the BRAIN - Shepherd Center

medical errors. Medicare and other plans
no longer pay for the treatment of these
complications, and several states have
enacted laws requiring the disclosure of
“never events” at hospitals.
Possible Complications from SCI
• Skin breakdown or “pressure sores”
• Urinary tract and bowel management
problems, including loss of bladder or
bowel control that increases the risk of
urinary tract infections
• Respiratory problems, including pneumonia
or ventilator dependence
• Muscle spasms
• Blood clots
• Weight loss and muscle atrophy
• Pain
• Increased likelihood of new injuries, especially
where there is impaired sensation
“Shepherd is both a teacher and an asset
for hospitals worried about never-event costs
because it’s all we do,” says Mitch Fillhaber, vice
president of marketing and managed care at
Shepherd. “Our acute-care capabilities provide
added value for the patient, facilitate earlier referrals
and also can help trauma centers turn over
beds more quickly and help transition patients
into rehab more quickly.”
The rehabilitative environment at Shepherd gives
patients – even the most severely injured – a sense
of control over their situation. Even in the ICU,
aggressive physical therapy is started at some level,
and patients are often helped out of bed and into a
wheelchair.
“Shepherd Center appears to have one of the most
advanced programs for early treatment and strategic
planning for spinal cord injury management, including
having their own ICU,” says Julian E. Bailes,
M.D., chairman of the Department of Neurosurgery
at West Virginia University School of Medicine.
King is most proud of the careful attention
Shepherd clinicians give to every body system, from
the heart and bladder to their sexuality and spirituality.
“Our long-term outcomes are a reflection of everything
we’ve done throughout the continuum of care,”
she says. “And we don’t consider only acute medical or
physical issues. We also take time to focus on patients’
spiritual and emotional well-being.”
Ahead of Its Time
Shepherd’s on-site intensive care unit ensures continuity of care.
Even though Shepherd Center was established 34 years ago, its founders had the foresight to
structure the hospital’s care model so every aspect of spinal cord injury care would be available
under one roof.
In doing so, patients receive seamless, comprehensive care – from acute medical services
and cutting-edge interventions that maximize rehabilitation and recovery to bridge programs that
help them transition back to their communities.
“The founders developed a hospital for the future, where catastrophically injured patients
wouldn’t have to be transferred and there would be no disruption in care,” says Mitch Fillhaber,
vice president of marketing and managed care at Shepherd Center. “Such early intervention and
coordinated rehabilitation are critical for long-term recovery.”
Beginning a rehabilitation regimen within two weeks of injury can lead to increases in
functional improvement and more cost-effective care for people with spinal cord injury (SCI),
experts say. Today, Shepherd Center remains one of only a few facilities that has an on-site
intensive care unit (ICU). Shepherd accepts patients directly from a trauma center’s emergency
department and aggressively starts rehabilitation from day one.
“This capability allows us to admit patients earlier in the acute stage and possibly shorten
their hospital stay by reducing the number of complications,” says Andrew Zadoff, M.D.,
medical director of Shepherd’s 10-bed ICU. “We can start patients in rehabilitation even
while they’re still in the ICU. We get them out of the bed, and that improves their mobility.”
A team of rehabilitation and medical professionals – including orthopedists, internists
and urologists – who have extensive experience in catastrophic care address individual
patient needs and establish short- and long-term rehabilitation goals from the start. The
ICU staff works alongside physical, occupational and speech therapists to begin rehab as
soon as possible and can draw upon the expertise of other specialists as needed.
Dr. Zadoff is proud of Shepherd’s dedicated respiratory therapy and nursing staffs that
work collaboratively to minimize SCI-related complications (for example, skin, bladder
and bowel problems, blood clots, nutritional deficiencies) and have helped contribute to
low, hospital-acquired infection rates.
“Our ICU nurses have both rehabilitation and critical care training, so they look at both
medical issues (the injury itself, as well as related complications) at the same time, and
that benefits patients greatly,” he says. “For example, our ventilator-associated pneumonia
rate is next to zero. That’s because of the way we wean patients and our careful
attention to secretion control. A rate this low is unheard of in an ICU environment.”
This is important because such infections can cost an extra $40,000 per episode
and greatly lengthen a patient’s stay in the ICU, potentially hindering their rehabilitation.
Having an on-site ICU has clear clinical benefits for patients. Much of the care that
starts in the ICU will continue as the patient moves to a regular room and through
rehabilitation to ensure seamless care for patients – and provides reassurance for
patients and families who already have enough to worry about. — Amanda Crowe
Photo by Gary Meek
Left: Shepherd ICU
charge nurse Anneka
Maguigan checks on
patient Tyler Epps
of Lincolnton, Ga.
Patients benefit from
the depth and breadth
of experience of
Shepherd nurses like
Maguigan.
1 8 Spinal Column
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