13 and counting: Top rehab hospital recognized for research, patient care

New brain injury unit, academy top list of innovations

For 13 years in a row, the Rehabilitation Institute of Chicago (RIC) has landed at the top spot on the rehab section of U.S. News & World Report’s annual list of the best hospitals in America. No other hospital in any specialty consistently has been ranked No. 1. What could be so special in Chicago to garner this honor?

From innovative research to a new state-of-the-art brain injury unit to a new cohesive approach to continuing education, there’s a lot going on. More than 250 research projects are under way at RIC, which conducts the largest rehabilitation research effort in the world. RIC offers dedicated programs for each specialty, including spinal cord injury, brain injury, stroke, amputation, pediatric rehabilitation, and transplants.

To be considered for the U.S. News rankings, institutions must either be a member of the Council of Teaching Hospitals, affiliated with a medical school, or offer at least nine of the 17 specialties surveyed. The rankings are determined by a survey of board-certified specialists in each category, who are asked to identify those hospitals that are leaders in their specialty without regard to location or cost.

RIC, which has more than 20 sites of care throughout Chicago and southern Illinois, is the home of the Northwestern University Feinberg School of Medicine’s Department of Physical Medicine and Rehabilitation. It operates one of the largest physiatry residency programs in the United States.

"The ranking is due, in large part, to our staff. Everyone from the therapists to the nurses to the case managers to the physicians to the care techs is highly dedicated, not only to clinical work but also to research," says Ricardo Senno, MD, medical director of the brain injury medicine and rehabilitation program. "We are all involved in patient advocacy programs at the local, national, and international level. We have a large, high-quality residency program where the lectures are all done by the attending physicians. That shows you their level of dedication."

Senno cites RIC’s continuum of care as another reason for the top ranking. "It’s not just an inpatient hospital. When a person leaves here they get discharged to the appropriate level of care. It’s to the point that we do consults in the intensive care unit so we know the patients even before they come to us."

Senno is especially proud of RIC’s new inpatient brain injury medicine and rehabilitation unit at its flagship hospital. The $5 million unit, which opened in July, not only serves to provide more efficient and cost-effective care for patients, but also incorporates innovative clinical, safety, and design elements. Most of the ideas for the new unit came from the staff. Features include a soothing gray, blue, and white color scheme, large private patient rooms and bathrooms, video surveillance for patient safety, and glass walls in certain patient rooms to aid observation. At the flip of a switch, the glass wall can be turned opaque if necessary.

"All brain injury patients go through an agitation stage, and it’s contagious," Senno says. "With these private rooms, we can turn the lights down and decrease stimulation, while still keeping an eye on the patient through the glass wall."

The rooms include sofa beds that allow family members to stay overnight, which enables quicker attention to pain and agitation issues, Senno says. The large rooms also allow space for individual therapy. Special beds, which have pressure-relief mattresses, turn into chairs to help prevent pneumonia and include a built-in scale that aids in appropriate medicine dosage. Special lighting in the rooms aids examinations.

The new unit also has three rooms that are set up for patients on ventilators. In the past, those patients were sent to another hospital for ventilator weaning and then transferred back to the brain injury program. "After we get some training for our staff, we’ll be able to wean patients off the ventilator and do family teaching right on our unit," he says.

Senno predicts the unit’s fall rate, infectious diseases, and pain ratings will diminish. He expects to see the unit’s 26-day average length of stay decrease because of more effective monitoring, and he’s also hoping to see an increase in functional independence measure scores and patient satisfaction rates.

Aside from improving patient care, RIC was also looking to better use its space, says Sean O’Grady, vice president of operations and patient services. With a license for 155 beds, the hospital appeared full when only 130 were occupied. Most of the rooms were doubles or triples, and with gender and infection control issues, as well as patient preference for private rooms, there was a problem.

