Innovative research keeps rehab hospital on top

Patients invited to team meetings

Want to know what it takes to be one of the top rehab hospitals in the country? At the University of Washington (UW) in Seattle, the answer is outstanding quantity and quality of research, cutting-edge treatment, and administrative processes that focus on the patient. At UW, the patients even get to come to the weekly team conferences. UW ranked third on the rehab section of U.S. News & World Report’s annual list of the best hospitals in America in 2003. 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.

It’s not hard to see why UW is well known and highly regarded around the country. The rehabilitation medicine department receives more National Institutes of Health (NIH) funding than any other in the country and annually turns out around 100 peer-reviewed publications.

"The big thing is we have an outstanding reputation for our faculty and our staff, both for providing outstanding critical care and for our research efforts," says Lawrence Robinson, MD, professor and chairman of rehabilitation medicine at UW. "When you look at the research work at the University of Washington, it’s really quite amazing. What that level of research means is we’re at that cutting edge where research meets clini- cal care. Patients who come here can expect the latest in clinical care that can be offered any place. Some patients are enrolled in new treatments they couldn’t get anywhere else," he adds.

Robinson supervises the work of about 50 faculty members who are split among the UW system hospitals: University of Washington Medical Center, Harborview Medical Center, and Children’s Hospital and Regional Medical Center. The department also provides services at VA Puget Sound Health Care System and Overlake Hospital Medical Center in Bellevue. Half of the faculty are physicians; the other half are PhD-level psychologists and therapists. "We have a little different model than some institutions in that our researchers are pretty much all clinicians, too," he says. "In some places, those functions are separated; and it takes a little more effort to make sure that translation between research and clinical care occurs. Here we have overlap since the researchers are the clinicians."

UW researchers are working on a number of interesting developments in rehab care:

1. Psychological treatment of pain.

UW researchers have found that patients’ attitudes strongly influence their experience of pain. It has long been puzzling why patients with similar injuries report such wide differences in how much pain they feel and how much it inhibits their daily function. "One of the things we’ve found is it depends on how much people catastrophize about their pain," Robinson explains. "If someone has an injury that’s painful and they say, What am I going to do, and how am I going to survive this?’ they don’t do as well as someone with the same type of injury and the same type of pain who says, I’m just going to figure out a way to get through this.’" UW is starting a new treatment called "de-catastrophizing" in which patients are given the tools they need to better take their situation in stride. "We’re hoping to see that it will improve their function," he says.

2. Treatment for burn pain.

UW has an NIH research grant for a project that examines the ability of virtual reality and hypnosis to improve pain during procedures such as dressing changes. "With virtual reality, you basically enter another world. The glasses give you such a three-dimensional picture and cover enough of your field of vision that you feel like you’re someplace else," Robinson adds. "We’re looking at ways for burn patients to go in this place called snow world’ where it’s a cool, snowy area that you can maneuver around in. You get a sense of deep relaxation. It looks like it’s very effective in reducing pain during some of the procedures," he explains.

3. Prevention of phantom limb pain.

Robinson is the principal investigator of a trial on using epidural anesthesia during amputation to prevent phantom limb pain. "We put a catheter into the spine region and give anesthetics during the amputation and for several days after to try to prevent phantom limb pain from occurring even a year or two down the road," he says. "We don’t really know if it works yet, but it might; and there’s some evidence in the literature that makes us optimistic about it."

Robinson also works on patients with voice disorders. "Some people have vocal cords that are too tight. We’ve worked with surgeons to put fine wires into the muscles that control the vocal cords," he says. "We have people do a bunch of vocal tasks, and we can tell which muscle is the problem. Then we put BOTOX in the offending muscle, and they usually get some improvement."

UW is the only hospital in the country that has earned model systems grants from the National Institute for Disability and Rehabilitation Research in all four areas offered: spinal cord injury, traumatic brain injury, multiple sclerosis, and burns.

Diana Cardenas, MD, MHA, professor and chief of service in the department of rehabilitation medicine, is the principal investigator of the Model Spinal Cord Injury System. "As researchers, we attempt to bring the latest findings to our patient care," she says. "We are able to provide rehab for spinal cord injury patients on ventilators and utilize computers widely for all our patients."

The model systems grants have research, education, and clinical care components. The grant provides a patient/family advisory board that gives input on rehab services. UW also offers a monthly spinal cord forum for patients and families where neurologists, physiatrists, and other experts speak on a related topic. "It’s a really nice educational session that really brings it above the level of a support group," says Robinson.

The UW Medical Center was the first hospital in the country to be certified as a Magnet hospital by the American Nurses Credentialing Center. The Magnet program identifies institutions that provide top-quality nursing care for patients. Sandy Painter, RN, nurse manager for inpatient rehab, says all of her staff are registered nurses. "We have developed the primary nurse and nursing panel representative role to facilitate continuity of care for the patients," she says. "The nurses are assigned to a team and are responsible for the patients assigned to that team."

UW’s weekly team conferences are unique in that patients and families are invited to attend, Painter adds. "This has helped to involve the patient and family in working toward their goals. Everyone on the team hears the same information at panels. This has improved the patients’ and families’ communication with the team," she says.

Robinson says staff, at first, were concerned that involving patients and families would complicate the meeting process. What they have found, however, is that care becomes more efficient when patients help make the goals. "It doesn’t take that much longer," he says. "Patients are prepped ahead of time that we only have so many minutes per session. It also saves us time in terms of other meetings with the patient to go over the stuff that we just went over in the team meeting." With ever-shorter lengths of stay, the rehab department decided that the weekly conference was not enough. So teams began the daily huddle, a 45-minute session that hits the high points on what patients need that day.

Cardenas says the keys to rehab success at UW are its core values, which include:

  • compassion and service to the patient above all else;
  • encouraging individual ability and creativity in staff, patients and students;
  • excellence in reputation and being part of something special.

Need more information?

  • Lawrence Robinson, MD, Professor and Chairman, Department of Rehabilitation Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave., Seattle, WA 98104. Phone: (206) 731-3167.
  • Diana Cardenas, MD, Professor of Rehabilitation Medicine, Chief of Service, UW Medical Center, 1959 N.E. Pacific Ave., Seattle, WA 98195. Phone: (206) 543-8171.
  • Sandy Painter, RN, Nurse Manager, Inpatient Rehabilitation, UW Medical Center, 1959 N.E. Pacific Ave., Seattle, WA 98195. Phone: (206) 598-4803.