I. Scope of Service
Types of Patients
All honorably discharged veterans are accepted into the program, regardless of activity limitations, behavioral status, cultural needs, impairments, intended discharge/transition environments, and participation restrictions, unless they are medically unstable and meet exclusion criteria noted elsewhere.
The types of patients served are Veterans with spinal cord injury and/or disorders from etiologies such as trauma, Multiple Sclerosis, ALS, and Guillain Barre. We provide services to the Veterans regardless of Spinal Cord Injury Level Cervical (C1) to Sacral (S5) including both incomplete and complete injuries.
SCI serve patients over 18 years of age.
Procedures/Services
Mission
Hines Spinal Cord Injury/Disorders Service will partner within a continuum of care with each veteran and his/her family, to optimize the veteran’s health, enhance their quality of life, and promote their independence to attain the Veteran’s individual goals.
Vision
Hines Spinal Cord Injury/Disorders Service will provide necessary support and understanding so that all Veterans will fully achieve their cognitive, emotional, and functional potential.
Values
SCI/D adheres to the VA’s I CARE values. The following values – Integrity, Commitment, Advocacy, Respect, and Excellence – define the culture of the SCI/D service and strengthen our dedication to those we serve.
Definition of Patient Care Services
SCI/D provides primary, secondary, and tertiary care for Veterans, primarily in the Midwest. We obtain referrals from SCI/D Coordinators in the Hines SCI/D Catchment areas and from the Hines Transfer Office. Care and services are provided in a collaborative interdisciplinary manner by the medical staff, registered nurses, and other health care professionals to achieve optimal outcomes. We are committed to uniform standards of care for our patients with equivalent health care needs. The program evaluates and addresses cultural and behavioral issues at the onset and during rehabilitation and beyond using specific motivational and Veteran-centered strategies.
Support Services
On-site consultation, diagnostic, and treatment services include radiology, laboratory, pharmacy, assistive technology, vascular access team, audiology, dental, behavioral medicine, extensive medical and surgical consultation services (gastroenterology, urology, neurology, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, psychiatry, pulmonary) and multiple others. Services are available on a routine or emergent basis to accommodate any volume of patients in the Rehab Program. Critical findings are communicated immediately to the ordering provider. Reports and/or recommendations are typically available to the provider within 24 hours. Hines SCI/D has the capacity to provide all these services for its Inpatient Rehabilitation Program.
Spinal Cord Home Care Program
Spinal Cord Injury/Disorders Home Care is a specialized program with resources to instruct and coordinate for the rehabilitative, social, nursing, nutritional and medical needs of patients with spinal cord injury/impairment at their place of residency up to 99 miles from the facility.
The SCI/D primary care physicians make SCI/D-Home Care services available through referrals by SCI/D inpatient staff and by the SCI/D outpatient clinic nurse, as well as through high-risk case identification through the SCI/D-Home Care Case Management Service.
SCI/D Home Care Program home visits are on a scheduled and as needed basis and as determined by specific categories of care. The team, the patient, and the patient’s family determine the purpose, frequency, and length of visitation.
Hours of Operation
Acute/Continuing & Rehabilitation Care
Bldg. 128 North and South Wards
- 24/7
- SCI/D Attending O.D. – Emergency calls after 6 p.m., on weekends, and federal holidays.
- In house nocturnist service Mon – Sat including federal holidays.
- Frequency of services depends on the needs. May range from 0 hrs to 5 hrs/day.
Administrative Offices (Chief of SCI Service)
Bldg. 128 Room A124
- 8 a.m. – 4:30 p.m.
- Monday – Friday
- Closed weekends
SCI/D Outpatient Clinic
Bldg. 128 Room A137
- 8 a.m. – 4 p.m.
- Monday – Friday
- Closed weekends
SCI/D-HC (SCI/D Home Care)
Bldg. 128 Room A129
- 7:30 a.m. – 4 p.m.
- Monday-Friday
- SCI/D Attending O.D. – Emergency calls after 4 p.m. on weekdays, weekends and federal holidays.
SCI-RCF (Residential Care Facility)
- Bldg. 221
- 24/7
- SCI/D Attending O.D. – Emergency calls after 6 p.m., on weekends and federal holidays.
II. Access to Service
Mechanisms for Accessing Services
Inpatient admissions
Inpatient admissions via referrals are facilitated through the Chief SCI/D Office in coordination with the SCI/D Coordinator & Hospital Transfer Coordinator. Admission is coordinated after verification that the patient with spinal cord injury is an honorably discharged Veteran of the regular U.S. Armed Forces.
SCI/D Outpatient (OPT)
SCI/D Outpatient (OPT) appointments are handled by the SCI/D OPT Clinic which is a stand-alone clinic located in the Spinal Cord Injury Service under the direction of the Chief, SCI/D Services. Appointments are made through the OPT Clinic receptionist.
