Health Matters. All Rehabilitation Facilities Are Not Created Equal. Checklist for finding an Excellent Program

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1 Health Matters The latest news on the health and wellness issues that matter most July 03 All Rehabilitation Facilities Are Not Created Equal By Kevin Caffrey As patients who have experienced a debilitating injury or joint replacement procedure and their families know, the rehabilitation facility they utilize can impact the prospects for reclaiming a normal life. Finding a facility that best suits a patient s needs can be a challenge for family members faced with decisions they have had little time to research. Rehabilitation facilities are not something people investigate until there is a need, said Heather Baker, Administrative Director of NCH Healthcare System s Brookdale Center for Healthy Aging & Rehabilitation in North Naples. Family members often have little time to prepare and end up making decisions during a time of crisis. It can be overwhelming. Each patient must be assessed based on his or her unique situation Brookdale Center for Healthy Aging and Rehabilitation Physical Therapist Patti Governile works with patient Dick Cameron and his wife Susan Cameron. to determine the appropriate level of care. The patient s needs must fit the capabilities of the facility. Two levels of care for in-patient rehabilitation are typically explored. The first is acute rehabilitation performed in a rehabilitation hospital. The second is care provided in a skilled nursing facility. The goal is to improve function capabilities so patients are ready to return home and to minimize the possibility of complications. The care at an acute rehabilitation hospital like Brookdale includes daily medical management, access to testing, imaging, labs and an array of medical staff services, said Baker. Conditions are monitored and managed with tight control. Physical, occupational and speech therapy, cognition and adaptation to residual impairments can all be part of the regimen. Acute rehabilitation hospitals offer the most intensive and aggressive type of therapy available. Not every patient is ready for that. We have admissions criterion that help us determine if the patient is right for us versus another setting. Different resources are available to patients and family members seeking an appropriate rehabilitation setting. The National Stroke Association offers a guide that outlines the levels of care provided by different facilities. This comparative shopping guide enables families to tour a facility, interview staff members and to ascertain the capabilities of a variety of providers. That information can certainly help patients and families make an educated decision, said Baker. It is also important to know if a facility is accredited by CARF International. CARF establishes the standards of practice for rehabilitation providers worldwide. Brookdale and other facilities and organizations accredited by CARF have fully embraced a commitment to continuous improvement and the implementation of quality measures to ensure a superior level of patient care and outcomes. Checklist for finding an Excellent Program Has the program been in operation at least Yes one year? No Does the program have a formal system for Yes No evaluating the progress made by its patients and the overall outcomes of the stroke rehab program? Does the program have any partners that Yes No offer rehab services at other levels of care that I may eventually need (day treatment, outpatient treatment or home care)? Does the program provide a wide range Yes No of therapy services? (physical therapy, occupational therapy, speech therapy) Does the program have on staff a full-time Yes No physiatrist or another doctor who is experienced in stroke and rehab medicine? Is medical care available at the rehab Yes No center if I need it? Can my doctor visit me at the rehab center? Yes No (Does he/she have visiting privileges?) Does the program have a stroke support Yes No group for survivors and their families? If not, can they refer me to a local group? Yes No Does the program use outside groups Yes No (such as consumer advocacy groups) to get ideas for serving disabled people? Does the program conduct home visits Yes No before checking people out of the center and releasing them to their homes? Are staff members required to keep up Yes No with new information about stroke and rehabilitation? How do they do so? Source: For additional information about the Brookdale Center for Healthy Aging & Rehabilitation, call or visit

