2013 quality data report - Nexus Specialty Hospital

2013 QUALITY
DATA REPORT
PHYSICIAN LED.
P AT I E N T C E N T E R E D .
F A M I LY F O C U S E D .
By demonstrating compliance adherence
with the Medicare Conditions of
Participation integrated with the ISO
9001 quality management system,
Nexus Specialty Hospital has earned the
Certificate of Hospital Accreditation.
Nexus Specialty Hospital is licensed by the
State of Texas as a Medicare provider.
Nexus Specialty Hospital is certified by
the State of Texas as a Department of
Assistive and Rehabilitative Services
(DARS) vendor.
MISSION
Nexus Specialty Hospital is dedicated
to providing individualized, holistic,
compassionate care in a safe
and comfortable environment to
patients with complex medical and
rehabilitative needs.
VISION
Nexus Specialty Hospital will be
the leading provider of exemplary
patient and family centered care.
CONTENT
Introduction.............................................................................................................. 2-3
Objective, Mission, Vision..............................................................................................3
CEO Welcome...............................................................................................................3
Physician Leadership................................................................................................ 4-5
Patient Satisfaction.......................................................................................................6
Where do our patients come from?...............................................................................6
Payor Mix.....................................................................................................................7
Where do our patients go?............................................................................................7
2013 Diagnoses...........................................................................................................8
Patient Demographics...................................................................................................8
Quality Management System........................................................................................9
Community Outreach..................................................................................................24
Infection Control Quality Data................................................................................ 10-11
Patient Safety Initiative...............................................................................................12
Team Conference........................................................................................................12
Respiratory Services...................................................................................................13
Wound Care.......................................................................................................... 14-15
Rehabilitation Services......................................................................................... 18-19
Neuro Continuum Program.................................................................................... 20-23
NUMBER OF EMPLOYEES:.........................................................................267
LICENSED BEDS:............................................................................................ 75
NUMBER OF INPATIENTS IN 2013:.......................................................... 549
AVERAGE INPATIENT LENGTH OF STAY:........................................ 28 days
OUTPATIENT VISITS IN 2013:................................................................... 493
NUMBER OF OUTPATIENTS IN 2013....................................................... 141
AVERAGE NUMBER OF OUTPATIENT VISITS............................................ 27
4
Nexus Specialty Hospital | a part of Nexus Health Systems
We are committed to exceeding the
expectations of the community
we serve.
VALUES
• We strive for excellence.
• We treat everyone with dignity,
integrity, respect and sincerity.
• We are dependable and ethical in
all interactions.
HISTORY OF NEXUS SPECIALTY
HOSPITAL
In 1992, Nexus Health Systems embarked on a mission to create specialized
healthcare environments where patients could receive treatment and
rehabilitation specific to their needs. The company, which is privately owned
and headquartered in Houston, Texas, has continued to build upon a tradition
of excellence as it strives to provide each individual with dignity, respect and
compassion.
Nexus Specialty Hospital is an adult medical specialty hospital located in the
beautiful wooded suburbs of North Houston.
Nexus Specialty Hospital screens each potential patient for medical necessity
to ensure that the appropriate level of care is identified.
Welcome to Nexus Specialty Hospital! I would like to take this opportunity
to thank you for choosing Nexus for your care. Although continued
hospitalization can certainly be difficult for you and your family, we are
committed to ensuring your stay here with us is as pleasant as possible. Our
average patient satisfaction score for 2013 was 4.6 out of 5, and it is our
goal to exceed this level of excellence in 2014. It is our mission to provide
physician led, patient centered, and family focused health care, where our
patients always come first.
• We value each person’s spiritual
and cultural beliefs.
