• The typical stay at a traditional hospital is five days. At Kindred Transitional Care Hospitals, the length of stay may be measured in weeks, not days. Why? Because we know that not all patients can recover in five days or less. Some have underlying conditions that make illnesses or other conditions harder to treat. Others are still too ill to return home.

    At Kindred Hospitals, we offer a range of services to help patients who need additional time to recover, and the length of the stay depends on the needs of the patient. This includes the specialized services of our Subacute Units, where we work with patients who have an acute illness or injury or worsening of a disease but no longer need the aggressive level of care provided in a hospital. We offer short-term comprehensive inpatient medical care and rehabilitation that is designed to get the patient home or to a facility such as a skilled nursing center.

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  • Insight Into Aortic Valve Disease: A Personal Journey

    By Kindred Healthcare

    You wouldn’t know it to look at her, but Sally Meilun who has worked at Kindred Healthcare for nearly 23 years, has heart disease.

    When you talk to Sally, it’s clear that a healthy lifestyle is important to her. She’s always been active, and she still is, but when she was in her 40s, she was diagnosed with aortic valve disease, a condition in which the valve between the left ventricle and the aorta doesn’t work properly.

    “When you have heart disease, it’s not always obvious,” says Sally, who works as the Director of Travel and Relocation at Kindred’s Support Center in Louisville, Kentucky.

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  • An intervention known as noninvasive ventilation is being increasingly studied and used in patients with chronic respiratory failure. An article in a recent issue of the journal Respiratory Care, which followed a national symposium dedicated to the care of the chronically critically ill patient, examined its use in several patient populations. Noninvasive ventilation, or NIV, does not require an artificial airway, in contrast to tracheostomy (surgical creation of an airway through the neck) or the placement of a breathing tube through the nose or mouth. NIV is achieved most often through the delivery of pressure and flow to the normal airway through the nose and/or mouth.

    The benefits of NIV therapy include reduced re-hospitalizations of out-patients and a reduction in potential complications such as infection that can occur with invasive ventilation techniques.

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  • October 21-27 is Respiratory Care Week, a week set aside to recognize respiratory therapists for their hard work and dedication. “The respiratory therapists at Kindred provide a wide range of respiratory care to patients with complex respiratory disorders and other extensive medical complexities,” says Kelly Bailey, Area Director of Respiratory Care, Kindred Healthcare. “Our respiratory therapists add value and expertise to the interdisciplinary team through the development, utilization, and implementation of best clinical practices and standardization.”

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  • The publication of the June 2012 issue of the journal Respiratory Care followed a national symposium dedicated to the “chronically critically ill patient,” the patient with ongoing costly medical interventions, risk for medical complications and death, and the need for extensive post-acute care services.  One article and subsequent discussion was devoted to the topic of liberating patients on prolonged mechanical ventilation, or PMV patients, from their need for this ongoing treatment. PMV is defined, in this article, as mechanical ventilation needed for at least 21 days.

    We know there are barriers to weaning patients from PMV, but it can be argued that we haven’t formally studied them enough to know how to overcome them. The barriers may include age, identifying windows of opportunity for weaning, a concurrent condition known as critical illness neuromyopathy (CINM) and cardiac issues.

    Can we do a better job of weaning patients from prolonged mechanical ventilation?

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  • How Do We Best Care For the Chronically Critically Ill?

    By Sean Muldoon, MD
     Sean R. Muldoon, M.D., M.P.H., F.C.C.P.<br />Senior Vice President and Chief Medical Officer<br />Kindred Healthcare Hospital Division Sean R. Muldoon, M.D., M.P.H., F.C.C.P.
    Senior Vice President and Chief Medical Officer
    Kindred Healthcare Hospital Division

    Many important questions were raised by information published in the June 2012 issue of the journal Respiratory Care. This issue followed a national symposium dedicated to the “chronically critically ill patient,” the patient with ongoing costly medical interventions, risk for medical complications and death, and the need for extensive post-acute care services.

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  • The 2011 Clinical Impact Symposium Cardio-Pulmonary Rehabilitation Across the Continuum, held December 6-8 in Louisville, Ky., offered some great information on providing patients the highest level of care.

    Cardio-Pulmonary Clinical Impact Symposium “The clinical guidelines for long-term care and rehabilitation have evolved gradually and changed considerably over the last several years,” he says. “Skilled nursing facilities have sometimes lagged behind. Dr. Pandya provided some easy-to-follow instructions and tools that will help those facilities to better manage their patients with diabetes.”

    Sean Muldoon, M.D., Chief Medical Officer and Senior Vice President, Hospital Division, Kindred Healthcare, says that the “hazards of immobility that lead to polymyoneuropathy” theme was a common one during several of the sessions. “This validates the Kindred model of integrated restorative services, which will lead staff to update these findings with renewed determination into hospital care models,” he says.

     

    Daniel Forman, MD, FACC, FAHADaniel Forman, MD, FACC, FAHA

     

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  • Ehtel Frese, PT, DPT, MHS, CCSEhtel Frese, PT, DPT, MHS, CCS

    Congestive heart failure is a very common reason for hospitalization, with over 1 million congestive heart failure (CHF) admissions per year; readmission rates are 30% at 30-60 days. Identifying methods to reduce the frequency of hospitalization and the associated costs are critically important.

    Early exercise training may be useful in reducing morbidity and mortality in CHF. Aerobic and strength training are both key as muscle strength is a key predictor of long term survival, better than peak VO2.

    The 6 min walk test is commonly used to measure functional capacity.  A result under 300 meters is associated with increased mortality.  The test is sensitive to changes in cardiac function, and a difference of 99 feet is considered the minimal improvement of clinical  importance according to Ethel Frese.

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  • Diabetes: Risk for Cardio-Pulmonary Disease

    By Ryan Squire
    Naushira Pandya, MD, CMDNaushira Pandya, MD, CMD

    Dr. Pandya outlined identified the objectives of her talk to review the goals of glycemic control: One size does not fit all, review the current guidelines from several national organizations for cardiovascular risk, and review best practices for diabetes management.

    Diabetes is a head to toe disease: Retinal disease, stroke, nephropathy, neuropathy, large and small vessel disease of the extremities and  this emphasizes the range of diabetes impact.

    There are many potential barriers to improved management of diabetes: Institutional challenges, staff/practitioner resistance, and complexity of medication regimens and all may negatively impact diabetic control. Yet, there are several basic principles that apply to diabetes management, and must involve an inter professional clinical team:

    Maintaining functional status is the over arching goal of all interventions applicable to diabetes management.

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  • Weakness: Polyneuromyopathy - the Role of Mobility

    By Ryan Squire
    Peter Morris, MDPeter Morris, MD

    The issue of chronic critical illness or Post Intensive Care Unit Syndrome (PICS) is of great importance in the management of patients in the ICU.   There are many additional synonyms for the problem, and the number of names for syndrome demonstrates lack of critical understanding of the syndrome.

    Why is this an important concern? Acute respiratory failure results in 1.1 million ICU admissions needing mechanical ventilation annually.   There are 400,000 ICU deaths/yr with resp failure; hospital mortality: 37%.  The cost of this care is substantial and rising; total health care costs total 17.6% of GDP in the US.

    The key questions to be answered about early rehab care in the ICU are:

    Morris points out fiscal considerations of ICU rehabilitation are a potential barrier and historically, the fear of early movement of ICU patients may also fuel reluctance to intervene.

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