Plan treatment to meet patient’s needs, resources
Planning focuses on discharge first
While providing excellent rehabilitation services for years, rehab hospital staff have attempted to be mind readers, assuming they know what the patient wants and needs, says Connie Burgess, MS, RN, of Connie Burgess and Associates, a Lakewood, CA, consulting firm.
"With the advent of managed care, we need to move to a higher level of practice and prioritize the patients’ needs rather than giving them everything we think they need," Burgess adds.
Burgess has developed what she calls the Salient Features approach to designing a treatment plan. Salient Features is an interdisciplinary treatment model that focuses on the key issues for each individual patient and is designed to streamline care without affecting quality.
The model focuses on the key issues for each patient and encompasses a continuum of care that may include acute care, inpatient rehabilitation, day treatment, home care, or outpatient services.
For instance, if a patient has deficits in several different areas and wants to return to doing all of his or her activities, the treatment team determines if this is feasible, then focuses on what should be worked on while the patient is in the hospital and what can be accomplished later in day treatment, outpatient care, or another part of the continuum.
The model first focuses on where the patient will be going after discharge, so the team is aware at the onset of the physical features of the patient’s home, as well as resources and support structure in the home and community.
"Life is never the same for patients as it was prior to their illness and injury. It is presumptuous to think we can put a plan of care together without knowing what a patient’s life was like and what their resources are. We should find out what a patient’s needs are, what benefits are available, and put the two together," Burgess says.
Put patient’s priorities first
Because lengths of stay and money available for rehabilitation are limited, the plan of care should consider what will happen after discharge and what a patient’s priorities are, Burgess says.
"How can you put a plan of care together without knowing where the patient is going and who is going to be there? If we don’t know these things, we haven’t really rehabilitated these patients," Burgess says.
For instance, a person who lives alone and can’t afford to hire a personal aide may need to concentrate on learning to get out of bed, dressing, and bathing, while someone with a support structure in place may have different needs and goals.
A patient who lives in a two-story house may need to concentrate on negotiating stairs while postponing cooking skills until outpatient rehab, since the inpatient length of stay is short.
In the past, all spinal cord patients learned to drive. But someone who doesn’t have a car should concentrate instead on learning to use public transportation, Burgess says.
"Rather than provide the full gamut of services whether the patient wanted it or not, we are using the maximum resources available to the patient to achieve what the patient and family see as goals. This system is directed by positive outcomes but also is sensitive to the patient’s resources," she adds.
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