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Madonna Rehabilitation Hospitals

Pulmonary Partnerships Lead to Quality Outcomes

January 22, 2019

Since April 2017, the Lincoln Campus has partnered with Nebraska Pulmonary Specialties. Five days a week for eight hours each day, pulmonologists and advanced-practice providers (APP) work side-by-side with nursing and respiratory therapists in developing the best treatment plan for patients requiring ventilator support.

“In our specialty hospitals, we serve chronically-critically ill/injured patients with complex medical needs," Susan Klanecky, vice president of Patient Care for Madonna Rehabilitation Hospitals, said. "Pulmonary and other multi-specialty physician services are required to meet the needs of these patients with increasing medical acuity. Our
pulmonary physician partnerships help support our mission of providing patient-focused care and quality patient outcomes.”

The collaboration has resulted in positive key findings on the Lincoln Campus:
• Ventilator weaning is 71 percent (nearly 10 percent above the national average)
• Days to wean a patient from a ventilator are under 14
• Low number of ventilatorassociated pneumonia

“These early results are encouraging,” Jim Pelton, director of Respiratory Therapy, Lincoln Campus, said. “The goal is to get our patients weaned from the ventilator permanently, helping to improve their overall quality of life."

Madonna’s Omaha Campus’ partnership began in October with Nebraska Medicine’s Pulmonary and Critical Care department and involves APPs like Hayley Heimes, Nebraska Medicine APRN. She, along with onsite department pulmonologists, round five days a week on patients, working closely with the hospitalist, respiratory therapy and care teams on best patient outcomes. Often that includes working with them to wean from ventilator support. “It is truly a team effort in the patient's recovery, Heimes said. “Given we aren't there all day every day, we need those extra eyes and hands to help us guide our treatments and interventions.”

Heimes worked collaboratively with Madonna's staff to care for 38-yearold Angela Prusse. A busy wife and mother, Angela was diagnosed with multiple sclerosis (MS) in her early twenties. Friday nights were reserved for a weekly softball league with friends. However, an unknown infection, combined with an MS flare up in late September, contributed to Angela’s sudden health decline and subsequent hospitalization, requiring ventilator support including a tracheostomy. When she arrived at Madonna, Prusse was confused, weak and unable to breathe on her own. With Heimes' support, Angela weaned from oxygen support in a week. She has since moved to the Rehabilitation Hospital and is regaining strength to go home.

“This extra layer of support APPs provide benefits our most vulnerable patients,” Dr. Susan Ohnoutka, medical director for the Madonna Rehabilitation Specialty Hospital, Omaha Campus, said. “The attention, knowledge and early intervention plan allow patients to return to their highest level of independence faster. For Angela, that’s being a mom to her 8-year-old daughter.”



Madonna continues to improve pulmonary patient outcomes by introducing new treatment strategies and technologies. Both campuses are designated Centers of Excellence for implementing cutting-edge technology solutions that help patients breathe easier and wean quicker from the ventilator.

Since 2015 Madonna has been a Center of Excellence for the Passy Muir Valve (PMV). Also known as a speaking valve, the PMV is a oneway valve connected to the tracheostomy tube, allowing patients to speak and swallow, increasing independence and ventilator weaning. Madonna was the first of 12 Centers of Excellence
in the country.

In 2017, Vapotherm recognized Madonna as a Center of Excellence for successful use in warm mist humidification as part of the weaning process for tracheostomy patients. Madonna has incorporated this progressive, warm mist humidification, leading to the highest level of independence for patients.