Where Does that Tube Connect?

Teamwork is the Key to Success in Sub Acute Care

By Elyse Matson, MA, CCC-SLP, Carmel Mountain Rehab & Healthcare Center, San Diego, CA

As we all gathered Monday morning for our weekly rounds to our patients, it occurred to me that we really are a TEAM. Although we hear that word so much in our work, this was starting to look more like the Webster’s definition: “cooperative or coordinated effort on the part of a group of persons acting together as a team or in the interests of a common cause.”

A few years back when we were first launching our Sub-Acute unit, there was some apprehension in rehab as we were unsure of our role on this new unit. How would our skills fit into this new set of patients? Even questions as simple as, “How do we move these patients?” were being asked. As training began and the unit took shape, it was clear that rehab could take its place on the team along with many other disciplines.

I remember when we received orders to see our first patient—he was on a tracheostomy tube and ventilator. The first time we placed a Passy-Muir Valve on this patient, and he spoke clearly to the staff and family, it was one of those a-ha moments. As the nursing and respiratory staff began to see how speech therapy might be utilized with these patients, we knew we could create something special. Less than a week later, physical and occupational therapy assisted that same patient out of bed and walked with him down the hall. Everyone saw we were not just going to sit idly by and care for bedbound patients. We were here to do what we always do—rehabilitate the patient to their highest potential, whatever that is.

Over the last two years of working with these incredible patients, we have worked together as a team to develop protocols, policies and procedures, and, in the process, helped many patients. We have even seen a few of our patients who were on ventilators return to visit by walking in the door unassisted.

When we review each patient with the team every week, we address issues involving their medical care, psychosocial needs, nutrition and, of course rehab. Our Director of the Sub Acute Unit and lead Pulmonologist facilitates our meeting.

Because he is there, we can make changes to the patient plan of care with ease. For example, if a patient is starting to eat, we can change the tube feeding schedule right then. If we want to evaluate a patient for tolerance of the Passy-Muir Valve, we can discuss the parameters and schedule a time to evaluate this with respiratory therapy and/or nursing. Everyone is then aware of the plan.

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