Patients with complex medical conditions are welcome

Robert Reini was on the mend from the pulmonary and leg embolisms—blood clots—that brought him to the Emerson Emergency Department and then the intensive care unit (ICU). Although Mr. Reini made progress, he needed to gain strength before heading home, and he needed treatment for his diabetes and associated complications. By moving to the hospital’s Rehabilitation and Transitional Care Unit (TCU), he benefited from a team, including medical specialists and rehabilitation staff, who collaborated on a plan for his recovery. Mr. Reini regained his health and was able to return to work.

He remembers when the sudden pain first occurred, because it happened to be September 30—his birthday. “I was walking to the car to head to work, and I felt a blinding pain in my right leg,” Mr. Reini recalls. “I literally dragged my leg along and couldn’t even pull it into the car. I sat there for 20 minutes, expecting to feel better. When that didn’t happen, I dialed 911, and they took me to Emerson.”

The staff conducted the appropriate tests, diagnosed the embolisms and administered blood-thinning medication. “They transferred me to the ICU so that they could monitor me closely,” says the Maynard resident. “I felt relieved to be alive, but I was so weak.” The embolism in his lung had caused acute respiratory failure, so Mr. Reini received supplemental oxygen for the next few weeks.

“Mr. Reini had large blood clots in his pulmonary vessels,” says Emerson’s Ali Khodabandeh, MD, who specializes in pulmonary and critical care medicine. “This condition can be potentially lifethreatening, and he most likely will need to remain on a blood-thinning agent.

“Fortunately, he gradually improved, and from the inpatient unit, where I continued to monitor his progress, he went to the hospital’s Transitional Care Unit.

“That is a good location—not just for the patient, but for specialists who can follow patients who need ongoing care. For example, when my patients with chronic obstructive pulmonary disease [COPD] require a hospital stay, they can benefit from spending some time on the TCU so that we can be sure they are stable enough to go home.”

Staff worked together in one direction Mr. Reini recovered from his pulmonary emergency thanks to the TCU staff. “At first, I had trouble just standing up,” he says. “The physical therapists got me on a walker and then using a cane. There were days when I didn’t want to do any therapy, but they insisted. I realized they were all eager to get me well again. Everyone on the unit was working together in one direction.”

It included a new approach to managing his type 1 diabetes. Mr. Reini’s blood sugar level was high, and he had ulcers that were not healing. The TCU staff asked Cheryl Laundry, RN, CDE, the hospital’s certified diabetes educator, to visit.

“I had to begin taking insulin, which meant I would need to begin checking my blood sugar three or four times a day,” says Mr. Reini. “Cheryl visited me several times to make sure I was equipped to monitor myself and administer insulin. She also taught me a lot about diet, including the ‘traps’ for diabetics, such as eating sugar-free foods, and how I need to watch my carbohydrates, since that’s where the sugar is.”

“The cornerstone of diabetes care is education,” says Ms. Laundry. “People need to know how the body regulates sugar normally, what happens as a result of diabetes and what we’re going to do about it. I gave Bob lots of information, but in small bites, because I wanted him to win. I told him it would be a challenge, but we were going to fit insulin into his life, rather than make his life be about taking insulin.

“The good thing about the TCU is that we work together; the nurses and other staff reinforce everything I teach the patient. Bob was eager to learn because he wanted to take his life back.”

Emerson wound specialists focused on healing his leg ulcers. “They cleaned and treated my ulcers, which improved every day,” says Mr. Reini.

Happy to be on “Emerson’s radar”

As time went by, Mr. Reini came to appreciate the TCU as a setting that is designed for getting back to life. “You’re not in bed, which is good, because when you’re in bed, the world shrinks,” he says. “I spent a lot of time in the gym and the activities room, where I got to know the other patients and their families. There is a social aspect to the TCU. It made me feel hopeful.

“And I had a ring of specialists around me—all the Emerson physicians and other staff. They knew my story, so I didn’t have to keep repeating it.”

Because Mr. Reini lives alone, much attention was paid to a discharge plan that would assure he could function safely at home. “I was still unsteady on my feet, and I couldn’t drive,” he explains. Emerson Home Care staff stopped in regularly, checking that his blood-thinner was in the correct range. TCU medical director, Karen Bougas, MD, MPH, wrote a letter requesting that Mr. Reini be allowed to avoid stairs by moving to a first-floor apartment.

After missing several months of work, Mr. Reini was able to return—first on a part-time basis, then full-time. “My life is totally different now,” he notes. “I check my blood sugar, take my insulin, and I’ve changed the way I eat—more protein, more vegetables and no dessert. I don’t miss it.

“I received so much support when I was at the TCU and after I left,” says Mr. Reini. “I felt like I was still on Emerson’s radar, and they continued to monitor my health. When I think of how sick I was when I arrived at Emerson, I realize I wasn’t in any position, emotionally or physically, to make any decisions. But they knew what was best for me.”

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For many, the Transitional Care Unit is the right setting

Today, few acute care hospitals provide a transitional step to going home. But Emerson does, and patients and their families appreciate it. The Rehabilitation and Transitional Care Unit (TCU), which consistently receives satisfaction rankings greater than 98 percent, is just right for those patients who will benefit from additional care after an acute illness or surgery.

”The TCU is a key component of Emerson’s continuum of care,” says Janice Clement, RN, nursing director. “Because it is within the hospital, Emerson physicians can continue to follow the progress of their patients during their rehab stay. However, we welcome patients from other hospitals as well. In fact, about one-third of our patients are admitted from hospitals in Boston and the surrounding communities.”

The TCU has been a familiar stop for patients who have had orthopedic surgery, including joint replacements, and need a few days of physical therapy before heading home. Cardiopulmonary, neurological, oncology and hospice patients often spend time on the TCU. During the past year, the unit has expanded its capabilities to care for patients with complex medical conditions, such as chronic kidney disease, or who require wound care or tube feeding.

Dr. Karen Bougas, the medical director, who is a physiatrist, has access to all of the hospital’s specialists. The TCU staff includes nurses; physical, occupational, respiratory and speech therapists; social workers; and an activities director. Wound care/ostomy and diabetes nurse specialists are also part of the TCU team.

The 20-bed unit includes a rehabilitation gym, sitting room and activities room, and patients order their meals from a restaurant-style menu.

  • Note: The preceding article is from Healthworks Magazine, Emerson Hospital, Fall 2015.