Design and Application of Electronic Rehabilitation Medical Record (ERMR) Sharing Scheme Based on Blockchain Technology.

As the value of blockchain has been widely recognized, more and more industries are proposing their blockchain solutions, including the rehabilitation medical industry. Blockchain can play a powerful role in the field of rehabilitation medicine, bringing a new research idea to the management of rehabilitation medical data. The electronic rehabilitation medical record (ERMR) contains rich data dimensions, which can provide comprehensive and accurate information for assessing the health of patients, thereby enhancing the effect of rehabilitation treatment. This paper analyzed the data characteristics of ERMR and the application requirements of blockchain in rehabilitation medicine. Based on the basic principles of blockchain, the technical advantages of blockchain used in ERMR sharing have been studied. In addition, this paper designed a blockchain-based ERMR sharing scheme in detail, using the specific technologies of blockchain such as hybrid P2P network, block-chain data structure, asymmetric encryption algorithm, digital signature, and Raft consensus algorithm to achieve distributed storage, data security, privacy protection, data consistency, data traceability, and data ownership in the process of ERMR sharing. The research results of this paper have important practical significance for realizing the safe and efficient sharing of ERMR, and can provide important technical references for the management of rehabilitation medical data with broad application prospects.

A Retrospective Quality Improvement Study to Describe Operational Management Strategies in an Inpatient Rehabilitation Facility During the COVID-19 Pandemic.

The delivery of care in the inpatient rehabilitation setting was disrupted during the coronavirus disease 2019 (COVID-19) pandemic. As a 150-bed freestanding inpatient rehabilitation facility in the epicenter of the pandemic, Burke Rehabilitation Hospital was required to increase overall bed capacity for regional overflow needs and still maintain our mission to provide inpatient rehabilitation for patients with and without COVID-19. During the period between March and September 2020, Burke Rehabilitation Hospital treated over 300 rehabilitation patients who were COVID-19 positive and at one point had a census that was >50% COVID-19 positive. A model grounded in 5 priorities-communication, personal protective equipment, clinical service delivery, discharge planning, and patient/staff support-was implemented to reprioritize daily operations and ensure patient and staff safety while providing valuable rehabilitation services. The delivery of physical, occupational, speech, and recreational therapy services transformed, and a number of innovative clinical practices were developed. During the study period, 100% of our patients continued to be scheduled to receive therapy services. Patient length of stay values did increase during the pandemic (from 16.38d to 19.93d), and slightly more patients were discharged to home (68.7% compared with 68.3%). Despite modifications to rehabilitation care delivery, patients continued to make functional gains in the areas of self-care, mobility, and walking. Flexible leadership was pivotal in the development and implementation of new processes and procedures to meet the evolving needs of patients, staff, and the organization as a whole.

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016).

BACKGROUND: Patient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals. OBJECTIVES: To determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016. METHOD: Data were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register. RESULTS: A total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50-59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs. CONCLUSION: The study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.

[Post-acute and rehabilitation care in young patients with multiple comorbidities: An observational study]. / Soins de suite et réadaptation (SSR) de Médecine Interne pour sujets jeunes polypathologiques : étude observationnelle d'une structure pilote.

INTRODUCTION: A unique structure devoted to post-acute and rehabilitation care for patients under 75 with multiple comorbidities has been created within the Department of Internal Medicine, Bichat Hospital, Paris. We aim to report on demographic factors, clinical characteristics and outcomes of patients hospitalized in this pilot structure. METHODS: All consecutive adult patients admitted between May 2017 and May 2018 were retrospectively reviewed. RESULTS: Analysis was performed on 61 (61 [24-75] years-old) admitted patients. The median length of hospital stays was 108 [13-974] days. At admission, the median Charlson comorbidity index was 6 [0-12] predicting a 10-year survival of 21 [0-99]%. Most patients were unemployed (83.6%) and had very low-income (< national minimum wage in 65.6% of cases). At hospital discharge, most patients (85.4%) were able to return home. The complete resolution of health problems occurred in most cases (65.6%) and was associated with a lower probability of both hospital readmission and death 1-year after discharge. CONCLUSION: The structure served a high percentage of patients with major and complex health needs but limited access to care due to individual disabilities, low-income and underinsured status. However, despite major health disorders, functional limitations, and vulnerability, admission improved patient outcomes and reduced excess hospital readmissions in most cases.

Building and Sustaining a Culture of Innovation in an Academic Health Centre.