4.6
patient
satisfaction
score
Erin Cassidy, MSN, MBA
Chief Executive Officer
Nexus Specialty Hospital
713-482-3313
2013 QUALITY DATA REPORT
5
NEXUS SPECIALTY HOSPITAL
PHYSICIAN LEADERSHIP
PHYSICAL MEDICINE AND REHABILITATION, MEDICAL DIRECTOR
Benjamin Agana, MD
Medical Education: Rush Medical College, Chicago, Illinois
Residency: Baylor College of Medicine, Houston, Texas
MEDICAL DIRECTOR
Ather Jalil Siddiqi, MD
Medical Education: King Edward Medical College, Lahore, Pakistan
Residency: Cleveland Clinic Foundation, Cleveland, Ohio
Fellowship: Baylor College of Medicine, Houston, Texas
ASSISTANT MEDICAL DIRECTOR
Nadeem Jamil, MD
NEURO CONTINUUM, MEDICAL DIRECTOR
Ronald Tintner, MD
Medical Education: University of Florida College of Medicine, Gainesville, Florida
Internship: Presbyterian Hospital of Dallas, Texas
Residency: University of Texas Southwestern Medical School, Dallas, Texas
Fellowship: Baylor College of Medicine, Houston, Texas
Medical Education: Dow Medical College, Karachi, Pakistan
Residency: University of Missouri, Columbia, Missouri
WOUND MANAGEMENT, MEDICAL DIRECTOR
John Thomas, MD
Charles Sims, MD
Medical Education: American University of the Caribbean School of Medicine,
St. Maarten, Netherlands Antilles
Internship: Providence Hospital, Southfield, Michigan
Residency: Providence Hospital, Southfield, Michigan
Medical Education: University of Texas Medical School, Houston, Texas
Residency: University of Texas Medical School, Houston, Texas
Fellowship: University of Texas Medical School, Houston, Texas
UTILIZATION REVIEW, MEDICAL DIRECTOR
CRITICAL CARE, MEDICAL DIRECTOR
Medical Education: West Visayas State Univeristy, Phillippines
Internship: St. Paul’s Hospital, Phillippines
Residency: University of Oklahoma Health Sciences Center, Oklahoma City, Okla-homa
INFECTION CONTROL, MEDICAL DIRECTOR
Aries Bajoyo, MD
Jefy Mathew, MD
Medical Education: Baylor College of Medicine, Houston, Texas
Residency: Baylor College of Medicine, Houston, Texas
Fellowship: Harvard University Medical School, Boston, Massachusetts
NIGHT HOUSE OFFICER
Chris Sparkman, MD
Medical Education: University of Texas Medical School, Houston, Texas
Residency: Memorial Family Practice, Houston, Texas
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Nexus Specialty Hospital | a part of Nexus Health Systems
2013 QUALITY DATA REPORT
7
Worker’s Compensation/
Self-pay (5%)
PAYOR MIX
PATIENT SATISFACTION
5%
Nexus Specialty Hospital prides itself on exemplary customer service. Initial and discharge satisfaction surveys are
conducted with each patient. Our scores are based on a 5 point rating scale. Nexus Specialty Hospital using this feedback
to drive quality initiatives and ensure patient and family needs are met.
Commercial
Insurance (20%)
“Nursing staff was excellent. The personal
care assistants were
very caring, uplifting
and supportive. The
therapists got me
walking for the first
time in a year.”
20%
Medicare
75%
2013 AVERAGE
PATIENT SATISFACTION SCORES
5
Nexus Specialty Hospital ensures that discharges are thoroughly planned
and properly communicated to the patient and family members. Our goal
is to identify the most appropriate level of care for each patient.
4.4
4.2
re
ici
ys
Ph
ag
an
M
se
15%
Home
33%
Ca
Assisted
Living (15%)
19%
5% 4%
Skilled Nursing
Facility (19%)
2013 ADMISSION
SOURCES
WHERE DO OUR PATIENTS
COME FROM?
Our patients come to us from all over Southeast Texas as well as
nationwide. We collaborate with different payor sources to admit
patients too.
Nexus Specialty Hospital | a part of Nexus Health Systems
Other
16%
an
vic
er
tS
en
em
tio
tri
Ca
es
s
ice
Se
n
ag
Nu
an
M
n
tio
ica
ed
M
rv
em
st
Sy
ry
to
ira
sp
Re
an
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ha
Re
en
em
re
nd
rv
Se
g
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rs
Nu
Ca
ice
ac
db
lF
ee
ra
ne
Other (4%)
Acute Care Hospital
91%
8
t
4
Ge
Home or Inpatient
Rehab (5%)
-David Prestwood,
patient
WHERE DO OUR PATIENTS GO?
4.6
k
PATIENT
SATISFACTION
SCORE
4.8
s
4.6
2013 PAYOR MIX
dW
ou
AVERAGE
“This has been the
best experience. The
entire staff treated
me wonderfully.
