the BRAIN - Shepherd Center

Early Intervention
Level of Injury
C1 - C2 7
C3
C4
C5 - C7
T1 - T12
L1 - L5
Rancho 1 - 3
Total Volume
6
25
25
6
1
13
2007 2008
Ventilator-weaning data is analyzed
annually by Andrew Zadoff,
M.D., medical director, ICU and
PulmonaryServices.
Data includes patients admitted within
the calendar year.
# D/C Home on Vent
4
2
3
3
0
0
3
# Weaned
3
4
22
22
6
1
10
Avg Days to Wean
-
8
23
16
18
8
7
Wean Rate
42.9%
66.7%
88%
88%
100%
100%
76.9%
Level of Injury
C1 - C2
C3
C4
C5 - C7
T1 - T12
Rancho 1 - 3
Total Volume
12
6
27
26
18
6
# D/C Home on Vent
9
4
4
2
2
1
# Weaned
3
2
22
24
15
5
Avg Days to Wean
27
21
24
13
20
12
Wean Rate
25%
33.3%
81.5%
92.3%
83.3%
83.3%
Patients excluded from population:
• Patients with a primary diagnosis
other than SCI or ABI.
• Patients who have not
discharged by reporting cut-off
date.
• Patients whose injury level is
not complex and are, therefore,
“expected” to wean.
SCI/ABI dual diagnosis patients are
reported according to their spinal
cord injury level.
Independence
90
75
60
45
Discharge Total FIM ®
Total Spinal Cord Injury
85.0
80.1
Q3
2008
83.3
81.6
Q4
2008
88.4
83.2
Q1
2009
85.8
80.9
Q2
2009
40
30
20
10
28.7
28.9
Q3
2008
Shepherd
Nation
Total FIM ® Change
Total Brain Injury
33.2
29.7
Q4
2008
30.1
26.9
Q1
2009
30.3
29.0
Q2
2009
Story Behind the Data
Wean Rates
• Data represents medically complex patients only.
• Influenced by clinical acuity and primary/
secondary diagnoses, the following are
considered significant influences in determining
the potential capability to wean a patient from
ventilator assistance:
• Level of injury
• Patient age
• Complete vs. incomplete spinal cord injury
• Co-morbidity
Discharge to Community
• Rate is high because of Shepherd Center family
education programs and continued support of
families in their homes.
Discharge to Community
100%
75%
50%
25%
Total Spinal Cord Injury
90.1%
74.2%
Q3
2008
92.8%
74.7%
Q4
2008
93.1%
73.1%
Q1
2009
87.8%
74.8%
Q2
2009
100%
75%
50%
25%
Total Brain Injury
Source: UDS Quarterly Trends Report M240_9021 (July 1, 2008 – June 30, 2009) unless otherwise cited.
91.9%
70.0%
Q3
2008
93.5%
68.8%
Q4
2008
92.2%
70.0%
Q1
2009
91.0%
70.7%
Q2
2009
• Discharge Total FIM ® (Total SCI) Published quarterly by UDS.
The functional assessment instrument is composed of 18
items rated on a seven-level scale that represents gradations
in function from independence to complete dependence.
Measured at discharge to the rehabilitation program.
• Total FIM ® Change (Total Brain Injury) Published quarterly
by UDS. The difference in FIM ® Score as measured at
discharge to the rehabilitation program and admission to the
rehabilitation program.
• Discharge to Community (Total Spinal Cord Injury and Total Brain
Injury) Published quarterly by UDS. The percentage of patients
who return to a community-based setting, including a home
(of the patient, relative or another person), transitional living
setting, board and care setting, or assisted living residence.