Journey to Neuro Recovery
Kentfield Hospital’s neuro program is innovative and unique, affording patients with neurological injury, transitioning from neuro intensive care units, the best possible chance of recovery. This transitional period is a time in recovery at which the patient remains with complex neurological and medical problems that require expert medical knowledge in order to provide for optimal outcomes. Our team of medical experts is specially trained and credentialed to care for complex neuro injuries as well as supporting the patient’s families adjusting to the effects of the brain injury.
Why Kentfield Hospital?
Kentfield Hospital provides a unique program that targets care for brain-injured patients in the acute transitional period of their recovery. Kentfield Hospital benefits those patients who remain very sick and complicated medically and requires a high level of support, medical expertise, and attention from a team with expertise in neurocritical care, as well as general medical care. Kentfield Hospital is currently the only hospital in the community to provide this unique service.
Kentfield Hospital’s role is to:
Ensure a continuum of neurological, neurosurgical, and medical care throughout the stages after an acute brain injury.
Ensure that goals of care are constantly addressed and good communication is provided through the patient’s stay
Ensure and coordinate necessary follow-up and interventions.
Kentfield Hospital assists patients with acute brain injury including:
- Intracranial Hemorrhage
- Subarachnoid Hemorrhage
- Traumatic Brain Injury
- Subdural Hematomas
- Post Neurosurgical interventions
- Infections – meningitis, encephalitis, autoimmune
- Status Epilepticus
- Spinal cord injury
- Acute Neuromuscular diseases (e.g. Gillian Barre syndrome, myasthenia gravis, critical illness neuropathy/myopathy)
- Acute spinal cord diseases (e.g. myelopathy)
- Other (severe demyelinating disease, hydrocephalus)
Benefits of Kentfield Hospital:
- High-quality metrics and success rates for neuro patients
- Specialty ‘Journey to Neuro Recovery Program’
- Onsite Neuro Intensivist
- Telemedicine Intensivist coverage at night
- Neuro RN’s and other staff trained to handle neuro patients
- Intensive Rehabilitation for neuro patients to get them ready for Acute Rehabilitation or Home
- Concierge services for helping patients spend quality time when family/friends not able to visit
Programs and Services
Long term acute care (LTAC) is a specialty hospital for patients who require medical services coupled with rehabilitation for an extended period of time to recover and strengthen. At Kentfield Hospital, we offer LTAC services that are innovative, personalized, and cost-effective. Our knowledgeable and dedicated medical professionals work around the clock to ensure all our patients get the high-quality healthcare services they need and deserve. Using our state-of-the-art equipment and facilities, we have helped countless patients efficiently recover from their conditions and get back to living their lives.
At Kentfield Hospital, we work day and night to ensure each and every one of our patients are provided the care and attention that is owed to them. You will never have to question if you are getting sufficient medical care because we will be with you every step of the way throughout the healing process. Our comprehensive and individualized treatment plans are custom designed for each patient to utilize the patient’s strengths to assist with their weaknesses.
Our medical personnel strive to build a relationship with patients on an individual level and we are well known for our compassionate method of care. As we build a better understanding of each individual and their medical condition, we utilize that relationship to more effectively help the patient and their family.
Advanced Testing Capabilities
EEG and Continuous EEG
Kentfield’s Journey to Brain recovery program has the ability to perform regular electroencephalograms (EEGs) and the unique ability to perform continuous long-term EEGs for up to 24hrs. For the brain-injured patient having this capability can be immensely helpful for treatment planning. Our patients are frequently emerging from comas and the clinical exam does not give a full picture of what is going on in the brain.
The EEGs provide more information that is often critical in treatment decisions. Seizures, both with overt manifestations, or what is called subclinical seizures (seizures with no over clinical signs), are fairly common after any type of brain injury. The EEGs allow us to differentiate these movements as either epileptic of not thereby direct appropriate therapy. These seizures, or signs of a propensity towards seizures, may be intermittent, and therefore monitoring brain waves for a longer time period increases the opportunity of picking up these abnormalities. Lastly, these brain wave studies in certain patients may help with prognostication.