Everyone, including
nursing, therapy and
respiratory, was very
encouraging!”
-Madhu Vallaru,
patient
17%
Inpatient
Rehab (17%)
2013 DISCHARGES
“The hospital staff
went above and
beyond to accommodate our family. All
the staff, down to the
housekeepers, were
excellent”
-Family of David
Prestwood
In 2013, Nexus was selected by the Texas Medical Foundation (TMF)
Health Quality Initiative to participate in an innovation project that will
focus on reducing readmissions to short term acute care hospitals by 20%.
TMF Health Quality Institute conducted a one year project in the Houston
Hospital Referral Region (HRR) to identify strengths and weaknesses
in Long-Term Care Hospitals (LTCH) through a collaborative effort with
providers, community leaders, and stakeholders. This community will
develop recommendations and select interventions to improve patient
outcomes, lower costs, and achieve sustainable improvement. Nexus
Specialty Hospital is proud to be a part of this project. For more
information, please visit: http://texasqio.tmf.org/
2013 QUALITY DATA REPORT
9
2013 DIAGNOSES
QUALITY MANAGEMENT SYSTEM
Nexus’ Case Mix Index (CMI) for 2013 was 1.03. A CMI greater than 1.0
indicates a high level of medical complexity. The physicians and staff at Nexus
are well equipped and able to manage those patients with a higher level of
medical acuity.
2013 MOST COMMON DIAGNOSES
Respiratory Complications
Sepsis
Chronic Obstructive Pulmonary Disease
TBI
Pressure Ulcers
PATIENT DEMOGRAPHICS
Location
Average Age
Males/Females
Shenandoah
Campus
The Woodlands
Campus
70 years
55 years
52% Males/
48% Females
75% Males/
25% Females
“The reason I like
working with Nexus
Wound Care Team
is simple— Nexus is
always looking to “Do
the right thing” when
it comes to patient
care. The wound care
patients always get
the best personalized
care and state of
the art equipment.
The feedback from
the Wound Care
Team helps to direct
focused care and the
most efficient healing
processes possible.
Outcomes are second
to none.“
John Thomas, MD,
Medical Director,
Nexus Specialty
Hospital
Nexus Specialty Hospital’s quality management system focuses on a process of analyzing
outcomes and sustaining improvements. A philosophy of quality is everyone’s responsibility
and individual accountability. At the center of coordination patient care is the Nursing Team. Nurses have a responsibility
as key caregivers providing day-to-day coordination of patient services. They meaningfully influence the quality of care
provided and ultimately patient outcomes. Nursing collaborates with all disciplines to ensure our care delivery system is
unified and positive. Providing evidenced based practices lend to prudent care and patient satisfaction. The best practices
aid in the best recovery for our patients.
Our hospital culture reflects “One Team, One Touch,” which is essential for the healthcare team, as they build important
developments in quality results. For quality improvements to be successful, the CEO leads the healthcare team to achieve
sustained positive outcomes. Quality patient care and healing is what Nexus Specialty Hospital desires for you and your
loved one.
SPECIAL PROCEDURES
Nexus Specialty Hospital is able to perform many procedures either at bedside or in our procedure room. These procedures
include, but are not limited to
Bronchoscopy
Biopsies—thyroid, renal, lung, bone
Colonoscopy
PICC and midline placement
EGD
Botox injection
EGD with peg placement
Declotting of portocath
Percutaneous placement of J tube
Chest tube insertion
Repositioning of gastric feed tube
Thoracentesis/paracentesis
G-tube placement under fluoroscopy
Ultrasound guided aspiration of abscess
Baclofen pump refill/maintenance/
programming
Central line placement
IVC filter placement
Hemodialysis catheter placement/removal
Lumbar puncture
Tunneled dialysis catheter placement/removal
Nephrostomy tube exchange
Venogram assess CVC placement
Removal of abdominal drains
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Nexus Specialty Hospital | a part of Nexus Health Systems
2013 QUALITY DATA REPORT
11
WHAT IS A CENTRAL LINE-ASSOCIATED BLOODSTREAM
INFECTION (CLABSI)?
INFECTION CONTROL QUALITY DATA
Nexus Specialty Hospital participates in the National Healthcare Safety Network’s (NHSN) national reporting program for
infection control indicators. Our benchmarks are set based upon NHSN recommendations which is managed by the Division
of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control.