2 Quality Initiatives Making a Difference for Patients at NCH By Kevin Caffrey Four years ago, NCH Healthcare System undertook the first of three initiatives designed to reduce infections and complications associated with the use of central line IVs and ventilators. Led by Medical Director of Critical Care Services Dr. Doug Harrington, and NCH System Director for Critical Care and Emergency Department Services Jonathan Kling, the success of the initiatives has drawn national attention. Medical Administration challenged us to reduce Central Line Associated Blood Stream Infections known as CLABSI, said Harrington. Central lines are large IVs used to resuscitate critically ill patients or to care for patients on life support. Because they are invasive catheters, there is always a risk of infection. Medical Director of Critical Care Services Dr. Doug Harrington and NCH System Director for Critical Care and Emergency Department Services Jonathan Kling Harrington and Kling established a protocol for every step involved with the use of central line IVs. Emergency Department Physicians, critical care intensivists, ER personnel and 0 critical care nurses received detailed training. The results have been more than impressive. We have gone from a moderate infection rate in our critical care units to none, said Kling. It is a collaborative effort. We must stay diligent in how we place and care for the line and remove the line as quickly as possible. Our approach was presented at a Florida Hospital Association Quality Conference, and we ll present at IHI s National Quality Forum in December. Harrington, Kling and the NCH Infection Control Department took a similar approach to reducing the occurrence of Ventilator Associated Pneumonia, or VAP. Patients who can no longer breathe effectively are placed on a respirator. A large tube is inserted in the patient s windpipe and connected to the respirator to assist their breathing until they re better. That tube, like a tube in the vein, can lead to a portal infection, said Harrington. Patients on a ventilator can develop pneumonia. Since starting our VAP initiative, we went months without a VAP case, had one case, and are now at three months without another occurrence. This is notable. Like CLABSI, VAP can lengthen a hospital stay and cause permanent outcome conditions. Our VLOS, or Ventilator Length of Stay initiative, plays a role in the decrease of VAP cases, said Kling. The longer a patient is on a ventilator, the greater the risk of complications, including pneumonia. The national benchmark for VLOS is 3.5 days. Since last fall, our VLOS has averaged.75 days. That.75 difference is highly significant. These are just three examples of NCH s system-wide focus on improving patient care and outcomes, said Harrington. They are indicative of how people at every level are saying, We can do better. That is what NCH is about. For more information call Jonathan Kling, NCH System Director for Critical Care and Emergency Department Services at (39)

3 Speech development and your childby Jean Amodea Speech and Language pathologist Ruth A. Faye, MS, CCC-SLP, evaluates a child s speech development. It may seem cute to hear a baby coo or vocalize da-da early on. However, being mindful of specific milestones in early speech and language development is crucial in ensuring a child is on the path to meeting benchmarks. In the presence of need, early intervention is critical. Unless deficits are remedied as early as possible, children may not attain age-appropriate speech and language milestones, which can hinder them from successfully reaching pre-school and kindergarten speech and language goals and standards. Although children develop skills at their own pace, Speech and Language pathologist Ruth A. Faye, MS, CCC-SLP* at NCH Outpatient Rehabilitation, encourages parents and caregivers to note the key indicators below during a child s early stages of speech development that may signify the need for immediate assessment. By six months of age... the child does not laugh or squeal or look toward the source of a sound. By NINE months... there is limited or no babbling or you cannot tell if the child is happy or upset. By months... the child does not wave bye-bye or shake their head. By 5 months... the child has not used first words other than mama or dada. By 8 months... the child does not use six to 0 words consistently. By 0 months... the child does not follow simple directions and does not use six consonant sounds. By 4 months... the child does not have a 50-word vocabulary, and the child is disinterested in social situations. For example, by years, the child should be using two word phrases such as My cup or go bye-bye. Faye encourages parents and caregivers to speak with their pediatricians if early developmental benchmarks have not been reached, especially when the child has suffered ear infections. A physician referral may then be made to a specialist for an audiological exam and also to a speech language pathologist for speech therapy services. The speech language pathologist will review the findings, conduct a thorough evaluation, test and observe the child for feeding or sensory issues, and then implement a therapeutic treatment plan. Faye also includes the family in education and the child s home exercise program so newly learned skills can be applied outside of therapy sessions. Parents usually have good instincts. If they feel their child should be doing more in the area of speech development, they should not wait, as the best results can be realized when therapy is started early, added Faye. For more information about NCH Outpatient Rehabilitation Services speech therapy, call (39) NEW Starting in JUNE 03 A Class Just For Dads! Basic Training Prenatal Class One 3 ½ hour class / $50.00 per Dad / Snacks provided Offering useful advice and practical solutions to common challenges that include: preparing for the future, survival strategies, supporting mom, recapturing romance, baby-proofing basics, bonding with your baby and much more. Fun and fast-paced, this class also provides time to talk with a Pediatrician and a workbook to take home. First class starts Sunday, June 30th from 9:00 a.m. to :30 p.m. Future Classes Sunday, July 8th from 9:00 a.m. to :30 p.m. Saturday, August 4th from 9:00 a.m. to :30 p.m. Saturday, September st from 9:00 a.m. to :30 p.m. For more information call NCH BirthPlace Childbirth Education at (39) or (39)