Although innovative organizations have the advantage of superior performance, the idea of adopting innovative practices and embracing risk taking at work can be intimidating, especially for those working in healthcare. When responsible for the health and safety of others, healthcare workers tend to gravitate away from ideas that could result in failure. The challenge of promoting innovation in a healthcare context can be addressed by creating an organizational culture of innovation - where innovative thinking is normalized, rewarded and even expected of employees. In this article, we share our journey and outline lessons learned in creating a culture of innovation at Holland Bloorview, Canada's largest pediatric rehabilitation hospital. It is our hope that those seeking to create a culture of innovation within their organization can learn from and apply these lessons in their own contexts.

Establishment of a COVID-19 Recovery Unit in a Veterans Affairs Post-Acute Facility.

Coronavirus disease 2019 (COVID-19) is now an epidemic of global proportion, with major adverse impacts on older adults, persons with chronic diseases, and especially residents of long-term care facilities. This health catastrophe has challenged healthcare facilities' capacity to deliver care to not only COVID-19 patients but all patients who need hospital care. We report on a novel approach of utilizing long-term care beds at a Department of Veterans Affairs healthcare facility for managing recovering COVID-19 patients. J Am Geriatr Soc 68:2163-2166, 2020.

Work-related stress among health professionals in Swiss acute care and rehabilitation hospitals-A cross-sectional study.

AIMS AND OBJECTIVES: This study aimed to identify significant work stressors associated with stress symptoms, job satisfaction, intention to leave and health-related outcomes among health professionals. BACKGROUND: The workforce shortage of health professionals is a current concern, and a reduction of work-related stress is thus essential for retaining health professionals. Studies on the extent of work-related stress in different health professions are limited. METHODS: The research was conducted with a cross-sectional study encompassing 26 randomly selected acute care and rehabilitation hospitals. The sample consisted of 3,398 health professionals. The study was undertaken in accordance with the STROBE checklist for observational studies. RESULTS: Work-private life conflicts were significantly associated with health professionals' stress symptoms, job satisfaction, intention to leave the organisation and profession, their general health status, burnout symptoms and quality of sleep. Also, opportunities for development and the behaviour of the direct line manager (e.g. quality of leadership, unfair behaviour, rewards given) along with various profession-specific stressors were the important predictors revealed. CONCLUSIONS: This study shows the high relevance of preventing and reducing work-private life conflicts, enhancing leadership qualities as well as opportunities for development among health professionals working in acute care and rehabilitation hospitals. Also, differences between health professions should be taken into consideration in developing strategies for reducing stress at work. RELEVANCE TO CLINICAL PRACTICE: The results of this study are particularly relevant for health professional leaders and reveal the urgent need in hospital practice for effective strategies to improve health professionals' work-private life balance, opportunities for development and quality of leadership.

Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation.

BACKGROUND: Preventing patient falls is a priority in tertiary spinal cord injury (SCI) rehabilitation. Falls can result in patient or staff injury, delayed rehabilitation, and hospital liability. A comprehensive overview of fall prevention/management policies and procedures in Canadian SCI rehabilitation is currently lacking. We describe and compare the fall prevention/management policies and procedures implemented in Canadian tertiary hospitals that provide SCI rehabilitation. METHODS: Fall prevention/management documents implemented in SCI rehabilitation at six Canadian tertiary rehabilitation hospitals across five provinces were analyzed using a document analysis. Analysis involved multiple readings of the documents followed by a content and thematic document analysis. RESULTS: Fall prevention/management policies and procedures in SCI rehabilitation were organized into three main categories: 1) pre-fall policies and procedures; 2) post-fall policies and procedures; and, 3) communication between and amongst staff, patients, and families. Pre-fall policies and procedures encompassed: a) the definition of a fall; b) fall risk assessments in SCI rehabilitation; and, c) fall prevention strategies. The post-fall policies and procedures included: a) recovery from a fall; b) incident reporting process; and, c) fall classification. Components of fall prevention/management policies and practices that differed between hospitals included the fall risk assessments, post-fall huddles, and fall classifications. CONCLUSIONS: Fall prevention/management is a required organizational practice for all hospitals. Although Canadian tertiary hospitals that provide SCI rehabilitation have similar components of fall prevention/management policies and procedures, the specific requirements differ at each site. There is a need for evidence-informed, consensus-driven implementation of SCI-specific fall prevention and management procedures across Canadian SCI rehabilitation settings.

