Home > RNJ > 2009 > March/April > Implementing a Back-to-Rehab Day

Implementing a Back-to-Rehab Day
Modestine Fain, MSN MA RN

This article discusses the process of planning and implementing an event during which former patients are invited to return to their acute inpatient rehabilitation facility to visit the treating team, provide information about their treatment satisfaction, participate in follow-up interviews, and measure the functional gains made since discharge. For staff members and former patients and their families, Back-to-Rehab Days are rewarding and educational experiences.
How are patients doing 1 year after being discharged from acute inpatient rehabilitation? Are they maintaining goals? What new problems have arisen? Have they kept appointments with their primary physicians? Some of these questions are answered by social workers' follow-up phone calls. Some are answered during the 180-day Functional Independence Measurement (FIM) follow-up. But what if it were possible to actually meet with the patients and ask them these questions, measure their gains, and refer them for needed services?

A 15-bed hospital-based unit in a major metropolitan area, part of a for-profit national healthcare chain, had only been open 2 years when a therapist suggested a Back-to-Rehab Day. The concept was presented to the leadership team, and the team decided to implement the program.

All stroke patients admitted during the past year (40 patients) were invited for a checkup with the rehabilitation team. Each patient’s primary caregiver or spouse was also invited to attend. The patients were asked to schedule appointments and to expect to spend approximately 2 hours at the rehabilitation unit. Sixteen patients participated.

The medical history, physical records, and discharge summary for each patient who responded were retrieved, and the entire team reviewed the documents to prepare for the event. On the day of the event, the unit was set up with various stations where specific services would be offered.

Back-to-Rehab Day consisted of the following activities:

  • Therapy staff members completed patient assessments using the FIM instrument. Transfers and assistance by caregivers were also assessed for safety.
  • Nurses reviewed patients’ vital signs. They also reviewed patients’ medications and were prepared to answer questions about medical complaints or problems.
  • The recreation therapist conducted a participation questionnaire to assess patients’ participation in the community and other activities.
  • The social worker asked about any referrals or resources needed, such as referrals to the stroke support group, attendant care, or the Department of Motor Vehicles for disabled parking placards.
  • Finally, participants were seen by a physiatrist (in this case, the program medical director), who reviewed all the information documented by the rehabilitation team. He then discussed any referrals they needed for outpatient therapy or their primary physicians for follow-up.

Before participants left, they were asked to complete an evaluation of Back-to-Rehab Day and add any suggestions for improvement. A patient-specific report was summarized and sent to each patient’s primary physician, letting him or her know of the patient’s functional status (Figure 1). An FIM follow-up score was added to the original FIM score, and this score was added to the medical record.

Data, including satisfaction, participation, and functional gains, were obtained from a convenience sample of former patients and were summarized in a comprehensive report (Figure 2). One limit of gathering data from this convenience sample is that results cannot be generalized to all stroke survivors. However, the comprehensive report identified information potentially relevant to other rehabilitation settings for long-term follow-up.

The program showed that functional gains had continued to improve among the 16 participants. In addition, community participation scores were high in this group, perhaps secondary to their ability to participate in this event.

A variety of referrals were made after the assessments were completed, and instructions about various topics, such as proper transfer techniques, were included as needed because most patients had brought a spouse or caregiver to the event with them.

All participants were very satisfied with this free service and enjoyed seeing the rehabilitation team again. They especially liked being able to ask questions and talk to healthcare professionals, including the physician. In addition, healthful snacks such as fruit and bottled water were available for participants while they waited to go to the next station.

It was decided the event should be hosted every year and may be expanded to twice a year as the number of patients continues to grow. For future events, it will be important to determine why so few patients initially participated. Given the small number of attendees, this program should be considered a pilot program.

It will also be necessary to determine how to cover the cost of the program if participation increases; this event was free to participants. The therapists included their time in the day’s treatments, and the physician volunteered his time. The patients’ primary physicians might be asked to assess their understanding of this event and of the value added to their patients’ recovery and rehabilitation process.

Approximately 4 hours were required to visit with the 16 patients who participated in the event. Suggestions for improvement include coordinating the rotation from one station to the next more efficiently to avoid lines because some stations took longer to complete than others. Although volunteers helped direct patients, there were people waiting for the next station. Also, the strategic plan for next year must include a review of the documentation by the staff before the event to facilitate timely completion of forms.

In summary, the staff thoroughly enjoyed Back-to-Rehab Day, and they were rewarded for their efforts by seeing the gains achieved by their former patients and contributing to their continued rehabilitation success.

About the Author

Modestine Fain, MSN MA RN, is a program director at Good Samaritan Hospital, San Jose, CA. Address correspondence to her at modestine.fain@hcahealthcare.com.