Spinal cord injury and disorders | veterans affairs

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.