Many patients come to the program on multiple sedatives and anti-epileptic medications that were necessary during their initial ICU treatment but could now be hindering recovery. If possible, these medications are reviewed with the goal of minimizing as many of these medications in order to help wake patients up and help the brain heal. Our EEG capabilities can help make the process of titrating of these medications safely.
Medication Management and Medication Trials
Recovery from any type of brain injury is a dynamic process. Medications that may have helped at the beginning of an injury may no longer beneficial or potentially harmful. On the other hand, new medications may be required to treat new emerging neurologic problems. There are also certain medications which may help wake patient up quicker or help with behavioral or cognitive issues that may develop. Our specialized brain injury team has unique training and experience in managing these complex medications.
Kentfield’s Role in the Stages of Recovery
Kentfield Hospital serves patients faced with critical illness by providing unique programs aimed at optimizing recovery. Our ‘Journey to Neuro Recovery’ Program is designed to serve patients who have gone through severe neurological injury and need close monitoring from a specialized neuro team. This program acts as a bridge between acute intensive care after the initial brain injury and the period of increased medical stability and convalescence.
This transitional period is a time point at which brain-injured patients remain severely ill with complex neurological and medical problems that require expert medical knowledge to manage their neurologic and medical problems in order to provide for an optimal outcome.
Brain Injury Team
The complexity of brain injuries demands an expert team that is able to appropriately manage the diagnosis and treat a myriad of brain injuries especially during the time the body starts to heal itself. Kentfield Hospital has developed a team of practitioners to manage brain-injured patients. The team consists of Neuro Intensivists, an acute Neuro Nurse Practitioner, Hospitalist, nurses, and the ancillary therapy staff.
Neurocritical physicians treat life-threatening diseases of the nervous system and identify, prevents/treats secondary brain injury. Neurointensivists have medical training in many fields, including neurology, anesthesiology, emergency medicine, internal medicine, or neurosurgery.
David Palestrant, MD is Board Certified in Neurocritical Care, Vascular Neurology, Critical Medicine, and Neurology. He went to medical school at the University of Arizona. He was an intern at New York Presbyterian Hospital - Columbia Campus. Dr. Palestrant completed his internal medicine and neurology residency at the University of Arizona. His critical care and neurocritical care/stroke fellowship occurred at UCSF.
He has spent his career taking care of patients with severe brain injuries and is a leader in the development of programs to support patients transitioning from neuro intensive care units. The goal of these hospital-based programs is to provide the support and medical expertise needed to ensure patients transitioning from the neuro ICU have the best chance for maximal recovery.
Hospital medicine is a type of practice within internal medicine in which the clinical focus is caring for hospitalized patients. Internists practicing hospital medicine are frequently called “hospitalists.” An important aspect of hospital medicine is the ability to collaborate and communicate with other physicians providing longitudinal care to ensure continuity between inpatient and ambulatory settings.
Aida Calvillo, MD is Board Certified in Internal Medicine. Dr. Calvillo graduated from the University Of Washington School Of Medicine in 1996. She completed her residency at Cambridge Hospital in Massachusetts. Dr. Calvillo has worked with patients at Kentfield Hospital for over 13 years including dedicating her practice to neurological patients for the past 5 years.
Update with the new NP’s info
A neurosurgical NP's primary tasks are to diagnose, treat, and manage patients with neurological and neurosurgical conditions. Neuroscience nursing encompasses the entire nervous system, and neurosurgery can include brain surgery, spinal surgery, and neurological trauma.
One critical component to recovery is having the help and support of family, friends, caregivers, or an extended support system. The Case Management team will schedule an initial care conference as well as continued “family meetings” throughout the patient’s stay in order to educate, update, clarify, and coordinate care.
Through the course of the stay, efforts are made to provide for a smooth transition to living independently. This may include establishing resources within the community such as transportation, housing, follow up appointments for prescheduled medical needs, etc. As the discharge approaches, the interdisciplinary team will involve the family as much as possible to ensure that a safe, cohesive, and appropriate discharge plan is in place.
Upon 72 hours of admission, our Concierge and Leadership visits the patient to ensure that expectation has been met regarding satisfaction with the physicians and licensed staff. If there is any concerns that need to be addressed after 72 hours, the Director of Quality Management is available to work together with you regarding your concerns.