A CLABSI is a serious infection that occurs when germs (usually bacteria orviruses) enter the bloodstream through the
central line. Healthcare providers must follow a strict protocol when inserting a central line as well as use stringent
infection control practices each time they check the line or change the dressing.
1.3
National Benchmark
NSH 2 Year CLABSI Rate per 1,000 line days
1.26
CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
(CAUTI)
A urinary tract infection (UTI) is an infection involving any part of the urinary system, including the urethra, bladder, ureters,
and kidney. Many UTIs acquired in the hospital are associated with a urinary catheter, a tube inserted into the bladder
through the urethra to drain urine. The most important risk factor for developing a CAUTI is prolonged use of the urinary
catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are
no longer needed.
HAND HYGIENE
Nexus Specialty Hospital follows the CDC’s Guidelines for Hand Hygiene in
Health-Care Settings. Performing hand hygiene can decrease the amount
of bacterial burden on the hands and is the number one way to prevent the
spread of infections.
WHAT IS A CENTRAL LINE?
A central line is a catheter (tube) that doctors often place in a large vein in the
neck, chest or groin to give medication or fluids or to collect blood for medical
tests. Central lines are different from IVs because central lines access a major
vein that is close to the heart and may remain in place for weeks or months
and have greater potential to cause serious infection.
NSH 2 Year CAUTI Rate per 1,000 Foley days
Nexus Specialty Hospital | a part of Nexus Health Systems
1.93
VENTILATOR-ASSOCIATED PNEUMONIA (VAP)
VAP is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a
patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the
neck. An infection may occur if germs enter through the tube and get into the patient’s lungs. The CDC provides guidelines
and tools to the healthcare community to help end VAP and resources to help the public understand these infections and
take measures to safeguard their own health when possible.
1.18
Internal Benchmark
NSH 2103 VAP Rate per 1,000 vent days
12
2.6
National Benchmark
1.08
2013 QUALITY DATA REPORT
13
PATIENT SAFETY INITIATIVES
Antibiotic utilization use has increased in the US and worldwide. Antibiotic medication use is associated with certain
morbidities including collateral damage (C. Diff colitis), toxicity (myelosuppresion), and the development of resistant species
of bacteria. All morbidities increase with increased length of the antibiotic course. Nexus Specialty Hospital adheres to a
strict sntibiotic stewardship program to ensure antibiotic utilization is appropriate and efficient. Our Medical
Director of Infection Control, Charles R. Sims, MD, monitors this program on a weekly basis in conjunction with our Director
of Pharmacy.
According to the Agency for Healthcare Research and Quality, between 700,000 and 1,000,000 falls occur in hospitals
annually. The Fall Prevention Committee at Nexus Specialty Hospital has worked to ensure that our patients are safe during
their stay by equipping every room with a bed alarm and performing fall risk assessments every shift.
OUR PATIENTS HAVE A VOICE IN THEIR CARE.
Kenneth Douglas, RRT, Director of Respiratory Services
TEAM CONFERENCE
Nexus Specialty Hospital offers weekly interdisciplinary team conferences in
an effort to better serve the needs of our patients and their families. Patient
and family goals are discussed in conjunction with clinical goals to prepare
the patient for an optimal discharge. Our conferences include members from
Respiratory Care, Rehabilitation, Wound Care, Infection Control, Nursing,
Dietary, and Case Management.
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Nexus Specialty Hospital | a part of Nexus Health Systems
IN 2013, 92% OF OUR PATIENTS WERE
SUCCESSFULLY WEANED FROM VENTILATOR
DEPENDENCY. 14.2 AVERAGE VENT DAYS.
Source: Nexus Internal Data (2013)
RESPIRATORY WHERE CLINICAL EXCELLENCE MEETS
STATE OF THE ART TECHNOLOGIES
The Respiratory Care Services program at Nexus Specialty Hospital represents one of the
best in ventilator management.
