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Rehab with Heart

July 15, 2011
by Kevin Kolus, Editor
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How a skilled nursing facility empowers patients to stay out of the hospital
The educators (from left): Karla Reese, OT; Barbara Bliss, AD; Theresa Schultz, RN, DCD; and Sue Kocin, RD, LD.

Theresa Schultz is on her way to Washington, D.C., flying in a bone-white puddle jumper. As it wobbles up through the crosswinds and gray storm clouds swirling over Cleveland, the plane's exposed twin black propellers hum loudly, unconvincingly—a nerve-racking distraction to most everyone seated on this dreadfully small aircraft. But Schultz carries on her conversations with a resilient focus, the importance of the trip hanging heavy on her tongue.

The American Heart Association recognized her as one of 10 advocates from Ohio to help lobby during tomorrow's April 2011 You're the Cure on the Hill campaign, pushing for legislation and the appropriation of funds to aid in the prevention of heart disease and stroke. Schultz, RN, and the director of care delivery at ManorCare Health Services - Rocky River in Cleveland, is responsible for a 32-bed cardiac recovery unit at the skilled nursing and rehabilitation facility that has quickly made her a figure of rising stature within and outside of her organization. It's why the American Heart Association plucked her from long-term care to help be a voice for a preventable cause.

“I'm not anyone up high on the food chain,” she explains. “I'm just a nurse director that cares a lot about her patients and I've found a different way to bring information to them and embrace this healthcare reform piece.”

The reform piece of which she speaks is that little matter of reducing unnecessary hospital readmissions, the animus of so much taking place in the framework of care quality discussions and healthcare delivery. Schultz's tactic involves a multidisciplinary approach to reducing those readmissions through comprehensive patient education—her “different way” of bringing information to patients in her facility's cardiac recovery program.

“Heart patients are heart patients for life,” Schultz states with conviction, as if she has said this exact phrase every day of her life. “If you can teach people how to change their lives by what they're eating, by exercising, and by taking their medication, it's huge.”

ANATOMY OF RECOVERY

The Centers for Disease Control and Prevention estimate that every 25 seconds, an American suffers a “coronary event.” Heart disease is the number one cause of death for a variety of reasons, one of which involves the cyclical behavior of individuals making poor personal choices. Healthcare organizations have therefore targeted heart failure readmission reduction programs as necessities, and a 2009 survey conducted by the Healthcare Intelligence Network found 77.6 percent of organizations identify heart failure as a top condition guiding their readmission reduction efforts. This is where Schultz's cardiac recovery program stands out, because the tools and initiative to live a healthier life are placed right into the patient's hands.

Recent research published by the American Heart Association ♥ Researchers examined data on 21,397 very elderly veterans (aged 80 and older) who experienced a first time heart failure hospitalization between '99-'08, and found that the frequency of 30-day all-cause rehospitalizations in this group remained largely unchanged during the decade ♥ An analysis of 15,459 Medicare patients with an average age of 80 who were discharged from the hospital after three or more days following heart failure treatment showed: twenty-five percent were discharged to an SNF; 14 percent of those discharged to an SNF died within 30 days of discharge compared to four percent who returned home; and 27 percent of those discharged to an SNF were readmitted to the hospital within 30 days compared to 24 percent who went home

When someone is admitted to ManorCare Health Services - Rocky River with a cardiac primary diagnosis, they are put on the facility's vigilant cardiac protocol. How vigilant is it? If a patient sees a two-pound weight gain in one day, or a five-pound weight gain in one week, his or her physician is notified. If the patient experiences chest pain, an EKG can be performed on the spot. And if he or she has a central line, labs can be run onsite as well. The skilled nursing facility is connected to the Cleveland Clinic's DrConnect, an Internet-based service allowing community physicians to view real-time electronic medical record information about their patients, which makes this particular ManorCare unique, Schultz says. But EKGs and EMRs don't keep a patient from returning to the hospital once they have left Schultz's realm, which is why patient education has become the mantra around these parts.

“If the patient is not compliant with their disease process, they're going to go back to the hospital,” argues Jody McConnell, administrator at ManorCare Health Services - Rocky River. “Nursing homes can be doing a much better job of educating these patients.” And that is easy to say when you have a team like the one assembled at this location, which features not one but three nurse practitioners who allow the facility to accept patients of increasingly high acuity; a consulting cardiologist in Muhammed Zahra, MD, who makes regular visits to assess cardiac patients and provide recommendations to prevent further hospitalization; and a full, caring staff that has bought into education as a part of the ongoing rehabilitation process.

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Congratulations Kevin Kolus on the "Best Profile- Silver Award" from The American Society of Healthcare Publication Editors 2012. Your professional expertise as a healthcare journalist continues to capture the essence of chronic disease management. For "Heart patient's are our Heart patient's for Life"! Thank you!!

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