Inside Duke Medicine

Behind the scenes: Durham Rehabilitation Institute

Go behind the scenes with Durham Rehabilitation Institute at Durham Regional Hospital.

Team Approach to Recovery

By Carol Clayton

Durham Rehabilitation Institute (DRI), located on the seventh floor of Durham Regional Hospital, provides a comprehensive, multidisciplinary approach to recovery. The rehabilitation team is dedicated to helping each patient regain independence and reach a higher standard of living.

DRI staff treat patients with a variety of traumas and disorders, including strokes, spinal cord injuries, amputations, joint replacements and neuromuscular disorders. The DRI team and rehabilitation nursing staff will tell you that it’s the team approach that makes this possible.

“In the gym, we have a multidisciplinary team that creates a personalized rehabilitation plan for each patient and makes sure that he or she is able to take advantage of all the technology and resources available,” explains Raphael Orenstein, M.D., medical director of DRI. “When we sit down to develop a plan, we’ll look at the kind of injury or disorder, how much stamina or endurance someone has and how much help they may have at home. Then, we start adding in different kinds of therapies based on the huge variety of specialties we have available.”

A Multi-Disciplinary Approach

“When someone has an illness, such as a stroke, it’s a devastating and life-changing event,” says Sally Bliss, MS, physical therapist at DRI. “The person finds herself living in a completely different way, and that’s where we come in. We work together to try to help someone become as independent as possible. We’re not just treating one part of the patient, so we have to work together to make sure we rehabilitate the whole person.”

This journey back to independence usually includes physical and occupational therapies, and often recreational and speech therapies. One of the most important aspects of anyone’s life is leisure activity. “My role in a patient’s therapy is to show patients that they can continue participating in the activities they enjoy,” says Betsy Roy, LRT, recreational therapist at DRI. Recreational therapy may include sports, social functions, music, art or even outings in the community. Roy organizes one-on-one trips into the community and, depending on the needs of the patient, she may also try to have other therapists from other disciplines accompany her on outings.

Teamwork is essential for positive outcomes at DRI. The care team is comprised of physicians, physical therapists, occupational therapists, therapy aides, speech therapists, registered dieticians, nurse practitioners, care managers, referral coordinators, rehabilitation nurses, certified nurse assistants, a licensed assistant therapist and a recreational therapist.

The teamwork starts every morning with a group meeting at 8:30 to review each new patient being admitted. The charge nurse, nurse manager, nurse practitioner, physician, therapists, care managers and referral coordinators discuss each new patient and become proactive about the resources needed for them. A primary nurse is assigned to each new patient (this is unique to rehab).

It is also during this time that the care planning for the new patient begins. The team also discusses any issues that may have occurred overnight to make sure every caregiver is aware.

The DRI care team also meets weekly to discuss each patient’s short and long term goals, and their progress to date. They discuss questions such as: Have we assessed the patient’s needs? Is he where he needs to be? Have we assessed their progress in meeting their goals? “We are constantly adjusting and customizing the discharge plan for the patient,” says Bliss. A physical therapist and occupational therapist form a team for each patient, so that the patient becomes comfortable with the same therapists, and it allows for more collaboration and communication between the therapists regarding the best ways to treat the whole patient.

“We talk about how we are going to get the patient where they need to be, which is functioning independently and ready to go home, and then together we do what’s needed to get there,” says Sherri Pearce, BSN, MSN, director of Adult Health.

The Latest Technology

Several of the latest advances in rehabilitative technology are available at DRI:

The Biodex De-Weighing System—a fully adjustable harness system that allows patients to practice walking but removes as much of their weight as necessary. This system gives patients opportunities for exercise and also speeds recovery and enhances ability.

Other tools are practice rooms and an automobile simulator. The mock car is available to help people practice getting in and out of cars, and is also adjustable so it can be put at whatever height matches the patient’s or caregiver’s car.

There is also a practice kitchen and a practice living room so patients can experiment with tasks such as food preparation and wheelchair maneuvers.

The technology available, combined with the comprehensive, team-oriented approach to rehabilitation, has led to DRI’s being recognized by the Uniform Data System as being in the top 10 percent nationally in patient outcomes.

Care Outside the Gym

There is a whole additional team of professionals who provide care outside the Rehabilitation gym. Unit 7-3 is the inpatient unit for DRI, and the bed capacity was recently expanded from 22 to 30 beds.

The Unit 7-3 care team includes registered nurses, certified nursing assistants, dietitians and health unit coordinators. In addition, the Food & Nutrition and Environmental staff are often commended for their customer-focused service in letters from 7-3 patients.

Regina Perry, RN, describes how nursing for Rehabilitation is both different and exciting. “Our main goal is to help patients learn how to do things for themselves. This is different than many of the other units. It requires a lot of teaching and a different type of care. We consider at every turn how much we are supposed to help our patients versus how much they are supposed to do for themselves.”

On 7-3, each patient still receives full nursing care with the same medical acuity as on other units, but in addition they must complete at least three hours of therapy at the gym a day. “There is a lot of coordination that happens between nursing and therapy— it’s kind of like a dance,” says Perry.

Ask any team member what his or her favorite part of working at DRI is, and he or she will tell you “it’s my patients.” Physical therapist Kristin Tell, relays an experience that is common at DRI, “A patient’s grandma told me ‘thank you for giving me my grandson back.’ Moments like this are what I love about this profession.”