Added Value: The Role of PM&R in the Acute Setting

For those who have worked in a post-acute care setting, the value of Physical Medicine and Rehabilitation, or PM&R (also called Physiatry) has been readily apparent. The physicians who lead our rehabilitation teams are 'big picture' thinkers, who focus on function and who understand how underlying pathology affects clinical outcomes. Physiatrists are trained to naturally facilitate an interdisciplinary process, to use contributing information from many team members to help navigate the course of a patient's recovery.

Now our PHS acute hospitals are experiencing the same benefit. Spaulding PM&R physicians are in place at MGH and at BWH. Ron Hirschberg, M.D., has been at MGH for over four years and has established a significant presence for PM&R, primarily in the neurotrauma and neurorehabilitation services. Now Jason Frankel, MD, has created a similar presence at Brigham and Women's, acting as an invaluable resource to care coordinators, physicians, patients and family members.

'The role of Physiatry at the Brigham is relatively new', says Dr. Frankel. 'The BWH staff now tell me that they knew they needed Physiatry here but didn't know why.' While the Spaulding Admission Liaisons have long had a vital role in the transition-of-care process, Dr. Frankel says that new pressures in the acute-care setting make his role even more important. 'Care coordinators (CC) are worried about patients 'bouncing back' to the acute setting if the discharge plan fails. I often work with the CCs on level-of-care decisions, so that we are confident in our recommendation and that our plan is safe and effective.'

In addition to helping with level-of-care decisions, PM&R physicians also assist diagnostically, particularly when patients are not recovering as expected. 'Because of our training, Physiatrists can help to identify barriers, such as pain, increased tone and altered cognition, that may be interfering with recovery. We have a better understanding of the normal course of recovery and assist team members as well as patients and families, to reduce their anxieties and set realistic expectations.' Frankel also sees BWH patients in his outpatient clinic, sometimes six to nine months after their acute stay. This helps him to better understand the process of recovery, and also provides him with information to share with the BWH acute caregivers.

Consider the case of an elderly man in the Neuro ICU who had sustained a severe TBI, who was trached and on a vent with a feeding tube. The patient's family and the care team were concerned that he wasn't waking up. After Dr. Frankel reviewed the scans, he was able to see that the patient's course of recovery was on target and that his functional profile was consistent with a very significant injury to his brain. Dr. Frankel was able to verify the course of recovery with the team and reduce the anxiety of the family.

BWH Care Coordinators attest to the value of his contributions. Cheryl Ventola, CC in the BWH Trauma Service, participates in weekly Trauma/Surg walk rounds with Jason and the BWH team.' Jason is a vital member of the Trauma Team at BWH. He is well-versed in Rehab Medicine and assists with level-of-care decisions and patients' rehab potential. He assists the team with management of complex cases, particularly TBI patients around medications, behavioral management and readiness for rehabilitation.'

Susan Tartaglia, Care Coordinator in the Cardiac Service, highlights Jason's ability to work with ventilator-dependent post-surgical patients. 'He assists the intensivists in the ICU and is a true voice for the patients who are unable to speak for themselves. He helps the cardiac team develop the best plan for those post-surgical cardiac patients.'

Spaulding is extremely pleased and proud that our PM&R experts have established such a significant presence in our major acute-care settings, as they have in our post-acute settings. Consider the value:

In our rehabilitation facilities, Physiatrists have long held a major role in the clinical care of our patients. They also help to bring the latest research findings to our patients. At Spaulding Boston, there are over 100 active research studies underway, bringing evidence-based treatments to patients with stroke, brain injury, spinal cord injury and musculoskeletal injuries.

Spaulding's PM&R Department is affiliated with Harvard Medical School, with many PM&R staff holding academic appointments at Harvard. Spaulding Rehabilitation Hospital is the only rehabilitation hospital in New England consistently ranked in the top ten by US News and World Report in the Best Hospitals issue.

For more information on the PM&R Department at Spaulding, please visit http://pmr.hms.harvard.edu

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