RESPIRATORY—V200
TALKING VENTILATORS
RESPIRATORY—HIGH
FLOW THERAPY
Several studies have been conducted illustrating the
experience of the ventilator-dependent patient. These
studies found that patients feel fear and anxiety relator
to several factors, including the inability to verbally
communicate. Our ventilators feature a speaking mode
that, if activated, allows for our tracheostomy patients
to speak. This feature provides patients with the ability
to communicate with caregivers and family members,
promoting interdisciplinary collaboration and ensures the
provision of patient centered care. Source: Tsay et. Al,
Nursing & Health Sciences, 2013
High flow oxygen therapy benefits patients with
secretion management issues, while providing an
oxygen enriched atmosphere. Compromised pulmonary
patients, who are ventilator dependent and attempting
to wean, may wean faster when high flow oxygen is
used rather than the conventional aerosol method. High
flow oxygen therapy shows efficiency in managing
complex respiratory patients, reducing overall length
of stay, preventing readmissions and providing patients
with the ability to transition to the home or an alternate
level of care with a high level of function.
Flow Track: The ventilator flow track mode provides
the patient with the amount of oxygen needed for each
controlled breath so the patient does not “fight” the
ventilator. This breath type greatly improves patient
ventilation synchrony and may reduce the need for
sedatives.
2013 QUALITY DATA REPORT
15
INPATIENT WOUND CARE
OUTPATIENT WOUND CARE CLINIC
Complex and comprehensive wound management is one of Nexus Specialty Hospital’s areas of expertise. Our Wound
Care Medical Director, John Thomas, MD, is board-certified in wound management and hyperbaric medicine. The Wound
Care Team is comprised of clinicians with specialty training in wound management as well as specialty certifications in
wound management (i.e., Certified Wound Specialist (CWS®), Certified Wound Care Associate (CWCA®), Diabetic Wound
Certified (DWC) and Wound Care Certified (WCC®)). The Wound Management Program has been meticulously developed
to provide customized care for patients with complicated and/or non-healing wounds. The Nexus Specialty Hospital Wound
Management Program has been recognized by The Joint Commission and DNV, hospital accrediting agencies.
Nexus Specialty Clinic’s main purpose is to continue the quality care our patients with wounds require after discharge from
the hospital. Nexus Specialty Clinic has been established with the same high standards as the Nexus Specialty Hospital
Wound Management Program. A multidisciplinary approach is utilized in order to achieve the optimal outcome for each
patient. Physicians work with specialty trained wound care nurses in order to provide an evidence-based plan of care for our
patients.
Physician specialties include: Wound Management, General Surgeons, Plastic
INTERVENTIONS OFFERED AT
Surgeons, Podiatric Surgeons, Infectious Disease, and Pain Management.
NEXUS SPECIALTY HOSPITAL
Advanced Wound Dressings
60
Inpatient
50
Outpatient
40
30
Negative pressure wound therapy
(VAC®)
Pulsatile lavage
20
Autologous platelet grafting
10
0
Debridements
Skin substitutes
Pressure
Ulcers
Surgical
Wounds
Trauma
Wounds
Skin
Tears
WOUND TYPE
Vascular
Wounds
Diabetic
Foot Ulcers
Biophysical modalities (non-contact, low
frequency ultrasound (MIST Therapy®),
electrical stimulation)
Specialty surfaces
CASE STUDY
March 29, 2013: 42 year old man bitten by rattlesnake two times on right hand/upper
arm and one time on left hand. Patient given CroFab anti-venom in ER and suffered
a severe anaphylactic reaction resulting in shock and requiring intubation acute care
hospital stay complicated by respiratory failure, development of DIC (disseminated
intravascular coagulation), and multiple wounds (snake bites, pressure ulcers).
Patient presented to Nexus on June 4, 2013 with the following:
Soft tissue necrosis to the left and right hands, right forearm, right upper arm, and
scrotum, Pressure ulcers to the left ear, occiput head, and left lateral lower leg, Less
than a week after admission, the wound care team noted soft tissue necrosis on his
abdomen.
Dr. Younghoon Cho (plastic surgeon) evaluated the patient on June 10, 2013.
June 12, 2013: Patient underwent debridement, skin graft application to scrotum and
left hand, and Integra graft to penile shaft, right hand, forearm, and upper arm.
July 3, 2013: The patient returned to the OR for skin grafts to the penile shaft, right
upper arm, forearm, and hand.
July 15, 2013: All wounds covered by grafts resolved.
RIGHT UPPER ARM
RIGHT UPPER ARM
July 17, 2013: Patient discharged to a rehabilitation facility and followed by Dr. John Thomas, Medical Director of
Wound Care at NSH, for continued wound care.
