Hospitals Re-Think Neurological Services to Meet Geriatric Needs

Joe Cantlupe, for HealthLeaders Media , April 5, 2013

Such programs may seem simple, but they are important for patients. During patient visits, hospital staff may adjust devices, carry out gait training, make suggestions for improved mobility, adjust medications, and even advise on changing pajamas—such as from fleece PJs to those with silk liners—to improve movement. These are "little tips we can provide," says Dawn Lucier, neuro-rehab physical therapist.

"It's different from the standard medical model," Lowell adds. "Typically, the person says, 'I've fallen twice,' and the doc would write a prescription for a physical therapy evaluation and send the patient to the therapist, who would then do an evaluation and develop a treatment program. We're actually watching the people and seeing what's wrong with their gait and then developing an individualized plan of action. Sometimes it doesn't require a physical therapy evaluation; it's something simple, like a reminder for them about how to walk with the walker and adjusting the walker."

The hospital continually works to reduce fall rates and bedsores among patients, Lowell says. Over the past year, the hospital fall rate was reported at 4.12 falls per 1,000 patients, compared to peer groups statewide that had 4.64, according to PatientCareLink, a quality and transparency collaborative established by the Massachusetts Hospital Association and the Organization of Nurse Leaders, MA-RI. The rate was calculated from April 2011 to March 2012. Patients having falls with injuries were calculated slightly higher at Spaulding, at 0.84 per 1,000 patients, compared to 0.78 among other rehab facilities. Those injuries are described "very broadly" to include a bruise or scrape, say Spaulding officials.

Pressure ulcers were reported at zero per 1,000 patients at Spaulding Cape Cod, compared to 0.65 per 1,000 patients for the reporting periods of June, September, and December 2011 and March 2012. Lowell attributes Spaulding's rounding program as a key reason for both reductions in falls and reduced bedsores. Spaulding started a nurse rounding program that "quickly evolved into a multidisciplinary" rounding program, Lowell says. The rounding occurs hourly during the day and every two hours at night. At that time, a member of either the nursing or therapy staff checks the patient and reviews key indicators that have a high correlation to quality, including the need for toileting, changing of position, and medications.

"We know that improvements in strength, balance, and endurance help people regain their footing if they should be caught off balance. The education we do around safety and mobility also helps people avoid potentially challenging circumstances at home and in the community," Lucier says.

Officials see the wellness program as an integral part of improving patient care, especially those with Parkinson's disease. Spaulding Rehabilitation Hospital's Cape Cod outpatient centers in Sandwich and Framingham, in partnership with Boston University's Sargent College of Health & Rehabilitation Services, runs the Parkinson's Disease Wellness and Exercise Program.

Participants learn exercises and also a problem-solving approach to manage daily mobility, self-care, and communication issues. The program addresses issues such as balance, strategies to facilitate self-care, improving volume of speech, and conserving energy.

The results of testing 17 patients in the most recent group in 2012 showed significant milestones of success for the geriatric patients, she adds. Fourteen of the 17 patients who completed the six-minute walk test showed improvement in distance. All of the 16 patients who completed the functional gait assessment, which assesses balancing during turning and stepping over obstacles, showed improvement.

Expanding care for the growing population with neurological needs will require innovation and creativity, as programs must be tailored to a wide array of symptoms, causes, and impacts. Watching some of the "best in class" medical centers adapt to the demographic demands of the neurological service line landscape will pave the way for other hospitals looking to do the same.

Joe Cantlupe is senior editor for physicians and service lines. He may be contacted at

Reprint HLR0313-7

This article appears in the March 2013 issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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