Madonna Rehabilitation Hospital treats patients, from the very ill to those who are close to being weaned.
As Nebraska’s only freestanding facility devoted entirely to physical rehabilitation, Madonna Rehabilitation Hospital in Lincoln has maintained a strong reputation among both respiratory care practitioners and other health care professionals. Situated on a 22-acre campus in a quiet residential neighborhood, the Madonna Rehabilitation hospital has been recognized for the past 40 years for its innovative approach to rehabilitation. In fact, for most Lincoln-area respiratory therapists wanting a career in rehabilitation, Madonna is the only game in town.
“Our progressive focus on rehabilitation has attracted many highly skilled respiratory therapists to Madonna,” explains David Gross, RRT, clinical manager of the respiratory therapy department. “The end result is that we haven’t had any turnover during the past 2 years.”
One major attraction of working at Madonna as a RCP is the ventilator-assisted program, which is highly acclaimed throughout the region with patients being referred from all over the state. A successful track record in patient outcomes has especially brought attention to the department. According to Gross, of special note during the past few years is the department’s reduction of oxygen weaning periods for patients. Currently, the hospital averages 21.6 days, compared to 35 days, only only 5 years ago. Gross attributes this improvement in weaning to the efforts of the interdisciplinary team that strives hard to improve patient outcomes. “We could never have made this type of progress without the help of every member of our rehab team,” Gross points out. “Close communication between our respiratory therapists, physical therapists, occupational therapists, and speech therapists–not to mention the physicians–is the primary reason we’ve been able to improve patient outcomes.” Other members of the rehab team include rehabilitation nurses, case management professionals, psychologists, social workers, nutritionists, and recreation therapists.
Madonna’s respiratory care department comprises 30 staff members, one director, and two supervisors. Clinical staff work 8- or 12-hour shifts, depending on whether they are part-time or full-time. The three shifts include day and night shifts plus an evening shift from 3 pm to 11 pm RCPs staff one of four areas: the complex medical unit, subacute unit, acute care unit, or extended care unit. To make their jobs more interesting, the respiratory therapy supervisors reassign each RCP to a different area every 2 to 3 weeks.
“We’ve found that therapists find it more satisfying if they can experience a little variety in their jobs,” explains Cheryl Forsyth, RRT, a respiratory therapy supervisor at Madonna. “But at the same time, it’s important that they have some continuity with their patients, and that’s why we don’t reassign them to another area any sooner.” Forsyth adds that rotating clinical positions is also advantageous since it adds objectivity in treating patients. “A new therapist sometimes is able to pick up on something another therapist hasn’t noticed,” she says.
Gross points out that one of the benefits of working in a comprehensive rehab facility such as Madonna is that respiratory therapists are able to treat a wider range of patients, from the very ill who are treated in the complex medical unit to those who are close to being weaned. Madonna’s ventilator-assisted programs offer an effective alternative to the 24-hour environment of an intensive care unit or community hospital. “We treat a wide variety of diagnoses, including traumatic brain injury, spinal cord injuries, and neuromuscular and chronic obstructive pulmonary diseases,” Gross says. Madonna has treated ventilator-assisted children and adults from 6 months of age to over 80.
To be admitted to Madonna’s ventilator-assisted program, patients must have a respiratory condition or injury requiring constant or intermittent use of a ventilator; must be using CPAP, a bilevel positive airway pressure system, or a pulmonary wrap; and must have passed the acute stage of an illness. Their direct care is provided under a Lincoln-area pulmonologist who is credentialed at Madonna Rehabilitation Hospital.
The complex medical unit at Madonna was developed in response to the growing need of patients whose care exceeds what can be provided in a skilled nursing unit. In addition to 24-hour respiratory support treatments including suctioning and tracheostomy care, the unit offers IV therapy requiring multiple lines or frequent multiple system involvement; complex wound management of complicated surgical recoveries; infectious disease management and terminal care; and peritoneal dialysis.