Kentfield Hospital measures healthcare outcomes, which include the patient experience of care, clinical outcomes, and organizational structure that are associated with the ability to provide high-quality health care. This data is submitted to the Center of Medicare and Medicaid Services- https://www.medicare.gov/longtermcarehospitalcompare/.
HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. These surveys are provided to the patients prior to their discharge from the hospital.
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Immediately after a brain injury, long term prognosis may difficult to determine. Time, rate, and degree of progress are variables that can help solidify a prognosis. At Kentfield Hospital we have a team with expertise with brain injury, providing a second look at diagnosis, providing expert knowledge in brain function and recovery, and a team that can follow a patient through their time at Kentfield Hospital. This allows us to offer a clearer picture in terms of longer-term prognosis after brain injury. Most often, brain function and behavior change as the healing process continues. While the body is going through the process, our team looks for opportunities to increase success and minimize regression.
Evoked potential tests are often used to confirm a diagnosis or monitor the nervous system, rather than determining the cause of an abnormality. One example is Electromyography (EMG. An EMG is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles. Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles.
Free to Breath Program
Kentfield Hospital’s ventilator weaning program is unique and unparalleled. Our neurodiagnostic approach includes electrodiagnostic computer studies to assess for phrenic nerve dysfunction and generalized nerve and muscle injury, which can often interfere with recovery and prolong ventilator dependence. It incorporates neurodiagnostic techniques, fluoroscopic imaging, spirometric studies, as well as interdisciplinary clinical evaluations. Clinical experts providing evaluations may include pulmonology, internal medicine, and physical medicine physicians as well as respiratory, physical, and speech therapists to evaluate the mechanics of respiration and prognosticate the patient’s ability to breathe independently of the ventilator.
This unique, structured approach is not available in any other hospital system. We started the Free to Breathe Ventilator Weaning Program at a Kentfield Hospital in 2011 and have been surprised at the amount of neurologic-based pathology, some previously undiagnosed, which contributed to the delay in weaning. Diagnoses responsible for respiratory failure have included Guillain-Barré Syndrome, critical illness neuropathy, cervical myelopathy/spinal cord injury, phrenic nerve dysfunction, and chronic aspiration.
By fully evaluating the pulmonary, neurologic, and muscle mechanics of respiration, our dedicated clinical team can work on specific remediation strategies to give our patients the highest chance of successfully coming off and staying off the ventilator.
- Perform a comprehensive evaluation of pulmonary function to facilitate successful ventilator weaning
- Predict ventilator weaning potential as it applies to the length of stay, disposition, and prognosis
- Provide feedback to the patient, family and treatment team, payors, regarding chances of successful weaning
- Identification of those patients with a strong potential for weaning successfully
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Access to Subspecialties
Telemedicine services are available to enhance the care provided to our patients. The telemedicine service allows for timely access to physicians in addition to other specialists who may not be available for an on-site consultation. The telemedicine physician provides the remote diagnosis and treatment of patients by means of telecommunications technology. This service is provided during the hours of 7 pm to 7 am, seven days a week.
The Kentfield Hospital nursing team has received advanced critical care training as well as continuous advanced instruction covering basic neurophysiology, neuroanatomy, neuro assessment, and emergency neuro resuscitation. With over 80 hours of additional neurological training, the nursing staff is capable of responding to the unique needs of patients who have a neurological disorder.
Because neurological problems can make some patients act erratically, neuro trained nurses have been provided additional training in the care of such behavior. As a neuroscience nurse, you must have patience and extremely effective communication skills.
Respiratory Care Team
The Kentfield Respiratory Therapy Department is passionate about weaning. When patients arrive at our facility, we immediately begin testing lung mechanics and the muscles that support respiration. Our neuro-diagnostic program tests diaphragmatic function using fluoroscopy and EMG testing. This gives us a map of the patient's capability at admission and allows us to develop a plan for rehabilitation. The goal is to wean every patient from ventilator support and return the patient to his or her baseline. The Respiratory Team works closely with physical therapists, occupational therapists, and speech therapists to coordinate weaning while allowing time for the other therapies to increase strength and functionality.
