Rehabilitation Hospitalists Play a Key Role in Improving Outcomes for Complex Patients

TIRR Memorial Hermann’s affiliated pediatric and adult hospitalist teams have allowed the rehabilitation hospital to respond to the medical issues of its high-acuity patient population quickly to keep them on track with their therapy.

“The complexity of all patients across the board has increased over the years, and with the trend toward reducing length of stay, improving outcomes and at the same time reducing costs, patients are moving through the pipeline of different levels of care much faster now,” says affiliated physician Jacob Joseph, MD, clinical chief of neuromuscular rehabilitation, vice chair for clinical operations in the Department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth Houston, and director of medical affairs and services for the Memorial Hermann Rehabilitation Network. “We also recognize that there are limitations in our physical medicine and rehabilitation training. Hospitalists have the clinical experience to care for complex patients with multiple comorbidities and the skills to lead medical quality improvement efforts. Having these additional resources has allowed us to stay ahead of our increasing acuity.”

Another affiliated physician, Autumn Atkinson, MD, is an assistant professor of pediatrics at McGovern Medical School at UTHealth Houston, and lead hospitalist for the pediatric group at TIRR Memorial Hermann. She works closely with pediatric physiatrist Stacey Hall, DO, an attending physician on the new pediatric inpatient unit.

“It’s crucial to have a pediatric hospitalist on the floor ready to help with medical management in the event of an emergency,” Dr. Atkinson says. “On any given day we might deal with autonomic dysreflexia, complications of traumatic brain injury like hydrocephalus, or electrolyte disturbances. We manage kids with congenital disorders as well, such as cerebral palsy and the full range of autoimmune and genetic disorders. It’s advantageous to have a pediatric hospitalist on board.”

Hospitalists and physiatrists come together to treat patients using a co-management model. “We round together on all patients and in the afternoon we have team meetings, making sure the family is an integral part of the team,” Dr. Atkinson says. "We schedule 3 to 5 hours of schooling a week to keep kids engaged in their schoolwork. As we get closer to discharge, we go over nitty-gritty details with schools, like recommendations for accommodations for better learning or special equipment needs. We’re a team of equals in co-management. We’ve learned that constant checking is so important to make sure we’re united as a physician team, and also that families know that their child is being cared for by two doctors who work closely together.”

Andreea Xavier, MD, an affiliated associate professor in the Department of Emergency Medicine and Wyatt Ranches Distinguished Professor in Geriatric and Palliative Medicine at McGovern Medical School at UTHealth Houston, is division director of acute care medicine and serves as medical director of the adult hospitalists at TIRR Memorial Hermann. “Employing hospitalists in rehabilitation hospitals is a developing field,” Dr. Xavier says. “We’ve had incredible success with our co-management models. By establishing very clear roles and responses and keeping open channels of communication, we have a significant impact on reducing transfers to acute care and improving outcomes. With eight adult hospitalists who rotate at TIRR regularly, 7 days off and 7 days on, we are available to meet with family members, follow up on tests, answer nurses’ questions and deal with problems that may arise.”

In the evenings, patients are cared for by a rotation of two advanced practice providers—either nurse practitioners or physician assistants—who are in-house and can provide assistance with inpatients and consultations for patients being admitted. “One of our advanced practice providers arrives at 1 p.m., and the other is responsible for the night shift,” Dr. Xavier says. “They are responsible for new admissions, rapid responses, codes, and evaluating and managing unstable patients during the night and have developed a great collaboration with TIRR’s nursing staff. Together, they’ve done a great job with our goal of improving mortality and morbidity and patient outcomes.”