helping patients breathe easier, Barlow Respiratory Hospital (BRH) enters its 110th year of service to the Southern California community. Barlow has evolved into a private, not-for-profit, 105-bed, long-term acute care (LTAC) hospital with a wide-ranging and distinguished history of providing respiratory and specialty medical care services to greater Los Angeles and the surrounding Southern California region. Barlow has long been established as an important regional resource for the diagnosis and treatment of chronic lung and respiratory disorders, including COPD, pneumonia, asthma, pulmonary fibrosis, bronchiectasis, chronic bronchitis, bronchiolitis, fungal infections, and other chronic breathing disorders. The facility is also a resource for local lung transplant programs, caring for patients both pre- and post-transplant. Additionally, patients admitted to BRH often have multiple comorbid conditions: diabetes, congestive heart failure, vascular disease, coronary artery disease, malnutrition, and functional impairment—all factors contributing to their prolonged severe illness. Barlow serves as a vital link in the continuum of care, especially given the emerging data on post-ICU syndrome (PICS) now recognized in survivors of critical illness.
Well-known as a regional weaning center, Barlow admits more than 300 ventilator-dependent patients each year, transferred from the ICUs of more than 50 area hospitals for weaning from prolonged mechanical ventilation (PMV). Over the last 2 decades, Barlow’s ventilator weaning program has consistently produced success rates of nearly 60%. These successful weaning outcomes, along with the results of other studies in this population, have resulted in numerous publications in peer-reviewed medical journals, establishing Barlow as the benchmark for weaning from PMV. Barlow’s ability to provide its specialized services has expanded over the years with the addition of two satellite facilities in Southern California. With the main hospital, two strategically placed satellites, and a multispecialty medical staff, Barlow is equipped to treat a total of more than 1,000 adult patients a year.
Barlow takes an interdisciplinary team approach to care in each of its specialized programs—ventilator weaning, pulmonary rehabilitation, chronically critically ill care, wound care, and palliative care—treating a full range of complex medical conditions. Barlow physicians and patients benefit from a wide spectrum of available pulmonary and critical care diagnostic services, interventions, treatments, and therapies. Patients suffering from delirium secondary to a prolonged ICU stay, resulting from the effects of critical illness, medications, and disrupted sleep/wake patterns, benefit from Barlow’s new sensory stimulation program. Evening support groups facilitated by Barlow’s Master of Social Work team from the department of social services provide encouragement, guidance, and assistance for families of patients with prolonged severe illness.
The Core of Barlow
If one were to speak with any of the 250 dedicated staff members at Barlow, you would learn that each holds the organization close to their heart, with a dozen employees topping more than 30 years of service. Under the leadership of David R. Nelson, MD, medical director, an expert staff of pulmonologists, consultants, and attending physicians take on the many challenges of treating the chronically critically ill and medically complex patient populations admitted to Barlow. Oswaldo Ruiz, RRT, MHA, leads a large staff of 36 respiratory care practitioners (RCPs). Barlow RCPs are key team members with extensive ventilator management experience and are responsible for the TIPS© protocol weaning process. RCPs work 12-hour shifts, and are assigned as many as eight ventilator-dependent patients at a time. Additionally, Ruiz is in charge of the pulmonary function lab and special procedures services. He also serves a pivotal role in The Joint Commission survey preparation and maintenance of standards compliance. Scott Sasse, MD, the medical director of respiratory care, works with the department to realize evidence-based standards of practice.
From an internal operation standpoint, all of Barlow’s patient-related data—clinical, financial, administrative, and communication—is in a single, confidential electronic health record (EHR) of care. The MEDITECH Health Care Information System in place at Barlow serves to improve operations, better coordinate care, prevent medical errors, streamline workflows, hasten reimbursements, and operate more efficiently overall.
Most recently, Barlow implemented a computerized provider order entry (CPOE) system and is one of the first LTAC hospitals to implement the module, an important step toward reducing medical errors while improving health care quality and efficiency.
Legacy in Research
For 2 decades, Barlow Respiratory Research Center (BRRC) has been committed to excellence in clinical research, addressing issues related to chronic lung diseases and weaning patients from PMV. Research is focused on studying the patient populations treated in the many programs at BRH. The health services research and outcomes studies seek to identify the most effective and efficient interventions, treatments, and services often referred to as “best practices.” These efforts have resulted in the publishing of four book chapters, 15 papers in peer-reviewed medical journals, nearly 50 abstracts, and numerous editorials and other communications. The BRRC was the first to develop and publish a protocol specifically for weaning patients from PMV. The TIPS© protocol was developed by Barlow pulmonologists and based on years of dedicated practice.
Administered by Meg Hassenpflug, MS, RD, FCCM, the research center maintains the ventilation-outcomes database (VOD), the largest single facility database capturing outcomes of weaning from PMV in the post-ICU setting of a LTAC hospital. Now with nearly 4,000 patients’ data—preadmission, admission, outcome, discharge, functional status, and survival data—the VOD is the foundation for all clinical studies of ventilator-dependent patients admitted to Barlow for weaning. The VOD served as the template for “Post-ICU Mechanical Ventilation at Long Term Care Hospitals: A Multicenter Outcomes Study,” a 23-facility study of weaning outcomes sponsored by the National Association of Long Term Hospitals (NALTH). Led by BRRC staff members, the results of the study were published as two papers in the January 2007 issue of CHEST.
Research efforts are enhanced by academic partnerships with the Keck School of Medicine of the University of Southern California (USC) and the UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System. Together, Barlow and BRRC have earned national and international recognition in the areas of post-ICU mechanical ventilation and outcomes research on weaning patients from PMV.
Service to the CommunityIn keeping with Barlow’s vision for a healthier community, the hospital serves the greater Los Angeles area through education and outreach activities for numerous local organizations, agencies, and schools. Each year, Barlow hosts two continuing medical education conferences for the pulmonary/critical care community. The Sam J. Sills, MD, Distinguished Scholar Program, held on Barlow’s campus each spring, is presented with Breathe California of Los Angeles County, in collaboration with the Trudeau Society of Los Angeles. In the fall, Barlow sponsors the Hans E. Einstein, MD, Lectureship as part of its annual meeting of the medical staff. The lectureship, now in its 11th year, honors Dr Einstein, a former Barlow medical director and CEO and current member of the board of directors. Einstein is internationally recognized as an expert in acute coccidioidomycosis, more commonly known as valley fever. Both lecture series draw nearly 80 physicians, nurses, and respiratory care practitioners from surrounding academic medical centers and community hospitals for an evening of networking and science.
Barlow also serves as a teaching hospital for students from the Keck School of Medicine of USC, and the UCLA David Geffen School of Medicine. In addition, the hospital hosts allied health professional school programs through affiliations with universities, community colleges, and vocational training centers. Barlow is home to the Lung Rangers, a support group for pulmonary patients open to all alumni as well as the community at large. Patients currently enrolled in Barlow’s pulmonary rehabilitation programs are also encouraged to attend bimonthly luncheon presentations.
The Future of Barlow
Now surpassing more than a century, Barlow’s history makes it a unique and important health care facility in Southern California. Looking forward, Barlow has plans under way for a new state-of-the-art medical facility and wellness campus that will also incorporate amenities to benefit the surrounding community.
Margaret Crane is CEO, Barlow Respiratory Hospital, Los Angeles. For further information, contact [email protected].