Medical Complexity and Unplanned Hospitalizations
ReMed serves individuals with a variety of medically complex needs, and provides strong physician and nursing support to address those needs. In 2013, three diagnostic categories were identified as reasons for the majority of unplanned hospital admissions; these were Urinary Tract Infections, Upper Respiratory Infections/Pneumonia; and Cellulites. In 2014, the Nursing Committee developed and with the review and approval of the Medical Directors, implemented “Early Intervention Protocols” for each client who had recurrent issues/hospitalizations precipitated by these three diagnoses. These protocols included increased hydration schedules, use of pulmonary vests, frequent monitoring of vital signs and pulse ox levels, monitoring skin status and prevention measures and identifying the parameters which would indicate the need to start early intervention antibiotic protocols. The goal of the early intervention protocols is to avoid hospitalizations and minimize Emergency Department utilization.
In 2016, our 141 residential clients had a total of 31 unplanned hospitalizations, with only 11 of these being due to the three frequent diagnostic categories of UTI, URI and Cellulites. The remaining 20 hospitalizations were due to other medical /surgical issues unrelated to the top three diagnostic categories for re-hospitalizations. The 11 episodes represented a decrease of 0% in unplanned hospitalizations from 2015 for these three diagnostic categories. The Early Intervention Protocols were implemented for 34 client episodes, and hospitalization was avoided for 32 client episodes. As a result of these protocols, client programming remains uninterrupted, deconditioning and other hospital related complications are avoided and overall adverse impact on the client, the family/support system, and the funder is minimized.
ReMed is committed to advancing the field of brain injury rehabilitation. Many of ReMed’s clinicians serve on national committees and boards to help develop and promote best practices. ReMed partners with experts and participates in research opportunities, and has been a primary driver in the development of a National Outcomes Database using the MPAI-4 as the benchmark outcomes measurement tool.
ReMed has been involved in two recent and important research projects related to outcomes in Post Acute Brain Injury Rehabilitation.
“Post Inpatient Brain Injury Rehab Outcomes: Report from the National OutcomeInfo Database” (Click here for article)
"Progress Assessed With the Mayo-Portland Adaptability Inventory in 604 Participants in 4 Types of Post–Inpatient Rehabilitation Brain Injury Programs" (Click here for article)