Patients with neurological diseases are at increased risk of micronutrient deficiency and dehydration. On the other hand, nutritional factors may be involved in the pathogenesis of neurological diseases. Dysphagia, ventilator support, malnutrition, and modified diets are just a few examples of disease processes monitored by the dietitian.
Our licensed Dietician conducts a nutritional assessment for each patient once admitted and designs a nutritional menu plan with patient input. Recommendations are provided and shared with clients and Treatment Team members in order to promote healthy meal planning and nutritional meals. Our dietician increases caloric support as we lessen ventilator support in order to enhance the patient's ability to wean.
Physical Therapy Team
Physical Therapy is an integral part of our team approach in the “Journey to Neuro Recovery” at Kentfield Hospital. We work closely with the patient, family, and other Kentfield Hospital team members in the customized treatment approach of patients. Our program is based on evidence-based studies and experience that “Early Mobilization” of patients improves outcomes.
Our physical therapists have experience working with all patients, from a coma to those who are independent with limited functional mobility (moving in and out of bed, transfers, walking). It is especially the ability of our physical therapists to work with patients in coma, vegetative or minimally alert states and patients that are not ready for acute rehab that sets our program apart from other brain injury programs. Many brain injury patients (traumatic brain injury, anoxic brain injury, and stroke patients) or other neurologic patients are not ready to go to acute rehabilitation or to skilled nursing after leaving the acute care hospitals. Our “Journey to Neuro Recovery” program will work with these patients to help prepare them to be ready for acute rehabilitation, subacute, skilled nursing, or even possibly home.
Our customized physical therapy program involves but is not limited to:
- Comprehensive physical therapy evaluations and other standardized testing
- Early mobilization (sitting edge of the bed, up in a wheelchair, standing on tilt table or standing frame or other methods of standing) of all patients that do not have medical contradictions in doing so. This often improves patient alertness and the ability to wean the patient from ventilators and decannulation of tracheostomies as part of our “Free to Breathe Program”
- Work on head control, sitting and standing balance and postural awareness including vestibular rehab
- Attempts at following commands (verbally, in context or with visual or manual demonstration)
- Work on patient’s ability to visually follow objects and become more aware of their environment
- Working closely with the physicians regarding medications that might be preventing the patient from being alert or that might help patients become more alert. Also giving physicians feedback regarding medications or behavioral plans for patients that are motor restless or agitated
- Team approach to treatment (working in collaboratively with patients, families, other therapists, nurses, doctors and case managers)
- Therapeutic exercise and neuromuscular re-education to maintain to increase range of motion, to facilitate movement and to increase strength and endurance
- Prone progression (getting patient on stomach on mat or over gymnastic balls, on hands and knees and kneeling) if medically appropriate to increase alertness, provide sensory stimulation and to provide different positions to increase head control, range of motion, strength and balance
- Functional mobility training (moving in bed, sitting, transferring, standing, walking, stair training and wheelchair mobility)
- The ability to treat patients outside on our therapy deck or out in our local community
- Splinting, serial casting and other durable medical equipment ordering including specialized wheelchairs
- Provide education and training of the patient, family, friends and caregivers
- Use of specialized equipment for treatment such as customized wheelchairs, tilt table, standing frame and Lite Gait (a body weight supportive gait training device so walking can begin before the ability to use parallel bars or other walking devices such as canes and walkers)
- The ability to have a restorative nursing aide to assist the physical therapists to move and treat patients that require more than one person to physically and safely treat
- Prepare the patient for the next phase in their “Journey to Neuro Recovery”
Occupational Therapy Team
Occupational Therapy is an integral part of the team in the “Journey to Neuro Recovery” program at Kentfield Hospital. Occupational Therapists focus on maximizing patient’s independence with activities of daily living (including but not limited to eating, grooming/hygiene, upper body & lower body dressing, toileting & bathing, toilet & tub/shower transfers) and promoting functional use of patient’s upper extremities.
