1996 OPEN FORUM Abstracts
Understanding Subacute Care: One Provider's Perspective
Berit Darby, RN, NHA Sunday, November 3, 1996
Describes how subacute care fits into the continuum of care. An overview of regulations affecting subacute pulmonary care and the RCP. Details the clinical skills that an RCP needs in the subacute unit.
UNDERSTANDING SUBACUTE CARE: One Provider's Perspective
Berit Kuntz-Darby, RN,BSN,NHA
Vice President of Subacute Services
Regency Health Services, Inc.
Definition of Subacute Care
* Medically stable
* Goal oriented team approach
* Frequent patient assessments
* Time limited treatment plan
Level of Care Overview
Medicare Subacute
Destinct Part Unit
Services Skilled Complex
Nursing Medical
Rehabilitation Subacute
Rehabilitation
Ventilator
Care
Admission Medicare Program
specific
Staffing 2.5 - 3.5 actual 4.0 - 6.0 actual
nursing hours nursing hours
MD visits Monthly 1 - 3 times per
week
Pulmonary Care Program Description
* Complex medical and rehabilitation needs
* Some respiratory impairment (may or may not be ventilator dependent)
* Require specialized equipment and staff
* Promote independence through rehabilitation and activities
Pulmonary Care - Related DRG's
* 75 Major chest procedure
* 79 Resp. infections & inflammations
* 85 Pleural effusion
* 88 COPD
* 89 Simple pneumonia & pleurisy w cc
* 96 Bronchitis & asthma w cc
* 475 Resp. system dx with ventilator
Pulmonary Care - RCP's Role in Interdisciplinary Care Planning
* Initial screen within 24 hours of admission
* Evaluation within 48 hours of admission
* Patient specific care plan
* Goals and objectives addresses living, learning, and social activities
* Measurable goals with time frames
* Adaptation to discharge destination
Pulmonary Care - Role of RCP
* Clinical services
* Patient assessment
* Develop and review P&P
* Staff training
* Patient/family education and training
* Marketing
* Recommendation for specialized equipment
Pulmonary Care- Physical Plant
* Room size
* Storage for equipment and supplies
* In-wall oxygen and vacuum system
* Electrical upgrade
Pulmonary Care - Admission Criteria
* Patient must have rehabilitation potential
* Intact respiratory system
* No spinal column damage
* Cardiovascular stability
* Temperature below 101 degrees F
* Ability to tolerate up to 4 hrs/day of therapy
* No TB or HIV
Pulmonary Care - Discharge Criteria
* Established goals have been met
* Patient/family education complete
* Laboratory work within normal/acceptable limits
* Comprehensive medical and skilled nursing care no longer required
Pulmonary Care - Interdisciplinary Team
* Medical Director
* Program/Clinical Director
* Respiratory Therapist
* IV certified licensed nurses
* PT, OT, and SLP
* Social Worker/Discharge Planner
* Recreational Therapist
* Registered Dietitian