Try a new search

Format these results:

Searched for:

person:cap2026

in-biosketch:yes

Total Results:

4


Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project

Corcoran, John R; Herbsman, Jodi M; Bushnik, Tamara; Van Lew, Steve; Stolfi, Angela; Parkin, Kate; McKenzie, Alison; Hall, Geoffrey W; Joseph, Waveney; Whiteson, Jonathan; Flanagan, Steven R
BACKGROUND: Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. In addition, Speech-Language Pathology rehabilitation was added to the early mobilization program. OBJECTIVE: 1. To assess the efficacy of early mobilization of patients with and without mechanical ventilation in the intensive care units (ICUs) on length of stay (LOS) and patient outcomes. 2. To determine the financial viability of the program. DESIGN: PIP. Prospective data collection in 2014 (PIP) compared to a historical patient population in 2012 (pre-PIP). SETTING: Medical and surgical ICUs of a Level 2 trauma hospital. PATIENTS: 160 in the PIP and 123 in the pre-PIP. INTERVENTIONS: Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the MICU and SICU for medically appropriate patients. MEASUREMENTS: Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; average cost per day. MAIN RESULTS: Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by more than 20% from 4.6 days (pre-PIP) to 3.8 days (PIP) (p=.05). A decrease of 30% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (p<.01). An increased percentage of PIP patients, 40.5%, were discharged home without services compared to 18.2% in the pre-PIP phase (p<.01). Average cost per day in the ICU and floor bed decreased in the PIP group resulting in an annualized net cost savings of $1.5 million. CONCLUSIONS: The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. Benefits include reduced hospitalization LOS, decreased health care costs and decreased need for post-acute care services.
PMID: 27346093
ISSN: 1934-1563
CID: 2166822

Introduction

Chapter by: Parkin, Kate; Corcoran, John R; Stolfi, Angela
in: Medical aspects of disability for the rehabilitation professionals by Moroz, Alex; Flanagan, Steven R; Zaretsky, Herbert H [Eds]
[New York] : Springer Publishing Company, 2017
pp. ?-?
ISBN: 9780826133199
CID: 2558762

Validity of the stroke rehabilitation assessment of movement scale in acute rehabilitation: a comparison with the functional independence measure and stroke impact scale-16

Ward, Irene; Pivko, Susan; Brooks, Gary; Parkin, Kate
OBJECTIVE: To demonstrate sensitivity to change of the Stroke Rehabilitation Assessment of Movement (STREAM) as well as the concurrent and predictive validity of the STREAM in an acute rehabilitation setting. DESIGN: Prospective cohort study. SETTING: Acute, in-patient rehabilitation department within a tertiary-care teaching hospital in the United States. PARTICIPANTS: Thirty adults with a newly diagnosed, first ischemic stroke. METHODS: Clinical assessments were conducted on admission and then again on discharge from the rehabilitation hospital with the STREAM (total STREAM and upper extremity, lower extremity, and mobility subscales), Functional Independence Measure (FIM), and Stroke Impact Scale-16 (SIS-16). Sensitivity to change was determined with the Wilcoxon signed rank test and by the calculation of standardized response means. Spearman correlations were used to assess concurrent validity of the total STREAM and STREAM subscales with the FIM and SIS-16 on admission and discharge. We determined predictive validity for all instruments by correlating admission scores with actual and predicted length of stay and by testing associations between admission scores and discharge destination (home vs subacute facility). MAIN OUTCOMES: Not applicable. RESULTS: For all instruments, there was statistically significant improvement from admission to discharge. The standardized response means for the total STREAM and STREAM subscales were large. Spearman correlations between the total STREAM and STREAM subscales and the FIM and SIS-16 were moderate to excellent, both on admission and discharge. Among change scores, only the SIS-16 correlated with the total STREAM. All 3 instruments were significantly associated with discharge destination; however, the associations were strongest for the total STREAM and STREAM subscales. All instruments showed moderate-to-excellent correlations with predicted and actual length of stay. CONCLUSIONS: The STREAM is sensitive to change and demonstrates good concurrent and predictive validity as compared with the FIM and SIS-16 in the acute inpatient rehabilitation population.
PMID: 22108228
ISSN: 1934-1563
CID: 2558752

Introduction

Chapter by: Parkin, Kate; Corcoran, John R; Denham, Tara
in: Medical aspects of disability : a handbook for the rehabilitation professional by Flanagan, Steven R; Zaretsky, Herbert H; Moroz, Alex [Eds]
New York : Springer, 2011
pp. 1-14
ISBN: 0826127843
CID: 1910172