Patients receive a comprehensive occupational therapy evaluation and individualized plan of care and treatment focusing on training patients to adapt to their physical, cognitive and perceptual abilities. Through adaptation of techniques and/or the environment and use of adaptive equipment, patients learn skills to progress toward independence in daily living.
Occupational Therapists focus on facilitating patient’s upper extremity functional abilities by addressing neuromuscular re-education, tone normalization, shoulder subluxations, splinting/casting needs, range of motion (ROM), and strength and motor control needed for functional use.
Occupational Therapists also work in collaboration with the physicians and other team members in detecting signs of responsiveness with patients, who are in a coma, vegetative state or minimally conscious state, assessing patient’s abilities to localize, visually track, and follow commands.
Speech Therapy Team
Our experience with patients with brain trauma allows us to address each patient as a person, aligning goals specific to their cognitive and communicative impairments, as well as their personality, background, family needs, and interests. We address aphasia (language impairment), cognition (memory, safety judgment, and organization), dysarthria and apraxia (oral musculature changes). Whether the patient is currently in a coma, is progressing through the stages of coma recovery, or is recovering from other neurologic insults, we tailor the therapy to the patient. This may include augmentative computer communication, a Day Planner, structured therapy, and/or specific cueing from the well-trained therapy team and nursing.
Speech Therapy also works closely with Respiratory Therapy to help wean patients from vents and tracheostomies. As the patient progresses, we carefully assess abilities to tolerate food and liquid, which may or may not include an on-site Modified Barium Swallow Study (MBSS). All diagnostics and therapy are tailored to the patient’s diagnosis, abilities, needs, and progress rate with the goal of returning to full meals.
Case Management Team
The Case Management teams are critical members of the interdisciplinary team as they are the link connecting the patient, the hospital care team, and the insurance company. The Case Management department is comprised of registered nurses and social workers who specialize in providing guidance, support, and education to help navigate the complicated world of healthcare.
The Case Managers coordinate care needs both while in the hospital and after discharge including appointments, home care needs, transportation assistance, outpatient treatments, and transferring to alternative care facilities. The Case Managers work with the families to identify lower levels of care. The families are encouraged to visit these facilities and organizations to identify the next step in the process of recovery. In addition, the Case Managers educate and assist with access to insurance benefits, authorization for inpatient and outpatient care needs, and apply for alternative programs that can help patients obtain the resources they require.
Medical records from the prior hospitalization are reviewed by our staff before and after the patient arrives. Our physicians and nurses speak with the transferring hospital’s physician and nurse prior to the patient’s arrival at Kentfield Hospital. A successful handoff allows for our accepting staff to be best prepared for the care and continued focus of the transferring treatment plan.
Over the first three days, the patient is assessed by the various members of our team. The attending physician works with the team to plan the various steps leading to the care and treatment of the patient over the course of the inpatient stay. The plan is updated regularly as required for the patient’s needs. The attending physician meets with the clinical team weekly. They review the patient’s past week’s successes and opportunities and prioritize the next steps of the patient’s road to recovery.
Transitions to Next Steps of Recovery
Upon arriving in our hospital, the Case Management team will schedule a Care Conference with the patient, the support system, and member of the interdisciplinary team in order to discuss what the patient’s care goals are. A care plan will be created in order to clarify what recovery goals are anticipated during the hospitalization, and what next steps to expect.
Once our inpatient care goals are reached, there are various different options for continued recovery such as Acute Rehabilitation Centers, Skilled Nursing Centers including Subacute Facilities, Congregate Living Facilities, Outpatient Care Centers, and Home Care within the home environment. The Case Management team will help make the transition out of our hospital as smooth as possible with careful discharge planning and care coordination.
As patients transition to our Outpatient Program, they are met with a comprehensive team of Physical Therapist, Occupational Therapist and Speech Pathologist to continue their recovery. We are proud to provide an hour long one on one session to focus and attend to a variety of details and work towards the continuation of recovery to higher levels of independence. The team approach from each discipline develops a plan of care towards the individual and family goals collaborated with the therapist.
The therapy team has extensive backgrounds for neurological care, orthopedic care, vestibular, balance and gait, lymphatic, and cardio pulmonary. Splinting and custom orthosis can be constructed by our Certified Hand therapists with adaptions to assistive devices and recommendations for equipment for independence. Our highly regarded wound team is also available for any care that may be required as clients continue their recovery to their highest level.
