Rehabilitation

• How I Heard

  I was on-call for the rehabilitation service the weekend of June 12, 2016, and early that morning I contacted our admissions team to discuss the plan for the day. I was surprised to receive a response text saying, “Mass shooting early this morning.” At that point, I knew this day would be very different than usual.

• Synopsis

  The Orlando Health Orlando Regional Medical Center Institute for Advanced Rehabilitation is a comprehensive inpatient and outpatient rehabilitation program located at Orlando Health Orlando Regional Medical Center (ORMC). Our purpose is to help patients and families through catastrophic conditions and prepare them for return to home and the community. Our usual process for inpatient admission is the careful evaluation of the patient’s ability to participate in an aggressive rehabilitation program, and the presence of a reasonable discharge plan. On June 12, we believed that participation in the care for the victims of the Pulse nightclub shooting was a given, and that the only criteria for us to rehabilitate these patients, in this extraordinary case, was their medical stability.

• Preparation

  As the rehabilitation service, we had the opportunity to prepare our team while the patients were being treated by our acute trauma colleagues. Our facility leadership efficiently arranged meetings with the physician, therapy, nursing and support staff in preparation to receive the patients. Despite the heightened attention and often overwhelming number of visitors, our leadership also asked the team to treat the patients no differently than any others, as the patients recovered to their prior level of function. We also had an Employee Assistance Program representative meet with our team to offer support to the care providers, and our leadership arranged for constant availability of psychological services to both patients and staff. Our leadership reminded our team about the importance of protecting patient privacy, with the use of aliases as needed. For all media inquiries, we directed questions to our hospital media relations department and coordinated with the ORMC patient experience team regarding visits from celebrities, while allowing patients the opportunity to meet with them if they chose.

• Response

  Our team immediately accepted the responsibility of providing coordinated rehabilitation services to these patients that needed them. Of the 35 survivors admitted to ORMC, 6 were eventually admitted to our rehabilitation program. Our therapy and nursing team members worked together to provide the much-needed rehabilitation for these patients during this challenging time, and transitioned them to outpatient therapy services when appropriate.

• Lessons Learned

  The primary lessons from this experience revolve around the importance of team communication throughout the continuum of care. Our inpatient rehab team was in constant communication with the trauma service, with potential medical and social issues being relayed to us regularly. This process allowed for a seamless transition of care. Our rehab team members, allied health and support services staff were also in constant communication with each other during all stages of the rehabilitation process. Regular communication with the administrative, patient experience and media relations teams allowed for the best possible outcomes. Interaction between inpatient and outpatient team members was essential in the patients’ transition back to the community. Most importantly, our team members communicated with the patients and families through every step of the rehabilitation course.

• What We Changed

  Through this experience, our rehabilitation team changed how we interact with our colleagues throughout the hospital. We developed interdisciplinary rounding on other units at ORMC and opened up patient access from other hospitals in our health system in order to better serve our community. We took these constructive steps, both with the Pulse patients and with our other patient populations, to provide the right care at the right time and place.

• Conclusion

  Interaction and collaboration between team members within the hospital, between inpatient and outpatient providers, and between hospital teams within the health system have been a critical part of the success of our rehabilitation program at Orlando Health. Our commitment to this collaboration was tested during the Pulse nightclub event, and our team pulled together to provide the best possible patient care. As these patients started in the ER, moved to the acute units, then completed treatment in our rehabilitation unit before transitioning back to the community, our team achieved the best possible outcomes through our continuum of care.

• Key Takeaways

  Communication between team members, patients and families most often leads to the best possible outcomes. By improving communication daily during ordinary times, a team is much better prepared when something extraordinary happens.