4 Adaptive Golf Expo Helping People with Physical Challenges Return to the Game of Golf By NCH Rehabilitation Services The NCH Healthcare System s Outpatient Rehabilitation Services, The Brookdale Center for Healthy Aging & Rehabilitation and The International Foundation for Adaptive Sports sponsored the third annual Adaptive Golf Expo on March 7th at the Arrowhead Golf Course in Naples. The event was attended and enthusiastically embraced by prior attendees, former patients and community members. The Adaptive Golf Expo is designed to encourage individuals who have stopped playing golf due to illness, injury, or other physical challenges to return to the game or to learn a new sport. Tailored instruction and custom golf carts were provided by experienced golf instructors certified by The International Foundation for Adaptive Sports. We help people play golf by teaching techniques that modify how the game is played to compensate for an individual s physical challenges or limitations, said Ken Walters, President and CEO of The International Foundation for Adaptive Sports. Licensed physical and occupational therapists from NCH Rehabilitation Services accompanied current and former patients, along with members of the community, onto the practice area at Arrowhead. Golf instructors from The International Foundation for Adaptive Sports provided compensatory golf strategies and guidance tailored to individuals needs. Returning participant Allan Goodfriend, who plays golf at LaPlaya Golf Club in Naples using an adaptive cart, said I enjoy attending the Adaptive Golf Expo each year. This event is a wonderful opportunity to apply the techniques taught by the pros to my golf game. Before adaptive golf instruction, I was uncertain if I would ever play again, but with physical therapy, determination and encouragement, I now play three to four times a week with my friends. Kathy Harenda, a former elementary school principal and newcomer to the event said, When you are unable to play golf for six to seven months you really need an experienced teacher skilled in adaptive instruction to help you re-enter the game you love. This event was positive for me as it changed my focus from what I cannot do, to what I can do! The event was well organized; I received one-on-one instruction, and I hope it continues to be offered. Diane Dagenbaugh, who survived a motor vehicle accident that resulted in a below-the-knee amputation on her right side said, Great experience! I play in two women s golf leagues, and this is the first time a pro addressed my issues with balance in the game of golf. I highly recommend this program. For some stroke survivors, returning to golf can be an integral part of their recovery process. In addition to improving motor control and balance, adaptive golf encourages patients to return to the game they love as well as engage in a social activity, said Colleen Murphy, physical therapist at The Brookdale Center for Healthy Aging & Rehabilitation. We are very pleased with the interest and support from the community and hope to continue to co-sponsor adaptive sporting events in Collier County, said Karen M. Judd OTR, MHSA, director of Therapy Operations, NCH Healthcare System. NCH Outpatient Rehabilitation Services provides physical, occupational, and speech therapy at five locations in Collier and South Lee counties. The B r o o k d a l e Center for Healthy Aging & Rehabilitation is the only rehab hospital in Collier County. Keeping things in line By Jean Amodea Jill Roy, wellness specialist and C.H.E.K. Level Practitioner uses a C.H.E.K. caliper to determine the forward head posture of client Mary Bonczek. NCH Program Coordinator Jill Roy is bringing a new dimension to the Briggs Wellness Center program line-up. In addition to her regular classes, Healthy Back which helps relieve back and neck pain with exercises that target proper postural and back alignment Roy is also incorporating her special training as a C.H.E.K. Level Practitioner. Developed by Paul Chek, the methods of C.H.E.K. (Corrective Holistic Exercise Kinesiology Institute) stress the use of comprehensive assessment and holistic protocols to help people achieve optimal health, performance and well-being. Clients are able to achieve goals through the integration of modalities like traditional exercise, mind-body fitness, soft-tissue therapies, alternative healthcare and orthopedic rehabilitation. Currently, Roy has seen impressive results by working one-on-one with selected clients who can benefit from the specialized program methodologies. An initial assessment of a client s overall health and alignment is performed with a focus on posture, function, and movement that shows which muscles are weak or tight. Other factors such as eating and sleeping habits, the way clients move through their day and at work, and prescribed medications are also considered. Afterward, an individualized exercise program is planned that focuses on getting clients back into balance for optimum overall functioning. A goal is to avoid sickness by helping clients elevate energy levels, attain proper alignment and move more efficiently. Strenuous exercise is not always the best option for those in pain, and according to the C.H.E.K philosophy, working in rather than working out may be a better plan of action, says Roy. Working out may break one down and cause more stress and injury. A better approach would be working in using specialized exercises designed to build up the body and realign it into balance. Roy says her desire is to create a more integrated approach to health and well-being throughout the healthcare system by making the program more widely available to a greater number of wellness center members. For more information, call the Whitaker Wellness Center at (39) or the Briggs Wellness Center at (39) You can also visit or on Facebook at