Madonna’s therapists, many of whom have worked in acute care hospitals, are quick to point out that the field of rehabilitation is very rewarding for RCPs. “Many of our therapists who came from acute care hospitals enjoy being more involved with patients and their families,” says Debbie Carstens, RRT, respiratory supervisor of extended care. “A greater emphasis is placed on patient and family education in the rehab setting.” Because the environment is very important for ventilator-assisted patients, Madonna’s rehab team members work hard to help patients and their families feel comfortable. Patients are encouraged to bring belongings from home to personalize their rooms. They also participate in recreational opportunities whenever possible. Visits from family pets and community outings to University of Nebraska Husker games, movies, or the mall take place frequently. Furthermore, Carstens adds that much of what goes on in a rehabilitation facility does not take place in an acute care hospital. “We do a lot of things on a daily basis that acute care hospital therapists never get a chance to do, such as ventilator weaning, helping patients with one-way valves and tracheostomy care,” she says. One-way valves, which enable ventilator-assisted patients to speak, are an important step to weaning and contribute to an improved quality of life for patients.
Madonna also offers patients an Assistive Technology Center, where they can learn how to use computers and adaptive equipment to increase independence in daily living. Madonna is well known in the rehab community for its ability to use technology to help patients communicate and control their environment, such as turning on lights, answering phones, or changing television channels. Madonna’s long-term hospital even offers an on-site child day care program, which provides intergenerational activities. Children often visit and play games with the patients or deliver hand-made items.
Regardless of which area of the hospital a respiratory therapist is assigned, a focus on the interdisciplinary team is why health care delivery has been exceptional at Madonna. According to Gross, this emphasis on teamwork not only keeps patient outcomes strong, it also promotes job satisfaction for therapists. “Our respiratory therapists are required to participate in interdisciplinary assessments of their patients on a daily basis from the minute they’re admitted to the time they’re discharged,” Gross stresses. “This is a big change from the past when therapists were just expected to perform treatments without providing their own assessments.” In fact, Gross asserts that the five physicians his department works with all look to the respiratory therapists for their input and advice. “There’s no question that working together closely helps improve patient outcomes,” he says. “The patient ultimately benefits since we’re all active participants on the team.”
Another reason patient outcomes have improved during the past several years is that the department has used a loosely structured weaning protocol, which helps direct the team members in treating patients. “Our weaning protocol is tailored differently, depending on the needs of the patient,” Gross says. “It’s particularly important in rehab to recognize the individual needs of the patient.” Despite these differences among patients, the protocol serves as a guide to make the rehab team take steps to help patients become stronger. “For most patients, we need to help them become more active as soon as possible by getting them on tilt tables and helping them walk so their strength is built up in order to endure being weaned off the ventilator,” Gross adds.
A more aggressive approach to rehabilitation has helped contribute to earlier discharges, which is important in an era dominated by managed care companies. With many contracts with HMOs and preferred provider organizations, Madonna has learned to make the best of the managed care environment. “We’ve experienced the greatest impact from managed care companies in our subacute unit where there have been many Medicare denials during the past few years,” Gross explains. But despite concerns with cost cutting and shorter lengths of stay, Gross admits that one of the positive aspects of managed care is that teamwork has become absolutely essential. “Managed care has forced us to work efficiently together through multitasking, which has resulted in better patient care,” he says. The respiratory care department has also found that an important strategy when dealing with managed care companies is to document patient charts with as much information as possible. “Our respiratory therapists fill in both objective and subjective information about a particular patient; for example, if a patient shows signs of depression, they record that since it’s an important factor in the treatment plan.”
Despite the challenges created by managed care, Gross stresses that the future for respiratory care in rehabilitation facilities like Madonna looks bright because of an aging population and shorter acute care hospital stays. “Increasing numbers of therapists are being attracted to rehab because of the rewards it offers,” Gross says. “There’s nothing better than getting sick people back on their feet or hearing a person speak for the first time after having a trach.”
Carol Daus is a contributing writer for RT.
Madonna Rehabilitation Hospital:
- Has been recognized for the past 40 years for its innovative approach to rehabilitation.
- One major attraction at Madonna is the ventilator-assisted program which is highly acclaimed throughout the region.
- Comprises 30 staff members, one director, and two supervisors.
- Offers 24-hour respiratory support treatments including suctioning and tracheostomy care.
- Their reduction of oxygen weaning periods for patients currently averages 21.6 days, compared to 35 days, only 5 years ago.