Case Study: Gallatin Center for Rehabilitation and Healing (February 2021 B)

Patient’s Age: 64-years-old
Admission Date: 12/29/20
Admitted From: Vanderbilt Wilson County Adult Hospital
Discharge Date: 02/13/21
Discharged To: Gallatin Center for Rehabilitation and Healing
Length of Stay: 6 weeks
Reason for Stay: Left distal femur supracondylar fracture
How did this patient hear about Gallatin Center for Rehabilitation and Healing? Discharge planner at the hospital

Details of Experience:
Mrs. Barbara arrived at the Gallatin Center for Rehabilitation and Healing on December 29, 2020, from Vanderbilt Wilson County Adult Hospital in Lebanon, TN. Barbara’s elective post-operative surgery to add stability to her left leg by the placement of an intramedullary nail to her left distal femur supracondylar fracture was due to a fall while walking her dogs. She was taken to the ER at Vanderbilt Wilson County on December 24, 2020. After being evaluated by the clinical team, she was diagnosed with a periprosthetic left distal femoral fracture. Barbara was seen by the surgical team to undergo a surgical procedure consisting of intramedullary fixation of her distal femoral fracture. She recovered well from the surgery and was eager about her upcoming discharge plans. After surgery, she was placed in a knee immobilizer and encouraged to not bear any weight on her left leg until it was fully healed. She participated in range of motion exercises with Physical Therapy and she would be safe to discharge to a skilled nursing rehab for the next step in the rehab process when she was medically stable.

Barbara’s left leg was healing well and showed no signs of swelling or infection. She worked with the Inpatient Rehab team and participated in therapeutic interventions to increase strength, range of motion, balance re-education, and other activities to increase functional mobility and independence with her bathing, dressing, functional transfers, and mobility. She would have to learn how to function while adhering to her non-weight bearing status for her left leg. Barbara required moderate to maximum assistance with her bathing, dressing, and functional mobility. Her inpatient therapy sessions focused on bed mobility, functional transfers, strengthening the upper and lower body, standing balance, and patient and family education. She was showing progress from participating in her treatment sessions and was now ready to transfer to a skilled nursing facility for therapy to prepare her for her discharge home.

On December 29, 2020, Barbara was admitted to the Gallatin Center for Rehabilitation and Healing and she was greeted by the Nursing department, Social Services, Dietary, Billing Department, Concierge, and Therapy. Each department discussed its role and how they might be of assistance to her. After being evaluated by the Therapy Department, she created goals with the therapists that would help her be more independent in her home environment. On admission, Barbara required minimum assistance with her upper body bathing and dressing tasks and functional transfers. She needed more assistance to perform lower body activities and to stand with support for one to three minutes. She was able to ambulate with minimum assistance and 10% verbal cues to adhere to her non-weight bearing status and use correct posture to ambulate 15 feet. Her pain level was 5/10 on the pain scale and she needed minimum assistance for bed mobility.

Barbara’s therapy interventions focused on stretching shortened connective tissue and joint mobilization techniques, therapeutic exercises for her legs to facilitate independence in mobility tasks, and standing balance training. There were days when therapy focused on gait training to normalize gait pattern, training in correct sequencing of gait with a rolling walker to increase safety and gait training, with emphasis on increasing safety and performance on stairs. After performing the activities with the therapists, Barbara showed progress in ambulation from 15 feet with a rolling walker to 50 feet with a rolling walker, take a rest break and repeat with no verbal cues to adhere to non-weight bearing status on February 7th. She was able to meet her goal for lower body bathing and dressing tasks from maximum assistance to modified independence. Barbara has also increased her standing balance from standing one to three minutes to five minutes supported while remaining good balance. Pain has also been an issue for Barbara during her journey and her pain decreased from 5/10 to 3/10 on February 7th and decreased again to 2/10 on the pain scale on February 12th.

After all of her hard work, Barbara was ready to be discharged from Gallatin Center! She has shown great progress and met the goals she had set at the start of her journey. Upon discharge, she was able to speak with the Concierge to discuss how she felt about her stay. Barbara shared that she felt the nurses were good and caring and the therapy department did their best while working with her non-weight bearing status, which added challenges to her recovery. She also shared that she made great friends with the other patients and Brenda, Amy, and Kay from the Activities department were excellent! The Discharge Planner spoke with Barbara and arranged for home health care for her transition to home with her son, for a short period of time, before she returned home to be independent.

The team at the Gallatin Center would like to congratulate Mrs. Barbara Eid for putting in the hard work, motivating the other patients in our community, and showing how consistent effort can bring you closer to your goals. The team is so proud of you and knows you’ll do great back in your home setting!