5 Shake it up for better health By Kelly Merritt The NCH von Arx Diabetes & Nutrition Health Center is located in the Briggs Health Pavilion at the NCH downtown campus. Here, people come from all walks of life in search of wellness. The Center helps patients with conditions from diabetes to heart disease and just about everything in between. Under the leadership of Diabetes Program Coordinator Mary McElligott, registered dietitians and registered nurses help people who simply want to be in better health. They specialize in helping people change behaviors that lead to illness and lack of fitness. They have a few new tools to help patients become healthy flavorful shakes that have doctors excited plus a new dietitian on staff, Leslie Deason. Many diseases require nutritional intervention and physicians are interested in sending their patients to a knowledgeable dietitian who can help them, says Deason, who has her master s degree in dietetics with an interest in child nutrition. Physicians see a lot of people in their practices with diet related behaviors that can accelerate conditions such as obesity and diabetes, she adds. A patient s own physician often refers them to the von Arx Diabetes & Nutrition Health Center. But every patient s needs are different. For example, McElligott and her team may Registered Dietitian Leslie Deason is the newest addition to the von Arx Diabetes & Nutrition Health Center. work with patients on certain medications who have a restricted diet, while another patient needs to eat better for heart health. That s why the Center offers full-service, medically-supervised customized programs. Previously, the shakes used in the programs were limited to predominately one brand. Several NCH physicians became interested in a new brand so now the Center offers greattasting products of two different brands as a way to customize an individual treatment plan. A lot of people think a protein shake is a cure-all, but it s really more about restructuring meal patterns taking out what would otherwise be an unhealthy breakfast and replacing it with a shake, says McElligott. For a third of the weeks, patients are on two shakes a day and a meal but not everyone graduates at the same time. The shakes play an important role in jumpstarting people who need that reinforcement of seeing some progress early on. Some patients need more protein to stay satisfied or to feel full longer, while others may need a different shake as they endeavor to take their fitness to the next level. They eventually transition into choosing whole food sources so they re not relying on a shake, says Deason. What s also important about these shakes is they are good for extremely busy people if you don t have time to sit down to a healthy meal, these provide you with an acceptable alternative. We encourage anyone interested in becoming healthier to call us, says McElligott. NCH recognized by Surgeons Commission on Cancer By Kelly Merritt The American College of Surgeons Commission on Cancer (ACoS CoC) has bestowed NCH s Cancer Program with a full three-year accreditation and five commendations. The ACoS CoC defines the NCH Healthcare System s category as a Comprehensive Community Cancer Program. The focus is on patient-centered needs, quality of care and better patient outcomes. That NCH received so many accolades from the American College of Surgeons Commission on Cancer in the accreditation process doesn t surprise veteran Cancer Program Administrator, Roy Threet. But he is impressed that NCH has been accredited for the past 30 years. I come to work every day looking for ways to partner with our doctors, nurses and specialists to support them to make things better for cancer patients, says Threet, who was recruited to steward the NCH Cancer Program to the next level. Referring to the ACoS CoC recognition, he says This accreditation honor is like the Good Housekeeping Seal of Approval for providing the best cancer care possible to our patients. The five commendations were related to the number of cancer patients placed on clinical trials which was made possible because of NCH s close relationship with Florida Cancer Specialists and st Century Oncology. Other commendations included NCH Cancer Registry s ontime data submission and submission of error-free annual data to the ACoS National Cancer Database, exceeding the number of quality improvement studies that ACoS CoC Accreditation Standards required and exceeding the number of early detection and screening events coordinated over the three-year survey period. The ACoS CoC Standard requires three or more screening events annually NCH, in partnering with Florida Cancer Specialists and st Century Oncology, performed at least a dozen early detection and screening events each year from 009 to 0. NCH von Arx Diabetes & Nutrition Health Center Briggs Health Pavilion 399 9th Street North, Suite 0 (39) For more information contact Roy Threet, NCH Administrator Oncology Services, at (39)64-96.