"We identified, given our historic growth rates, and projected for the future that we needed to create more space and flexibility within our given licensure," he says. "We moved the administrative functions to another building in the neighborhood and created a new unit to expand our inpatient capacity. Then we determined what specialty program could move into the new unit. The brain injury unit was the largest unit in the institution; and with brain injury patients, a lot of stimulation is about the worst thing you can do to them. Some days, our brain injury unit had a census of 33 patients, and that was just not conducive to the patients’ goals."

So RIC designed an entire floor with 20 private rooms for the treatment of patients with brain injuries. If the patient population exceeds those rooms, patients with no significant safety issues can be housed on the stroke unit.

"The partnering of the brain injury and stroke units was really an efficiency gain because we can move staff between the two teams as the need dictates," O’Grady explains. "It gives staff an avenue to move in and out of different types of patient populations easily. That’s particularly important for our therapy staff. They don’t want to do just brain injury for their whole career."

Other efficiencies include less need for one-to-one safety monitoring because of the glass walls and video monitors, reconfigured nursing stations that allow greater visibility, and therapy offices located on the unit for increased staff collaboration and less patient transfer time.

Research a priority

Another area that sets RIC above the crowd is its commitment to research. RIC set up a research corporation in 1990, a move almost unheard of for rehab hospitals, says Zev Rymer, MD, PhD, who directs a research staff of 120. RIC has given tremendous administrative and financial support to research. In fact, 40% of the proceeds for the upcoming fundraising campaign will be earmarked for research.

"RIC has understood that scholarship and research are pivotal not just to discover important things for treating people, but to bring a sense of inquiry and curiosity to the clinic, which is not normally a rehab thing," he says. "Rehab has not been a research-intensive area until recently. It’s a great recruiting and retaining tool as well. People will choose to work in academically-based programs where there is a sense of inquiry and intellectual engagement."

One of the keys to the success of the research program is researchers continue to do clinical and teaching work, Rymer says. Paid joint faculty appointments with Northwestern University help engineers, physiologists, biologists, and the like protect their career development while they do research. Therapists who do research in the hospital’s labs can use what they learn with patients and vice versa.

Research teams are involved in breakthrough studies with the Lokomat, a robot that may help people with paralysis walk again; brain mapping, to determine how brain activity changes after stroke; and creating a cyborg that connects animal brain cells with a robot in the quest for more functional artificial limbs. One researcher is working on a telerehab project that would provide a web-based training approach for stroke survivors to use at home.

RIC does not keep all of this knowledge to itself. Last year, the institute created the RIC Academy to bring all of its educational and training efforts under one corporate university umbrella, says Laura Ferrio, RN, MSN, MBA, vice president of patient care services and chief nurse executive. The academy provides inservices, staff development, and orientation for RIC staff and also offers about 40 courses per year that are attended by nurses, therapists, and physicians from around the country. The courses cover best practices, rehabilitation techniques and information specific to different diagnoses.

"Our own staff participate in these courses as both students and faculty. That’s something unique in that our staff have the opportunity not only to practice clinically but also to teach," she says. "We find that the best teachers are still doing hands-on care with patients."

The academy also sends teams to teach outreach courses at other hospitals and provides distance-learning opportunities over the Internet. "We have adopted a philosophy at the institute that continuous learning is an investment in our staff," Ferrio says. "It’s part of our mission to train others in what we do best and extend our reach into other facilities, to be able to touch more people with disabilities."

Need more information?

Rehabilitation Institute of Chicago, 345 E. Superior St., Chicago, IL 60611. Web site: www.rehabchicago.org.

Ricardo Senno, MD, Medical Director, Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago. Telephone: (312) 238-1165. E-mail: rsenno@rehabchicago.org.

Sean O’Grady, Vice President of Operations and Patient Services, Rehabilitation Institute of Chicago. Telephone: (312) 238-1188.

Zev Rymer, MD, PhD, Director of Research, Rehabilitation Institute of Chicago. Telephone: (312) 238-3381.

Laura Ferrio, RN, MSN, MBA, Vice President of Patient Care Services and Chief Nurse Executive, Rehabilitation Institute of Chicago. Telephone: (312) 238-1317.