WakeMed Neuro Care Unit & Program

Providing Healing & Hope

The WakeMed Neuro Care Program is designed to promote best possible outcomes for persons with severe neurological impairment. WakeMed is the region’s only provider of coordinated medical and rehabilitative care for patients and families who need the specialized transdisciplinary care our highly trained staff offers in a dedicated Neuro Care Unit.

Highly Specialized Care Severe neurological impairment, often referred to as disorders of consciousness, requires intensive medical management and rehabilitation to address the medical, physical and emotional aspects of recovery. At WakeMed, we recognize how a serious injury to the brain can affect the lives of patients and their families. Our goal is to help patients and their loved ones achieve the highest possible quality of life by providing top quality care, education and compassionate support.

Tour Our Unit Patients and families are welcome to tour the Neuro Care Unit on 6B at the WakeMed Raleigh Campus. Please call 919-350-7876 to arrange a tour.

Our Patients The WakeMed Neuro Care Program offers patients with neurological impairments comprehensive rehabilitation services and medical management in a dedicated acute care unit. Our patients have unique needs that many facilities cannot meet. Our patients:

• No longer require critical or intensive care services

• Need physician oversight, quality nursing care, and highly coordinated therapy services which are not typically provided by a skilled nursing facility

• Are not yet at a level where they can tolerate the more intensive therapy schedule or stimulation of traditional inpatient rehabilitation

• Must be medically stable and not require mechanical ventilation or telemetry

Diagnoses may include, but are not limited to:

• Brain Injury

• Stroke

• Neurological Disorders

• Multi-Trauma

Because the WakeMed Neuro Care Program is part of the WakeMed Health & Hospitals health care system, patients and their families also have direct access to the other important surgical, medical and rehabilitation services they may need.

A Special Team with Specialized Training The Neuro Care Program team is highly experienced in treating neurologically involved, medically complex patients. They work with patients and families to understand how the neurological issue is affecting the patient both mentally and physically. The team consists of:

• Rehabilitation Physician: A board-certified physiatrist (doctor who specializes in physical medicine and rehabiliation), is in charge of medical treatment. The physiatrist works closely with the primary team and coordinates the overall medical management of the patient, while also consulting other specialists as needed.

• Advanced Practice Providers (APP): This includes Physician Assistant (PA) or Nurse Practitioner (NP) who are nationally board certified and licensed by the state of North Carolina to practice medicine under the supervision of a physician. The physician assistants/nurse practitioners work closely with the physicians and the treatment team to optimize medical care.

• Clinical Case Manager (CCM): The CCM is a master’s level social worker who is the team leader and a liaison for the patient and family with the treatment team. The clinical case manager helps the patient and family with personal, financial, emotional and social concerns that may arise as a result of the illness or injury impacting their hospital stay and discharge plan. The case manager communicates with the insurance company and helps coordinate discharge plans.

• Nurse (RN): The Neuro Care Program nurse is responsible for monitoring and managing the patient’s physiological status (heart rate, blood pressure, skin integrity, infections, nutrition and respiratory status). Patients and families will find their Neuro Care Program nurse to be a good resource for information about medical status and plan of care.

• Nurse Tech: A nurse tech has a certified nursing assistant (CNA) degree and works under the direction of the nurse to assist in patient care.

• Registered Dietician (RD): The RD is specially trained in the field of nutrition. The RD reviews dietary restrictions, making recommendations for achieving optimal nutritional support.

• Physical Therapist (PT): The PT is a licensed therapist who works with the patient to maintain range of motion, manage muscle tone and increase flexibility. The focus of physical therapy is on mobility and having the balance and motor control to participate in functional tasks.

• Neuropsychologist: Neuropsychologists are psychologists with specialized training in brain-behavior relationships. They evaluate and treat cognitive, emotional and behavioral effects of brain injury. The neuropsychologist will perform a neuropsychological assessment and educate the patient and family about cognitive, behavioral or emotional issues that may be present. Families play an important role in the assessment by helping the neuropsychologist understand if the patient’s responses are typical of their personality or if they are a result of the brain injury.

• Occupational Therapist (OT): The OT is a licensed therapist who assesses and treats the patient’s ability to perform self-care tasks such as bathing, dressing and grooming as well as functional mobility used for toileting and showering. This includes the vision, visual-perceptual skills, cognition, and arm/hand coordination needed to perform these tasks.

• Speech-Language Pathologist (SLP): The SLP is a licensed therapist who evaluates and treats the patient’s communication, cognition and the ability to eat and drink safely. This may involve observing the patient’s response to his/her environment and communication attempts.

A Unique Treatment Plan Working closely with the patient and family, the team formulates a comprehensive treatment plan that is tailored to meet individual needs and goals. The team’s goal is to maximize the patient’s level of function and educate families about how to care for their family member after discharge.

The Neuro Care Program team meets weekly at a team conference. At the initial team conference, the team will discuss overall goals and set an estimated length of stay. Subsequent team conferences will review the patient’s progress, update goals and refine the estimated length of stay. The clinical case manager will relay family issues/concerns to the treatment team and keep the patient and family informed about the team discussion after each team meeting. Family input is vital to a successful treatment plan. Family members help caregivers understand a patient’s interests (sports, favorite TV shows, etc.) which help caregivers relate to patients.

