Combine exercise and education for outpatients
Cardiopulmonary rehab programs work in the outpatient as well as the inpatient setting. Here’s how several hospitals run their outpatient programs.The 12-week Take Charge at Columbia Ocala Regional Medical Center in Ocala, FL, combines cardiovascular strengthening with an extensive education program. "We teach the patients how to change the risk factors and have healthier lifestyles," says Christine Wilson, RN, clinical coordinator.
The program was started in 1988 for patients recovering from open heart surgery, transplants, heart attacks, and heart failure conditions.
"The goal is not just to get them over surgery or heart attacks. The goal is to help them realize the need to change their lifestyle and then to make changes," she says.
In fact, many patients opt to continue the program at their own expense in order to maintain their gains.
Sick and debilitated patients
Patients who have been discharged home but still remain sick and debilitated or who have graduated from the inpatient cardiac rehab program are candidates for outpatient rehabilitation at Spaulding Rehabilitation Hospital in Boston.Patients appropriate for this program are very sick cardiac patients — often older people with advanced heart disease. The program has been particularly effective for patients with arrhythmias, heart failure, angina, or those who have complicated heart disease and are on multiple medications, explains Paul LaRai, MD, director of Spaulding’s cardiac rehabilitation program.
In this program a cardiac nurse works with one patient at a time or in small groups of two or three.
"It gives patients self-confidence in their capacity to do what they can do and improves their independence and ability to do activities of daily living," LaRaia says.
The program also allows the hospital to continue to monitor patients when they go home to prevent readmissions.
For example, the nurse may notice changes in a patient’s weight or a chronic problem and suggest measures that will prevent rehospitalization.
More than 100 patients who have completed the initial 36 cardiac rehabilitation sessions at Emory University Medical Center in Atlanta, have opted to join a maintenance program and continue to exercise at their own expense.
Many patients referred to the Atlanta facility’s Health Enhancement Program have had a heart attack, bypass surgery, or heart failure, according to Claire Rice, RN, nurse coordinator.
For most, the program is their first experience with rehabilitation, she adds.
The staff evaluates new patients and sets up an individualized program that includes calisthenics, rowing, working out with weights, biking, walking, or using a treadmill. Education on healthy lifestyles is a big component of the program, Rice says.
Patients work are closely monitored and are treated in groups of eight.
Patients who opt to join the maintenance program may come to the center three times a week and use the equipment or participate in exercise classes or recreational activities.
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