Redefining Pathways into Acute Rehabilitation during the COVID-19 Crisis.

The coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes across the spectrum of health care, all of which have occurred with unprecedented rapidity. The need to accommodate change on such a large scale has required ingenuity and decisive thinking. The field of physical medicine and rehabilitation has been faced with many of these challenges. Healthcare practitioners in New York City, the epicenter of the pandemic in the United States, were among the first to encounter many of these challenges. One of the largest lessons included learning how to streamline admissions and transfer process into an acute rehabilitation hospital as part of a concerted effort to make acute care hospital beds available as quickly as possible.

Challenges of delivering evidence-based stroke services for rural areas in Australia.

OBJECTIVE: The aim of this paper was to use current stroke care guidelines to identify and discuss current stroke care challenges in rural Australian health care and potential solutions for delivery of evidence-based practice. DESIGN AND SETTING: A review of national guidelines since 2002 for organised stroke care was undertaken to determine best practice for delivering primary stroke care. We then employed a narrative literature review strategy looking at relevant articles, based on keywords, outlining current stroke service availability in Australia, highlighting the challenges of implementing evidence-based stroke care in rural areas in Australia based on the current guidelines. RESULTS: Delivery of evidence-based stroke care in rural Australia is fraught with challenges. Although national best-practice guidelines for stroke care are well established, the recommendations made in these guidelines do not always reflect the resource availability in rural Australia. Redesigning processes and utilising available resources, such as telemedicine or local clinical pathways, can achieve an evidence-based standard; however, ultimately better resourcing of these areas is required. CONCLUSION: Evidence-based stroke care, aligned with current national standards is the key to providing adequate stroke services in rural Australia. Improved health service resourcing and better utilisation of currently available resources are options for achieving elements of evidence-based stroke care. IMPLICATIONS FOR PUBLIC HEALTH: Availability of adequate services for stroke patients directly impacts public health as it determines health outcomes for these patients. Indirect implications for public health include the effects on health professionals and the general public.

Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report.

BACKGROUND: Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed. AIMS AND METHODS: This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d. RESULTS: At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital. CONCLUSIONS: Our observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. To this end, 'imprinting' patients at a DRC could be of considerable help.

Effects of an Intensive Inpatient Rehabilitation Program in Elderly Patients with Obesity.

OBJECTIVE: The aim of this study was to assess the short-term effectiveness of an intensive inpatient multidimensional rehabilitation program (MRP), including diet, exercise, and behavioral therapy, in elderly patients with severe obesity. METHODS: Forty-four elderly patients (old; age 69.3 ± 3.5 years, BMI 41.9 ± 14.9) were analyzed against 215 younger patients (young; age 48.2 ± 18.5 years, BMI 43.9 ± 9.4), who were used as controls. All patients underwent MRP, based on group therapy guided by a multidisciplinary team (physicians, dietitians, exercise trainers, psychologists). We evaluated changes in anthropometry, cardiovascular risk factors, physical fitness, quality of life, and eating behavior. RESULTS: After 3 weeks of MRP, we observed a reduction in body weight (old -3.8%, young -4.3%), BMI (old -3.9%, young -4.4%), waist circumference (old -3.4%, young -4.1%), total cholesterol (old -14.0%, young -15.0%), and fasting glucose (old -8.3%, young -8.1%), as well as improved performance in the Six-Minute-Walk Test (old +28.7%, young +15.3%), chair-stand test (old +24.8%, young +26.9%), and arm-curl test (old +15.2%, young +27.3%). Significant improvement was registered in all other analyzed domains. CONCLUSION: Our 3-week MRP provided significant clinical and functional improvement, which was similar between elderly and younger patients with severe obesity. In the long-term, this may be translated into better quality of life, through better management of obesity-associated morbidities and reduced frailty.

Untapped Potential: Engaging in Meaningful Client and Family Partnerships to Drive High-Quality, Safe Care.

Holland Bloorview Kids Rehabilitation Hospital developed an innovative framework that fully integrates 17 family and youth leaders into its accreditation preparation process to drive its quality and safety improvements. The hospital established a formalized committee, the Family Leader Accreditation Group (FLAG), where staff and family leaders (FLs), partnered equally to meet, update and share quality and safety initiatives as part of the accreditation preparedness process. The Quality, Safety and Performance (QSP) team was driven to partner more deeply with clients and families to advance quality and safety.