6 NCH and the NCH Physician Group HEALTH Services Directory Cardiology David Axline, MD, FACC Francis C. Boucek, MD, FACC Michael S. Flynn, MD, FACC, FSCAI Adam J. Frank, MD, FACC Bruce A. Gelinas, MD, FACC Tracey Roth, MD, FACC Carlo Santos-Ocampo, MD, FACC Herman Spilker, MD, FACC David A. Stone, MD, FACC Silvio C. Travalia, MD, FACC Shona Velamakanni, MD, FACC James Venable III, MD, FACC Cardiovascular Surgeons Robert Pascotto, MD, FACS Dennis Stapleton, MD, FACS Family Medicine Andrew M. Bernstein, DO Christian O. Beskow, MD Jennifer A. DiRocco, DO Richard S. Gould, MD Robert E. Hanson, MD Jesse H. Haven, MD Erik Hiester, DO Mark E. Josephson, MD Ashley L. Tunkle, MD, FAAFP Angela B. Beckwith, PA-C Jennifer Canfield, ARNP-BC, MSN Jill M. Hefti, ARNP Kearston Perfetto, ARNP Gastroenterology & Hepatology Jan M. Barrios, MD Guy R. Winzenried, MD Beth Diamond, ARNP General Surgery Yaritza Perez-Soto, MD, FACS Geriatric Medicine Angel H. Herrera, MD Obayedur R. Khan, MD, FACP, CMD Hospital Medicine Manuel Batlle, MD Carlos B. Quintero, MD Infectious Disease Gary A. Bergen, MD, FACP Vato Bochorishvili, MD Mark A. Brown, MD Internal Medicine George T. Crabb, DO, FACOI Diana Daoud, MD, Robert Folsom, MD Mark R. Goldstein, MD, FACP Jorge Guzman, MD Karen Henrichsen, DO Mary Ann M. LoMonaco, MD Gary A. Parsons, MD Nelly Perez, MD David I. Sommerfeld, MD Julie Southmayd, MD Tracy Walsh, MD David C. White, MD, FACP Doreen Cassarino, ARNP Melanie Makar, ARNP Victoria Wadsworth, ARNP Orthopedic Surgery Jon S. Dounchis, MD Howard J. Kapp, MD Pediatrics Reisha F. Brown, MD, FAAP Dulce V. Dudley, MD, FAAP Andrew P. Podos, MD, FAAP Debra G. Shepard, MD, FAAP Todd Vedder, MD, FAAP Debbie Schlief, ARNP Physical Medicine & Rehabilitation E. Sean Kelley, MD David Pitts, MD Psychiatry Alan K. Hagstrom, MD Damian McGovern, MD Pulmonary, Critical Care & Sleep Medicine Lawrence H. Albert, MD, FCCP Kenneth Bookman, MD, FCCP Howard L. Cohen, MD, FCCP Cartrell Cross, MD Douglas Harrington, DO, FCCP David H. Lindner, DO, FCCP Ismael Martin, DO, FCCP Christopher A. Mendello, MD, FCCP Bruce G. Roy, MD, FCCP, DASM Rheumatology Eric J. Hochman, MD Jay Bombero, PA Urgent Care Karl Korri, MD Steven A. West, MD, FACEP Michael Tanner, PA For an appointment with a physician, please call (39)

7 3 4 NCH Downtown Naples Hospital Campus NCH Downtown Naples Hospital: Breast Health Navigator: Business/Occupational Health: Community Blood Center: Dr. John N. Briggs Wellness Center: Naples Diagnostic Imaging Center: NCH Heart Institute: Outpatient Cardiac Rehabilitation: Outpatient Infusion Services: Outpatient Rehabilitation Center: Physician Referral / Access Healthline: vonarx Diabetes & Nutrition Health Center: NCH North Naples Hospital Campus NCH North Naples Hospital: The BirthPlace: Naples Diagnostic Imaging Center: NCH Wound Healing Center: Outpatient Infusion Services: Outpatient Pulmonary Rehabilitation: The Brookdale Center for Healthy Aging & Rehabilitation: 55-7 NCH Marco Island Campus Marco Urgent Care Center: Outpatient Cardiac Rehabilitation: Outpatient Pulmonary Rehabilitation: Outpatient Rehabilitation Center: Naples Diagnostic Imaging Center: NCH Wound Healing Center: W. Terry St NCH Central Campus: White Elephant Thrift Store: 53-7 Outpatient Rehabilitation Center: Whitaker Wellness Center: Outpatient Rehabilitation Center: Outpatient Rehabilitation Center: NCH Wound Healing Center: Bonita Community Health Center: NCH Urgent Care Center: NCH Heart Institute Bonita: NCH Physician Group - Rehabilitation Center: NCH Physician Group - Women s Imaging Center: NCH Physician Group - Imaging Center: For information on any of the NCH Healthcare System services, please call or visit us online at 3 3 The NCH Health Matters is a bi-monthly publication of the NCH Healthcare System. Every effort is made to ensure information published is accurate and current. NCH cannot be held responsible for any consequences resulting from omissions or errors. NCH Healthcare System, 350 7th Street North, Naples, FL 340, Telephone: (39) ,

8 The doctors and specialists at NCH & Mayo Clinic are sharing everything from first-hand experience to a wealth of knowledge allowing you access to Mayo Clinic s expertise for solving the hard-to-solve medical problems. For you that means peace of mind and the finest healthcare available. Right here at home. NCH and Mayo Clinic... working together to make your hospital even better.

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