Upon discharge from rehabilitation facility, the patient continued to see Dr. Thomas at Nexus Specialty Clinic (NSC)
for outpatient wound care.
August 27, 2013: Patient presented to NSC with abdominal wound, resolving occiput head pressure ulcer, left upper thigh
donor site surgical wound, and left lateral lower leg pressure ulcer. With the exception of the abdominal wound, all wounds
were resolved within one month.
October 8, 2013: Dr. Thomas applied graftjacketXpress to the tunnel in his abdominal wound.
October 22, 2013: The abdominal wound resolved, and the patient was discharged from clinic to home, treatment complete.
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Nexus Specialty Hospital | a part of Nexus Health Systems
2013 QUALITY DATA REPORT
17
Our PTs
specialize in the treatment of
medically complex patients
including deficits particular
to neurological diagnoses,
cardiopulmonary disease,
complex wounds and orthopedic
injuries are evaluated and a plan
of care is developed to enhance
mobility, strength, endurance,
balance, fall prevention safety
and coordination.
Our OTs
endeavor to maximize patient
independence through functional
activity. The core areas of focus
include activities of daily living,
strengthening, activity tolerance,
patient safety and adaptive
equipment training.
Our SLPs
assess cognitive dysfunction,
swallow disorders and speech/
sound production. These highly
trained clinicians are able to
perform on-site modified barium
swallow studies and passymuir
trials for ventilated patients.
REHABILITATION
SERVICES—
SHENANDOAH CAMPUS
All patients are evaluated by physical therapists (PT),
occupational therapists (OT), and speech language
pathologists (SLP). The therapists work with the patient, family
and physicians to develop a comprehensive treatment plan
customized to optimize outcomes for patients with a high
medical acuity. Patients who are not able to participate in
formal therapy services are eligible for the Restorative Care
Program.
NEXUS-SHENANDOAH THERAPY OUTCOMES
JANUARY DECEMBER 2013
(N=266)
Functional
Decline (10%)
Maintained
Functional Status (7%)
7%
10%
Functional
Improvement
83%
EARLY INTERVENTION IN
ICU
REHABILITATION SERVICES—
THE WOODLANDS CAMPUS
The Woodlands Campus provides neuro specialty
care to patients with an intense rehabfocus.
Theprogramisledbyaneurologist and is family centered with our
interdisciplinary team consisting of physicians, nursing, case
management, PT, OT, SLP, neuropsychologist, programming
coordinator, wound care specialist, dietician and infection
control practitioner. The team rounds weekly and offers
admission and family conferences to provide education and
training for our patients to smoothly reach the next level of care.
The treatment team is certified in Crisis Prevention Intervention
to ensure the environment is structured and safe. Behavioral programs are implemented as
needed. A Hawk Monitoring System allows mobility to occur
within a secure environment.
NEXUS-THE WOODLANDS THERAPY OUTCOMES
JANUARY DECEMBER 2013
(N=50)
Functional
Decline (2%)
2%
Functional
Improvement
98%
Our PTs
address positioning, strength,
endurance and balance training
for safety and sequencing
for transfers and walking.
Assessment may also include
custom seating with wheelchair
procurement and managing
spasticity.
Our OTs
address upper extremity function
and fine motor control, automatic
and procedural memory in
activities of daily living, visual
field deficits, splints, use of
adaptive equipment and iPad for
functional activities.
Our SLPs
address unique areas of
communication, cognition,
swallowing with Vital stim,
passymuir speaking valve/trach
progression, attention and
memory strategies, and aphasia/
apraxia with use of augmentative
communication devices.
Our therapists understand the importance of early mobilization
and therapeutic intervention with patients in the ICU . Sitting
programs, therapeutic exercises, energy conservation
techniques, among other activities, are used to increase
activity tolerance and ultimately patient function.
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Nexus Specialty Hospital | a part of Nexus Health Systems
2013 QUALITY DATA REPORT
19
THE NEURO CONTINUUM
PROGRAM
The Neuro Continuum Program begins at the Shenandoah Campus and is
under the direction of the Director of Neuro Rehabilitation. A neuro continuum
patient is defined as one who receives treatment at more than one of the
Nexus Health Systems’ campuses with a neurological diagnosis. This data
is monitored as a strategic planning focus. Therapists from both campuses
work closely together to ensure continuity of care. Handicapping conditions
and goals are identified to allow the treatment team to seamlessly progress
patients to maximize their functional outcome.
