Optimizing Transitions of Care for Stroke Rehabilitation, From Day One to Community Reintegration IC26
DAY Friday 14 April 2019
TIME 9:00 AM – 1:00 PM
FORMAT 4-hours instructional course, Demonstration
ROOM LOCATION to be determined
TOPIC AREAS Stroke, Clinical Practice
CAREER LEVEL Intermediate
WHO SHOULD ATTEND
Occupational Therapists, Physical Therapists, Speech Language Pathologists, Medical Doctors, Rehab Nursing, Therapy or Nursing Managers, Care Coordinators, Program Managers, Psychologists
OPTIMIZING TRANSITIONS OF CARE FOR STROKE REHABILITATION, FROM DAY ONE TO COMMUNITY REINTEGRATION
There have been significant advancements in the medical treatment of acute stroke in the past 15 years, but the care of stroke survivors following acute medical stabilization is paramount to their ultimate outcome. Patient outcomes have many domains, such as motor, language or cognitive outcomes. However, we are paying increased attention to psychological health, return to life and family roles, return to community, fitness and avocational pursuits. Our additional challenge is to provide these services in a patient and family centered way, which is efficient but low in cost, and integrates secondary stroke prevention strategies.
The use of a “high touch” strategy when dealing with patients and families will assist them in navigating the confusing and complex path of post-acute care services. At the same time, taking advantage of “high tech” options for tracking and monitoring those under our care and providing them with the right care at the right time is an ideal we would like to strive for.
We will present strategies for improving transitions of care in each arena, including the acute hospital stay, post hospital rehabilitation setting, home care, outpatient therapy and return to community. We will include emphasis on integrating secondary stroke prevention through sports, health, activity, recreation and exercise.
The use of care coordination in health care has increased greatly over the past five years. However, it is fairly unique to integrate rehabilitation care coordinators in the acute hospital setting and for at least 9-12 months post stroke. We know that taking good advantage of the first few months of rehabilitation efforts are especially fruitful in terms of neuroplasticity and patient outcome. If the first connection to rehabilitation services post acute hospital stay is delayed or lost, this can potentially reduce chances of an excellent outcome. The importance of making this first connection and coordinating with other services such as Neurology, Neurosurgery and Neurointerventional Radiology will be discussed. A baseline status of non-care coordinated stroke survivors will be compared to the status of 4 years of those who did have access to care coordination services. Differences in emergency department visits, therapy and physician visits, mortality and readmission to hospital will be presented.
We will also discuss proactive discharge preparedness to improve rate of community discharges, improve generalization of acquired skills from the acute care to community setting, and address barriers to successful community reintegration through early caregiver activation and caregiver empowerment. To illustrate this, implementation of a three pronged transdisciplinary approach to early activation is presented. Component one is the “Functional Program” which aims to improve continuity and repetition of functional mobility with family and staff and enhance understanding of post-stroke motor recovery. Component two includes “My Personal Health Goal” which promotes patient-centered care and patient engagement in development of exercises to promote salience. Component three includes the “Get Home Program” which focuses on family education, repetition of exercises and training, and hands on discharge preparedness. Family training was initiated within 10 days of admission to inpatient acute rehabilitation and continued weekly. Training was functionally patient-specific and exercises were given for the weekend. A gap analysis was completed to establish better communication and a more transdisciplinary approach between nursing and therapist. Solutions for improving health literacy of stroke survivors and caregivers will be explored.
Upon completion of the course, participants should be able to:
- Discuss an innovative transdisciplinary process for maximizing preparedness from inpatient discharge.
- Improve patient/client transitions to post acute care settings
- Identify community reintegration strategies
CME/CEUS 4 Hours
ACRM Training Institute registration includes CME/CEUs for the following disciplines:
- Case Managers (CCMC)
- Disability Management Specialists (CDMS)
- Healthcare Executives (ACHE)
- Nurses (ANCC)
- Occupational Therapists (AOTA)
- Physical Therapists (FSBPT-24 states)
- Physicians (ACCME-CME)
- Psychologists (APA Division 22)
- Rehabilitation Counselors (CRCC)
- Social Workers (NASW)
- Speech Therapists (ASHA)
4 hours of live instruction, continuing education credit processing, access to presentation slides (if provided by presenters), NON-ACRM members receive introductory 6- month membership.
Early Bird rate $49 for members and $99 for non-members
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Limited space available
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