Residential Care Facility (RCF)
Long-term care services are available and prioritized by need and service-connected status. Recommendations for admissions are requested via consult and are reviewed by RCF admission team.
SCI/D-HC (SCI/D Home Care)
SCI/D-Home Care Services are available through referrals.
Telehealth
Telehealth appointments are facilitated through the SCI telehealth coordinator. Each service line can also arrange telehealth visits as needed. Veteran Video Connect (VVC) encounters are scheduled to expand available options for ongoing patient encounters and care.
Respite Care
Respite care services may be provided either in home or in hospital by request to the Chief SCI/D or designee. Services are limited to 30 calendar days per year.
Access of SCI/D Scope of Service
SCI/D Scope of Service is available on the SCI/D Rehab Unit, and on the Hines VA internet site under SCI/D program.
III. Goals of Department / Service
Goals
The goal of the SCI/D team is to maximize levels of independence, quality of life and productivity through treatment, training and education which will enable the patient to live as independently as possible in an appropriate setting outside of the hospital that reflects their current functional levels at discharge and throughout their lifespan.
This is achieved through our comprehensive inpatient rehabilitation program, annual evaluation protocols and long-term outpatient management. To meet the unique aspects of delivering care to individuals with SCI/D, we offer services in the following areas:
- Medical/physiological sequalae: (including assessment/intervention on abnormal tone/spasticity management, autonomic dysfunction, bladder/bowel function, body composition (i.e., ideal body weight calculation), circulation, dysphagia, fertility, infection management, medication, men’s and women’s specific health issues, musculoskeletal complications, neurological changes, nutrition, pain, respiration, sexual function, skin integrity, and ventilation support).
- Functional: (including assessment/intervention for activities of daily living, independent living, assistive technology, behavior, cognition, communication, community integration, driving, durable medical equipment, emergency preparedness, environmental modifications, leisure and recreation, mobility, occupation, orthoses, personal care assistants, prostheses, and seating).
- Psychosocial (including assessment/intervention on adjustment to disability, behavioral health, substance use, family/support counseling, peer support services, and sexual adjustment).
- Education and Training: (including persons served, families/support systems, the community, and the professional community).
- Transitions across the Lifespan
- Case Management/Resource Management
- Health Promotion and Wellness (e.g., SCI/D Academy, Whole Health Program. KT Outpatient Program, vocational, and employment services)
- Safety Management (including local and community involvement, and discharge environments)
- Prevention (e.g., pressure ulcer prevention education, immunization monitoring)
- Follow-up (e.g., 90-day rehab f/u, annual evaluation process)
The ultimate goal of the SCI/D Home Care Program is to enhance, through a facilitating process, the independent functioning of the veterans with SCI/D in the community. Services are based on an individual treatment plan determined by patient needs.
IV. Plan to Improve Quality of Service
Performance Improvement Priorities – Aspects of Care High Volume, High Risk, Problem Prone
SCI/D rehabilitation program will meet the expected level of performance of the following indicators:
- Length of Rehabilitation Stay
- Unplanned transfers
- Neurologic deterioration
- Deaths during rehabilitation
- Co-morbidities at admission
- Co-morbidities at discharge
- Achievement of projected FIM/IRF-PAI Goals
- Decrease number of nosocomial ulcers
- Increase patient satisfaction as rated very good or excellent.
- Meet or exceed the levels of beds and staffing at each SCI/D Center specified in the VHA Directive specified in VHA directive 2008-085.
- Evaluate the appropriateness and effectiveness of fall management in the SCI/D Home Care Program
- Increase patient involvement/goal setting utilizing Motivational Interviewing (MI) techniques
V. Department Specific Standards
Standards
- CARF & The Joint Commission Standards for efficiency, effectiveness, and satisfaction indicators
- The Department of Veterans Affairs VHA Handbook 1176(2) & 1106
- Standards of Care Measures for SCI Veterans
VI. Staffing
Staffing Plan
SCI/D staff is a multidisciplinary staff with members from Nursing, Social Work, Psychology, Psychiatry, Vocational Rehabilitation Therapy, Recreational Therapy, General Surgery, Physical Medicine & Rehabilitation, Nutrition, Speech & Swallow Therapy, Assistive Technology, Pharmacy, Urology, Otolaryngology, Neurosurgery, Orthopedics, Plastic Surgery, Prosthetics Department, Performance Improvement/Quality Assurance, Infectious Disease, Wound Care, Palliative Care, Chaplain Services, and other relevant subspecialties.
Collaborative / Functional Relationships with Other Departments and Services
The SCI/D Service actively participates and promotes research to benefit SCI/D Veterans, as well as patients in the general population.
Some recent research collaborators include: the Department of Defense (DOD), the Shirley Ryan Ability Lab, and Rush University Medical Center.
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