Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________SUNY Upstate Trauma Center143PRACTICE GUIDELINES: TRANSFER TO INPATIENT REHABILITATIONMINIMAL MEDICAL REQUIREMENTS AND PATIENT STABILITYOBJECTIVE:Define the recommended medical status of a patient that can be considered for transfer to aninpatient rehabilitation facility.To define the optimal ongoing medical interventions that are acceptable for care in therehabilitation.DEFINITION:Rehabilitation unit: An inpatient facility which provides aggressive multidisciplinary rehabilitationprograms to enable patients to optimally re-enter the community after a disabling injury. AtUniversity Hospital, this unit is located on 2-North and staffed by full-time physiatrists andtherapists.GUIDELINES:1. The following guidelines represent “suggested” standards that will help define transfer.They can be altered for the individual patient’s needs and the resources that are currentlyavailable in the rehabilitation unit2. Cardiovasculara. No continuous monitoring requirementb. No continuous cardioactive drug drips, all cardiac drugs po or by patchc. Maintenance IV not required. IV fluids for line flushes onlyd. Arrhythmias controlled3. Pulmonarya. Patient completely weaned from ventilatorb. Tracheostomy is OK. Patient must be breathing spontaneouslyc. Suctioning requirement not less than every two hoursd. Active pneumonia’s are adequately treated with established course of antimicrobialse. Chest tubes have been removed4. Infectiona. Ideal – the patient is free of active infectionb. Infections have been diagnosed and are adequately treated with established courseof antimicrobialsc. White cell count < 12,000 or on a downward trend acceptable to PM&R staffd. Cutaneous infections controlled with appropriate debridement and wound careprotocolse. MRSA acceptable if treatment or observation plan is established5. Nutrition and feedinga. Optimal feeding tube is PEG or gastrostomy, should be previously placedb. Adequate nutritional intake provided by oral or enteric intakec. No requirement for supplemental IV fluid to maintain hydrationd. Wounds are healing