A personal journal is initiated by the therapy team at Shenandoah Campus
to serve as a tool for individualized care provide education and support for
improving memory skills. As appropriate, a patient is transferred to The
Woodlands Campus for progression in the Neuro Continuum. The patient’s
personal journal remains with them for the duration of their stay at Nexus.
This journal is used as a tool to help tell the patient’s story from injury through
recovery.
Patients receiving neuro rehabilitation will work with specialty trained
therapists. NeuroIntegrative Functional Rehabilitation and Habilitation
(NeuroIFRAH) certified therapists provide the framework for initiating return to
normal movement and function. Fitness programs are implemented for higher
functioning patients.
TNC
24%
“It has been an
amazing privilege
to be part of
developing a unique
neurocontinuum
program that focuses
on individualized
care. We truly change
the quality of life for
patients and families
facing brain injury
recovery.”
Rehab
14%
Acute
14%
Home
20%
12
Other post acute (2%)
10
Planned surgery (2%)
8
6
SNF
24%
4
2
0
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
NEURO CONTINUUM
NEURO CONTINUUM PATIENTS TRANSFERRED
DISCHARGE DISPOSITION
FROM SHENANDOAH TO WOODLANDS
(N=50)
(N=27)
NEURO SPECIALTY SAMPLE PROGRAMMING SCHEDULE
-Lisa Scheffe,
Director of Neuro
Rehabilitation
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
9:00 AM
Cognitive Group
Cognitive Group
Cognitive Group
Cognitive Group
Cognitive Group
10:00 AM
Physical Therapy
Project Group
Speech Therapy
Occupation Therapy
Physical Therapy
11:00 AM
Problem Solving
Group
Speech Therapy
Physical Therapy
Chef Group
Garden Group
1:00 PM
Open
Occupation Therapy
Wii Bowling
Physical Therapy
Occupation Therapy
2:00 PM
Occupation Therapy
Music Group
Open
Speech Therapy
Speech Therapy
3:00 PM
Leisure Pursuit
Open
Strategy Games
Excercise Group
Excercise Group
FAMILY SUPPORT
Psychologist Kermit Parker, PhD leads weekly support group meetings for the benefit of the
family and caregivers of brain injury survivors. Dr. Parker has over 20 years of experience
in brain injury rehabilitation. He is able to offer compassionate and practical coping skills
to a patient’s loved ones.
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Nexus Specialty Hospital | a part of Nexus Health Systems
2013 QUALITY DATA REPORT
21
THERAPEUTIC PROGRAMMING
BRAIN INJURY RECOVERY
Leisure is an important part of a balanced lifestyle. For many people, leisure facilitates social connections and self–
expression. For others, leisure provides opportunities for physical and mental fitness. At Nexus Specialty Hospital leisure
programming is an integral part of therapy; incorporating skills patients are working on in occupational, physical and
speech therapies.
At the core of the Neuro Specialty Program is an emphasis on recovery of cognition function. Cog- nition refers to a person’s
thinking skills and memory. Specific cognitive skills include attention/ concentration, organizing, planning, solving problems,
judgment, and awareness of problems. Memory skills include ability to remember things before and after the brain injury.
Leisure programming is responsive to patient skills and goals. Licensed therapists develop and lead leisure programming.
Patients engage in programming on a one to one basis as well as in groups. The groups include but are not limited to the
following: computers, cooking, crafts, current events, games, gardening, holiday celebrations, light construction, music, pet
visits, socialization,
Patient A represented in this case
study showed significant measurable
improvement in cognitive function,
recall of recent events, and orientation
to person, place, time, and situation.
The Galveston Orientation and
Amnesia Test (GOAT) was used as a
brief mental status examination that
evaluates orientation to time, place,
person, situation, and recall of events
prior to brain injury as well as events
immediately after.