The referrals from Kentfield Hospital come from a variety of sources. Most referrals come directly from the hospitals where the patient is located through the physicians and case managers. The referrals can also come from family members, workers compensation adjusters, health plans and others in the community. Each referral is reviewed for clinical necessity and clinical treatment viability. Next, those referrals that clinically require Kentfield Hospital’s services are processed administratively. This administrative process can include review by the CEO, review by a physician and review with the payer source. After the patient’s information is reviewed and the patient is accepted by the CEO, the patient is invited to Kentfield Hospital after being medically cleared by the sending physician.
Admitting staff receives prior notice of the date and time of a patient’s arrival. Upon admission, the patient or their designee must sign the Conditions of Admissions form to enable Kentfield to begin treatment. If the patient is unable to sign for him/herself, please have someone accompany the patient to the hospital. If a designated person cannot be present at the time of admission, please make arrangements to complete the admission paperwork prior to the patient’s arrival.
Kentfield also requires a copy of the insurance cards, identification card or drivers license, a copy of the patient’s advance directive/durable power of attorney and additional information as requested. Next, the patient and family will be met by a member of the nursing staff who will answer questions about the patient’s care or accommodations.
Settling into Kentfield
The first 2-3 days of a patient’s admission to Kentfield Hospital is an opportunity for the patient to learn the hospital staff and the staff to learn the needs, wants and desires of the patient and their family. The staff will be conducting studies of the patient and their care needs. Some of these tests may be duplication of tests from the previous hospitalization.
Depending upon the patient’s clinical needs, the patient will be encouraged to wear their own clothes. The clothes should not be constricting, especially for those on a ventilator or who have received a tracheostomy. Also, there may be an opportunity for the patient to go outside onto the patio. For many patients, this is the first time they have enjoyed being outside the hospital in weeks.
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ITEMS PATIENTS ARE ENCOURAGED TO BRING
5-6 outfits of loose-fitting tops & pants
Sweater or jacket
Supportive pair of athletic shoes with non-skid soles
Soap (if you prefer a certain brand)
Comb or brush
Eyeglasses and/or contacts
Incontinence pads (if needed)
PLEASE DO NOT BRING VALUABLE ITEMS THAT MAY BE DAMAGED OR LOST
Education and Resources
In-patient education is provided to patient/caregivers by a trained Neuro-Nurse and/or Nurse Educator. An individualized education plan is assessed based on patient’s neurological injury. Nursing education is implemented based on improved understanding of medical condition, disability related to the brain injury. Evaluations of learning needs are performed at the bedside, with return demonstration of understanding verbally or thru observation.
Bedside education and return demonstration of understanding by the patient/caregiver(s) is provided to the Team members weekly with the interdisciplinary team (IDT) meetings and weekly rounds with the Physicians
Your are encouraged to learn more about brain injuries and the healing pathways that can occur.
- Neurological Disorders and Strokes- www.ninds.nih.gov
- California Brain Injury- www.braininjurysupportcenter.com
- National Resource Center for Traumatic Brain injury- www.TBI.org
- Brain Injury Association of America- http://www.biausa.org/
- Traumatic Brain Injury Survival Guide- http://www.tbiguide.com/
- Centers for Disease Control and Prevention- http://www.cdc.gov/TraumaticBrainInjury/index.html
- Brain Trauma Foundation- https://braintrauma.org/about
Local Area Resources
(already on the Kentfield website; please replicate)
(already on the Kentfield website; please replicate)
Kentfield Hospital Foundation is a non-profit organization 501(c)(3) founded in 1983 and dedicated to providing assistance, support and encouragement to patients and families. The Foundation serves the needs of patients that fall outside the scope of hospital services, insurance or other funding services.
These needs may include:
- equipment not covered by insurance for patients during their hospital stay
- personal items for the comfort of patients during their hospital stay
- assistance for immediate family from outside the area
- recreation and entertainment to lift the spirits of patients and their families
- staff appreciation for their care and dedication to the patients’ well being