Addressing Hospital Deconditioning and Physical Impairment to Establish a COVID-19 Hospital Throughput Framework Michael Friedman, PT, MBA Senior Director, Program Development Director Activity and Mobility Promotion (AMP) Johns Hopkins Medicine Dr Sapna R Kudchadkar, MD, PhD Associate Professor Associate Vice Chair for Research Johns Hopkins School of Medicine @HopkinsAMP @RehabHopkins @ICUrehab Holly Russell, MS, OTR/L Team Leader, ACS Johns Hopkins Hospital Nicole Frost, M.A. CCC-SLP, BCS-S Team Leader, ACS Johns Hopkins Hospital Sowmya Kumble, PT, MPT, NCS Clinical Resource Analyst Johns Hopkins Hospital Megan Hosey, PhD Assistant Professor Rehabilitation Psychology Johns Hopkins School of Medicine
38
Embed
Addressing Hospital Deconditioning and Physical Impairment ...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Addressing Hospital Deconditioning and Physical Impairment to
Establish a COVID-19 Hospital Throughput Framework
Michael Friedman, PT, MBA
Senior Director, Program Development
Director Activity and Mobility Promotion (AMP)
Johns Hopkins Medicine
Dr Sapna R Kudchadkar, MD, PhD
Associate Professor
Associate Vice Chair for Research
Johns Hopkins School of Medicine
@HopkinsAMP @RehabHopkins @ICUrehab
Holly Russell, MS, OTR/L
Team Leader, ACS
Johns Hopkins Hospital
Nicole Frost, M.A. CCC-SLP, BCS-S
Team Leader, ACS
Johns Hopkins Hospital
Sowmya Kumble, PT, MPT, NCS
Clinical Resource Analyst
Johns Hopkins Hospital
Megan Hosey, PhD
Assistant Professor
Rehabilitation Psychology
Johns Hopkins School of Medicine
Objectives
• Review the challenges of addressing hospital deconditioning and
physical impairment in the COVID-19 environment
• Introduce the Johns Hopkins “Hospital direct Home” rehabilitation and
recovery framework
• Present practical ideas to overcome barriers to providing interventions
to address physical impairment in the COVID-19 environment
• Share intervention references and resources
FRAMEWORK DEVELOPMENT
Pre-COVID-19: Bedrest is Bad
Hospital-acquired physical impairment is
associated with INCREASED:
• Hospital-acquired complications
• Hospital length of stay
• 30-Day readmissions
• Nursing home and rehab stays
• Long-term impaired physical function
Covinsky et al. J Am Geriatr Soc. 2003; 51: 451-458.
Brown et al. J Am Geriatr Soc. 2004; 52: 1263-1270.
Brown et al. JAMA. 2013; 310: 1168-1177.
Hoyer et al. J. Hosp. Med. 2014; May;9(5):277-82
Disease
DebilityCo-morbidity
Leverage Our Models of Care:
Activity and Mobility Promotion (AMP), Adult
ICURehab, and Pediatric ICU (PICU Up!)
Essential concepts:
• Early and frequent mobilization
• Systematic measurement of function – “Common Language”
• Interdisciplinary team:
– nursing, rehabilitation team, respiratory team and medical team
• Normalize the 24 hour clock
– Sleep, Rest, Active
– ADLs: mobility with purpose
– Orientation to day and night
Critical Care Rehabilitation
Interdisciplinary Activity Mobility Program (AMP)
Rehabilitation
Consultation
Inpatient
Rehabilitation
Facilities
Homecare
Outpatient
Rehabilitation
Pre-COVID-19: Rehabilitation Continuum
COVID-19: Recipe for Physical Impairment
Treatment
• Sedation practices
• Mechanical ventilation
• Oxygen support
• Prolonged length of stay
• Bedrest
• ICU length of stay
Infection control
• Social isolation
• PPE conservation
• Reduce clinician access
• Redeployed nurses
• Access to mobilization equipment
WHO guidelines’ recommend management of COVID-19 includes prevention of hospital
acquired debility by actively mobilizing patients throughout the course of illness and addressing
functional decline.
Critical Care Rehabilitation
Interdisciplinary Activity and Mobility Program
(AMP)
Rehabilitation
Intervention
Inpatient
Rehabilitation
Facilities
HomecareOutpatient
Rehabilitation
COVID-19: Altered Health System
“Hospital Direct Home” Framework
1. “Common Language” of function
a. Capacity: AM-PAC Inpatient Mobility and Activity Scales (6 Clicks)
b. Performance: Johns Hopkins – Highest Level of Mobility (JH-HLM)
2. Utilize established ICU rehab criteria
3. Stratify patients
4. Establish formal interdisciplinary activity and mobility plans