Patient Outcomes For patients discharged from the Neuro Care Unit in 2016–2019:

• 56% of patients transferred to an intensive inpatient rehabilitation program like the one available at WakeMed

• 14% returned home with family support & community services

• 13% went to a skilled nursing facility

• 42 days – average length of stay

• Of those patients, who upon admission were unable to perform any self-care activities, 63% were able to perform some self-care activity by discharge

• 61% of patients who were unable to swallow fluids at admissison were able to swallow by discharge

Numbers don’t tell the whole story. Often the most important outcome after participation in the Neuro Care Program is improved caregiver and family member understanding of the impairments from severe neurological injury. This helps them become educated advocates for their loved one and to prepare for the next level of care.

The Family’s Role Family involvement is a critical factor in a patient’s recovery and rehabilitation. Family members are encouraged to participate in their loved one’s care by offering input into their loved one’s individual treatment plan.

Becoming a More Confident Caregiver The case manager will coordinate caregiver training sessions to help family members carry out the needs of their loved one. We want to be sure that family members feel comfortable with the program and are prepared for the patient to move to the next level of care. Family training may include, but is not limited to:

• Feeding tube care and use

• Nutrition

• Medication information

• Tracheostomy care

• Skin care and pressure sore prevention

• Getting patient in and out of bed safely

• Taking care of bowel and bladder

• Bathing, dressing and grooming

• Home equipment

• Communication and stimulation strategies

• Cognitive status

• Phases of recovery and expected outcomes

Our goal with family training is to help address questions and concerns and to facilitate a smooth transition at discharge. Family members are also encouraged to observe therapy sessions

Planning for Admission An admissions nurse from WakeMed Health & Hospitals will talk with you or your loved one to determine if the Neuro Care Program is the best fit. WakeMed contracts with a wide variety of managed care plans and insurance companies. Please call 919-350-7876 and we can talk to you specifically about your insurance plan including coverage, benefits and authorization for the Neuro Care Unit. We will coordinate with the insurance company and keep you fully informed. Once approved, the admission staff will help schedule your loved one’s transfer to WakeMed’s Neuro Care Unit.

What to Bring Comfort is the key. It is helpful to get your loved one back in the routine of dressing each day, and it is also a good therapy task. Here are some suggestions:

• Comfortable, loose-fitting, washable pants and tops

• Non-skid shoes, such as tennis shoes

• Toileting items (comb, brush, toothbrush, shampoo, deodorant, lotion, razor, and shaving cream)

• Photos of family and pets, mementos from home

• Insurance identification cards

• Valuables should be left at home

Arrival Family involvement is an important part of the treatment process and we strongly encourage the family to accompany their loved one on the day of transfer. Parking is available in the parking deck located at the front of the hospital (follow the visitors parking signs).

The First Day: What to Expect

• Check-in: Upon arrival the nurse will ask the family member to sign admission papers.

• Nursing staff will provide the orientation to the patient room, explain the basics of the program and how family will be involved.

• Treatment Team: the treatment team members will introduce themselves and prepare you and your loved one for the start of the therapy program.

• The medical staff will perform a patient assessment and review your loved one’s medical history and medications.

Length of Stay During your loved one’s first week, the treatment team will meet to discuss current status, goals, treatment schedule and length of stay. This is done with patient and family input to make sure the treatment plan is aligned with the family’s goals. There will be a team conference to review progress and the case manager will keep the patient and family informed after each conference. If there are any questions or concerns, feel free to talk with any of the treatment team members but keep in mind that the clinical case manager is best person with whom to raise any concerns.

Discharge and Transfer Patients are discharged from the Neuro Care Program when they have achieved their discharge goals, have progressed to a level that allows them to participate in intensive inpatient rehabilitation services, or when they are ready to move on to the next level of care. The case manager will meet with the patient and family members to discuss discharge needs and options to insure the patient has resources as needed for a safe smooth discharge from the Neuro Care Program.

Other Essentials

• Parking: A fee is required to park in the visitor parking lot. Family members may obtain a 7-day parking pass through the parking attendant.

• Visiting Hours: We encourage you to visit your loved ones while they are in the Neuro Care Program. There are no set visiting hours for primary caregivers (spouses, parents, significant others, and/or adult children). Other visits from friends and family are best between 4 and 8 pm Monday through Friday and from noon to 8 pm on the weekends. Please be mindful of your loved one’s care needs, therapy schedule, and need for rest while visiting. Please check with the nursing staff or with the clinical case manager to determine the best times to visit.

• At times, it may be recommended for visitors to be limited to 1 to 2 people at a time or to limit visits to a short amount of time due to your loved one becoming over-stimulated or fatigued.

• Café 3000, WakeMed’s cafeteria, is open Sunday through Saturday 6:30 am to 8 pm and midnight to 4 am.

For More Information About the WakeMed Neuro Care Unit A physician, hospital discharge planner/case manager, social worker or an insurance company case manager can request evaluation for admission to the WakeMed Neuro Care Program. Nurses and physicians work together to determine acceptance to the unit within 24 hours. Patients who come to WakeMed at the time of their injury can often stay at WakeMed for their entire care experience – a convenience for many patients and their families.

To make a referral or to request a patient evaluation for admission to the WakeMed Neuro Care Program, please call the Admissions department at 919-350-7876 or fax your request to 919-350-8791.

• For more information about the WakeMed Brain Injury and Neuro Care Unit programs, please call 919-350-7879.

• For more information about the WakeMed Rehabilitation continuum of care, please call 919-350-5108.

www.wakemed.org