GOAT
100
80
60
40
20
0
Week 1
Week 2
Week 3
Week 4
Patient B represented in this
LCFS
case study showed significant
8
measurable improvement in
cognitive function including attention/
6
concentration,awareness of
surroundings, organizing, planning,
4
judgment, problem solving, and ability
to remember before and after the brain
2
injury. The Rancho Los Amigos Levels
of Cognitive Functioning Scale (LCFS)
0
was used to monitor recovery and
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
classify outcome as well as describing
stages of cogni- tive function. Patient B progress from Level 4, Confused, Agitated to Level 6-7, Confused, Appro- priate
with periods of Automatic, Appropriate.
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Nexus Specialty Hospital | a part of Nexus Health Systems
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LIFE CARE PROGRAM
The Life Care Program at Nexus Specialty Hospital is a dynamic program designed to maximize a patient’s recovery
potential, improve quality of life and decrease his or her overall burden of care. Typically our patients are in need of chronic
health care after a catastrophic injury. The medical, rehabilitative and habilitation needs of the individual are addressed
over the lifespan of the patient. We also recognize that the disability process is a traumatic experience affecting not only
the injured person, but also the family.
THE PROGRAM PROMOTES:
• Quality of life issues by including interventions designed to:
+ Minimize risk and prevent medical complications and secondary disability
+ Maximize potentials for independence, productivity, self-actualization and self-advocacy
• Daily life within the least restrictive environment while protecting the rights of the individual and his/her family/ support
system.
LIFE CARE SERVICES:
Physical/Functional status: Care is taken to address the physical/cognitive, social/emotional, environmental, and pain
limitations.
Advocacy: Frequent communication is maintained between family members, guardians, trustees, advocates, hospital
disciplines, and case managers.
Education Programs: Developmental disabilities, physical disabilities, disability awareness, life care planning goals, rehab
issues, case management, interdisciplinary team process, family/professional relationships, patient;family teaching,
personal safety, and the use of restraints may all be included in the education process.
My son suffered a terrible injury on November 9th, 1991 which left him in a coma for six and a half
months. He lost 65 pounds and was forced to breathe through a tracheostomy for 18 months. Farris had
to start his life completely over. He was left unable to speak and feed himself. In addition, he had serious
memory and cognition deficits as well as severe physical limitations. For the next four years, I struggled
to find the right environment to provide Farris with the quality of life that he deserved. It wasn’t until
November 15th, 1995 that we found our home here at Nexus Specialty’s Woodlands Campus.
Farris’ life has completely changed thanks to the people at Nexus Specialty Hospital. The team
here is extraordinary. The medical staff, nurses, therapists, cases managers, wound care team, and
environmental services, just to name a few, have provided my son with the support and direction that
he needs. They have truly allowed him to have the quality of life that we struggled for years to find.
Here at Nexus we are a family. This is home to not only my son, but to me as well. Today, Farris is able
to communicate, has restored use of his arms, and is happier and healthier than he has been since his
accident. I truly do not know where my son and I would be without Nexus Specialty Hospital.
Pat Wilburn
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Nexus Specialty Hospital | a part of Nexus Health Systems
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COMMUNITY OUTREACH
Nexus Specialty Hospital is an active partner with the Nexus Hope Foundation. The Hope Foundation has three driving
principles:
• To provide charity care to individuals who meet eligibility criteria for medical equipment and supplies.
• To promote and sponsor education programs for the general public and the medical community on matters concerning traumatic brain injury and neurological disorders.
• To promote basic research regarding early intervention as it relates to brain injury recovery.
Nexus Specialty Hospital has participated in the Montgomery County YMCA’s Annual Dragon Boat Races for the past 3
years. Through these communities events, Nexus Specialty Hospital was able to distribute 400 helmets to children in the
community in an effort to proactively prevent traumatic brain injuries. The Nexus Hope Foundation raised over
$30,000 in 2013.
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Nexus Specialty Hospital | a part of Nexus Health Systems
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By demonstrating compliance adherence with the Medicare Conditions of Participation integrated with the ISO 9001
quality management system, Nexus Specialty Hospital has earned the Certificate of Hospital Accreditation.
Nexus Specialty Hospital is licensed by the State of Texas as a Medicare provider.
Nexus Specialty Hospital is certified by the State of Texas as a Department of Assistive and Rehabilitative Services
(DARS) vendor.
Shenandoah Campus
123 Vision Park Blvd.
Shenandoah, TX 77384
The Woodlands Campus
9182 Six Pines Drive
The Woodlands, TX 77380
281.364.0317
www.NexusSpecialty.com