The Science Journal of the American Association for Respiratory Care

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.


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




Admission Medicare Program


Staffing 2.5 - 3.5 actual 4.0 - 6.0 actual

nursing hours nursing hours

MD visits Monthly 1 - 3 times per


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

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