Cardiac rehab focuses on maximizing independence
Education is a big part of the program
Inpatient cardiac rehab one day may be as common among rehab hospitals as are outpatient cardiac rehab services. Because these types of programs are designed to decrease the lengths of stay in acute care hospitals, the need for cardiac rehab as an option will only grow as the prospective payment system and its resulting focus on efficiency spread throughout the health care industry.
Such programs are ideal for patients who require intensive rehab services in order to maximize their mobility and ability to perform activities of daily living, says Joe Golob, PT, director of the Inpatient Rehab Center at St. Francis Hospital in Greenville, SC. St. Francis opened its cardiac rehab program in May 1999.
"One of the first patients we had was a lady who didn’t have other major complicating diagnoses," Golob recalls. "She was elderly, and due to her cardiac disease and the trauma of her surgery, she needed some extra rehabilitation beyond what she got in acute care."
The woman was admitted to the cardiac rehab program because her physician felt it would not be safe for her to be discharged to her home. She received rehab services for about five days, and when she was discharged, she needed very minimal assistance with her activities of daily living, Golob adds.
Cardiac rehab programs give patients and families the tools to manage their disease process long term and to reduce hospitalizations by regaining control over their disease, says Julie Jones, PT, physical therapy supervisor for the cardiopulmonary unit and cardiac program co-manager at HealthSouth New England Rehabilitation Hospital in Woburn, MA. "Studies show patients are not able to retain the educational information they receive in acute care, so cardiac rehab has a huge educational component," Jones says.
Golob and Jones describe some features of a cardiac rehab program:
o Establish goals. HealthSouth New England’s program sets four major goals:
• The cardiac rehab team evaluates patients’ current levels of functioning and their hemodynamics functioning and establishes a target heart rate for them while at home. "As they begin to do more for themselves in preparation for being at home, we see what their heart rate and blood responses are to that level of activity," Jones says.
• The team also determines whether the patient’s body is adjusting to the levels of activity and helps patients progress to a level of activity that would be similar to what they would have to do at home.
• Cardiac patients often need medication adjustments, so the rehab team gives physicians feedback, providing doctors with information about patients’ activity responses so they can better adjust their medications.
• The team educates patients with basic information about their cardiac disease, emphasizing the same information the patient may have been given in the acute care facility but not retained. "The families get the education, but even they are so overwhelmed that they might not retain any of it," Jones says. "So when they get here, they have very limited knowledge about their cardiac disease, symptoms, limitations, understanding their appropriate level of activity, and how to progress in that activity."
St. Francis Hospital’s chief goal is to provide cardiac patients with a continuum of care, Golob says. The cardiac program meets the individual needs of patients who no longer meet acute care criteria but may have difficulty being discharged home, he adds. "It’s for patients who need something in between. We customize the program, and it may be a kind of fast track for those who really need a booster before they go home with a plan to be independent."
o Normal rehab is part of program. Cardiac patients, like other rehab patients, receive therapy training in range of motion, strengthening, and mobility. "When they have bypass surgery and the surgeon takes an incision from their leg, it’s sore and tight, and the patient needs range-of-motion training and strengthening," Jones explains. "They also need mobility training and help with decisions on when to use a walker."
Also, surgery patients sometimes have neurologic changes due to spending time on a heart-lung bypass machine, so the rehab team will evaluate patients’ cognitive levels. Some patients may have difficulty swallowing after surgery, and they may need voice training if they’ve been on a ventilator, Jones adds.
"The neat and tidy cardiac patient who is stable ends up going home," she says. "So we tend to receive the cardiac patients who need additional neuropsych evaluations and additional input on how to prepare a person to go back to work."
o Programs can save medical costs and have adequate reimbursement. Hospital-based rehab facilities benefit financially from being able to keep patients within their systems after the patients are discharged from the acute care facility, Golob says. So far, the St. Francis program has had no difficulty receiving Medicare reimbursement for its cardiac rehab program, he adds.
Cardiac diagnoses are not among the top 10 rehab diagnoses established by Medicare criteria, but even so, the HealthSouth program also has had no trouble with reimbursement, Jones says. "The majority of patients have Medicare, but we’ve also been getting a small percentage of managed care patients, as well."
Typically, the cardiac rehab patients are admitted for seven to 30 days with about two weeks being an average length of stay. Although there are not enough data to say whether the program saves the hospital money in acute care, anecdotal evidence suggests it does, Jones says.
"If you send these patients home after being discharged post-surgery, within a matter of days they would be bounced back to the acute care facility," she says. "I think Medicare recognizes that this is a valuable service, and rather than keep these patients in acute care for a week or two weeks, they can be some place where there’s an eye on them with people skilled in the cardiac disease process."
Need More Information?
Joe Golob, PT, Director of the Inpatient Rehab Center, St. Francis Hospital, One St. Francis Drive, Greenville, SC 29601. Phone: (864) 255-1953.
Bill Goodwin, RRT, Pulmonary Rehab Coordinator, Respiratory Therapist, Grossmont Hospital, 5555 Grossmont Center Drive, La Mesa, CA 91942. Phone: (619) 644-4118.
Julie Jones, PT, Physical Therapy Supervisor for the Cardiopulmonary Unit, Cardiac Program Co-manager, HealthSouth New England Rehabilitation Hospital, 2 Rehabilitation Way, Woburn, MA 01801. Phone: (781) 935-5050, ext. 1277.
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