2009 Annual Report - Saint Francis Hospital and Medical Center

The physiatrist reviews consultations and reports, incorporating the
input of all team members in overseeing the continuum of care.
assembles the team that will address the patient’s needs. Physician
Assistants (PAs) work closely with the attending physiatrist,
handling day-to-day management of medical issues. As Dr. Miller
points out, “The PAs are my right hand. They interact with the
patient and family, work with other team members and
consultants, write medical orders and do discharge paperwork.”
Acute rehabilitation nurses provide patient care 24 hours
a day, complementing and supplementing the work of
occupational, physical and speech therapists and serving
as case managers. Depending on a patient’s particular needs
and goals, consultants such as orthotists, prosthetists and
wheelchair seating specialists may also be part of the
team. “Everybody plays a vital role,” says Dr. Miller. “We like
to say it’s not just a multi-disciplinary team, it’s also an interdisciplinary
team. It’s not only different people doing their
thing; it’s those people doing their thing in a very
coordinated way.”
This kind of coordination enables an intense,
personalized, holistic approach to care — an approach
essential in situations that require a full court press of acute
rehabilitation. A good example is brain injury, where
disability may run the gamut from physical and cognitive, to
behavioral and emotional. “Brain injury is one of the most
complicated situations in rehab,” Dr. Miller says, “because the
brain controls everything we do. Not just the ability to move, but
thoughts and emotions. This has a dramatic impact on the patient
— and his or her family.” Once the level of that impact is assessed
(can the patient walk, speak, swallow, eat, dress?) physical
interventions, special equipment, medication, community resources
and other services are coordinated and implemented to rebuild the
patient’s life, step by step, goal by goal.
In fact, as Dr. Miller says, “Rehabilitation is all about setting
goals — and achieving measurable outcomes. There are very
specific outcomes measurements in rehab that consider all the
different activities of daily living a patient needs to do against his
or her current level of function. Based on how much assistance is
needed with these activities, we give the patient a number, on a
0 to 7 scale — from dependent to independent. Then we reassess
that score throughout his or her stay, and at discharge. The score
not only indicates how the patient is doing, but how the hospital is
performing as a whole.” For many patients, the focus on goals and
outcomes doesn’t end with discharge. Rehabilitation — and the
physiatrist’s role — continue with outpatient care in the day
treatment program. “It’s still intensive rehab,” says Dr. Miller, “and
the team still meets on a regular basis to discuss outpatient goals.”
Care also may extend beyond day treatment with visits to the
physiatrist’s office. Throughout, the emphasis is not just on
restoring function, but also a meaningful life — and hope for the
future. “It’s not just about therapy”, Dr. Miller explains. “It’s also
about attitude.”
Education is an important component of rehabilitation therapy.
Patients and families need to understand the patient’s medical
condition and how they can work together to achieve the best
possible outcome.
Following medical school, physiatrists
complete four additional years of residency
training in physical medicine and
rehabilitation. Specialty board certification
requires written and oral examinations
administered by the American Board of
Physical Medicine and Rehabilitation
(ABPMR).
Mount Sinai Rehabilitation Hospital 2 009 Annual Report
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