Continuity of Care

Shepherd Center’s comprehensive continuum of care includes a 10-bed intensive care unit (ICU). It is the only freestanding rehabilitation hospital nationwide with an ICU on site that specializes in patients with brain and spinal cord injuries That means rehabilitation can start more quickly after injury, usually within the first 24 hours of admission to Shepherd Center, which can help advance recovery.

“People think that patients in the ICU are not therapy-ready, but our philosophy is that rehab should start on day one,” explains Shepherd’s Chief Nursing Officer, Tiffany LeCroy, MSN, RN, CRRN, FNP-C, ACNS-BC, FARN. “Patients can be evaluated by each of the disciplines of therapy to determine the plan of care. It helps get to the next steps more quickly.”

Michael Marshall, BSN, RN, CCRN, has been a charge nurse in Shepherd Center’s ICU for more than a decade, and he says having an ICU on-site improves patient care.

“Even in the ICU, our focus is on rehabilitation — getting patients out of bed, getting them acclimated to a wheelchair, and addressing some of the problems they might be facing, like contractures and skin sores,” Marshall explains. 

When patients transfer to Shepherd from the ICU at an acute care hospital, many are admitted to Shepherd’s ICU.

“It’s a big shift for the caregivers and the patients from the intense one-on-one nursing care of the ICU to rehabilitation floor status. When they arrive at Shepherd, we want them to have an assurance that we're going to give them a safe place with the same level of care. So, if they are discharged from an ICU, they come to our ICU first,” LeCroy explains.

At Shepherd, with ICU-level support available, patients who use a ventilator to aid with breathing can move out of the ICU to one of the rehabilitation floors safely, building the bridge from critical care to their return to their communities. That’s a significant advantage for people who may use a ventilator long-term.

Patients ready to breathe independently, without the assistance of a ventilator, return ro the ICU for their first 24 hours off the ventilator to allow for closer monitoring. And if a patient experiences a medical setback, Marshall says the value of an on-site ICU becomes even more apparent.

“Shepherd has patients with very complex needs. If you were in a rehabilitation facility without an ICU, developed pneumonia, and needed a breathing tube or a ventilator, you would have to be discharged from that rehab hospital and admitted to a local acute care facility,” Marshall says. “They'd have to address your medical complications, and then you would be readmitted to rehab. And this bouncing back and forth can happen multiple times in a patient stay.”

At Shepherd, families don’t have to deal with the additional stress of transferring to another hospital for this level of care.

“It gives ease of mind to the caregivers and to the patient, knowing that we can handle vent weaning or a change in medical status within Shepherd,” LeCroy says.

She says the ICU is an essential part of the continuum of care at Shepherd.

“We treat patients with complicated conditions that many organizations would shy away from, and the ICU is a big factor in our ability to do that. There is a comfort level knowing that if that person needs to go to the ICU, then we can do it.”   

Written by Ruth Underwood