BREATHING ROOM OUTCOMES OUTCOMES 2023 2023
Outcomes of Care Center for Outcomes & Value
Development Zone Rebecca Suter Director of Development Our Barlow team at Los Angeles location looked on when our patient enjoyed a surprise 84th birthday party arranged by her family. With blue skies above and smiles all around, the family gathered on the patio for fun. Your donations make it possible for us to maintain operating reserves for just such unexpected and unpredictable events. Your support makes it possible to achieve our mission to make a difference in the lives of the critically ill patients we serve every day. You also make it possible for patients to recover to enjoy new life milestones. A string of medical complications following surgery brought Señora Nassar to Barlow Respiratory Hospital. She said, “I want to live and be with my family." Our Barlow team was charged with keeping the secret of a surprise celebration of her 84th birthday. It was an opportunity for the entire family, children, grandchildren and great-grandchildren, to gather on the patio and on FaceTime to celebrate Señora Nassar’s strength and spirit and to surround her with love, as she has done for them all their lives. It is that kind of love that inspired our Barlow Respiratory Hospital JSM Invitational Golf Tournament. This year was our 5th Annual and it was held on October 30, 2023 at Aliso Viejo Country Club. Together we enjoyed a full day of fun and made a difference in the lives of the patients we serve. To date, tournament proceeds have raised over $300,000 to fund hospital services. We are grateful to foundation board member Tom Gibbons and all the supporters and sponsors who participated. Thank you!
Thank you Barlow! Our Barlow team at our Los Angeles location watched as our patient enjoyed a surprise 84th birthday party arranged by her family. With blue skies above and smiles all around, the family gathered on the patio for fun.
PUBLISHER/EDITOR Julia Robinson Shimizu EDITORIAL DESIGN Deborah Grady DIRECTOR OF DEVELOPMENT Rebecca Suter BARLOW RESPIRATORY HOSPITAL BOARD OF DIRECTORS Michael D. Berger | Chair Diane Naegele | Vice Chair Jason Zayon, CPA | Secretary/Treasurer Amit Mohan, PhD, FACHE, FACMPE Bradford M. Bolger Eric Kleerup, MD David R. Nelson, MD Richard Seiden John Van Dyke, MD Daniel Weinstein
BARLOW FOUNDATION BOARD OF DIRECTORS Nancy Katayama | Chair Sergio Delgadillo | Vice Chair ODonnell Iselin | Secretary Amit Mohan, PhD, FACHE, FACMPE Brian D. Bartholomew Sophia Chang Kat Connolly Dario Frommer Tom Gibbons Krystal Kim Nicole Kuklok-Waldman David R. Nelson, MD Beth Quillen Thomas David A. Roberts David Thorson OUTCOMES DATA Meg Hassenpflug, MS, RD, FCCM Director of Outcomes & Value EMAIL foundation@barlowhospital.org WEBSITE www.barlowhospital.org ON THE COVER Photo provided by Gomez Family ON THIS PAGE Photo provided by Nassar Family COVER DESIGNED BY Deborah Grady
Enduring, Changing for a Brighter Future Barlow Respiratory Hospital is proud to present a hybrid publication that merges our Breathing Room newsletter with our annual Outcomes Book. This unified publication offers insights into the significant impact we have on our patients' lives and showcases the dedicated teams who facilitate life-altering recoveries. The Outcomes Book specifically focuses on the data that underscore Barlow's crucial role in the continuum of care, beginning in acute hospital Intensive Care Units (ICU). It is our mission to make a difference in the lives of our patients with expert treatment and a precious chance at recovery. It is our honor and privilege, every day, and at every opportunity, to renew our commitment to service as the only not-for-profit Long-Term Acute Care Hospital in California. Despite the ongoing financial repercussions of the COVID-19 pandemic, Barlow Respiratory Hospital continues to persevere and to provide the highest quality care to medically complex and chronically critically ill patients who need us. Our patient population continues to include survivors of COVID-19 pneumonia, referred to us by esteemed medical professionals at the finest hospitals in the region, accustomed to trusting Barlow with their most medically complex patients. At Barlow Respiratory Hospital, patients benefit from our multidisciplinary medical team of clinicians who specialize in pulmonary medicine, critical care medicine and internal medicine who work in close collaboration with physicians in a variety of medical practice specialties and with our team of registered nurses and rehabilitation and respiratory clinicians. The value of Barlow Respiratory Hospital outcomes-based approach to adult acute respiratory care is evident in our commitment to measuring and reporting on our outcomes. These metrics are more important than ever in our data-driven culture. But what does it mean to be “outcomes-based” and “data-driven”? It is a decision-making process that involves collecting data, extracting patterns and facts from those data and utilizing those facts to inform decision-making and ultimately enhance best outcomes in patient care. This reflects our culture of continuous improvement and provides a valuable tool for referring physicians, patients, and families to make informed decisions when selecting post-ICU care at Barlow Respiratory Hospital. We want to express our deepest gratitude for each and every one of our employees for unwavering commitment to our patients. It is truly inspiring, and truly an honor, to be a part of such a dedicated and compassionate team. To our many friends and supporters, thank you for all that you do to help us as we continue to work together towards a brighter future for Barlow Respiratory Hospital and our community.
Sincerely,
Amit Mohan, PhD, FACHE, FACMPE President & Chief Executive Officer
David R. Nelson, MD Medical Director
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Doctors and Women in Healthcare
"Just Another Climb"
It all began with a celebration. After a bite of spoiled food at his 26th birthday party. Jonathan “Jonny” Gomez was hospitalized, critically ill with botulism, and intubated. He missed holiday celebrations: Thanksgiving, Christmas, New Years. He even missed celebrating his first Wedding Anniversary. More than anything, he missed his wife and daughter, only 5 weeks old when he was first hospitalized. It was the cusp of 2021 / 2022 and the COVID pandemic shutdown meant hospital visitors were not allowed. Although Facebook and video-chat visits kept them connected, and first floor window visits allowed an in-person glimpse of his family, the months were lonely and difficult. “We were avid hikers and mountains mean so much to us. Jonny proposed at the top of the falls at Yosemite and we were married there and I like to say that this is just another climb for us. I want to look back and see how far we’ve come.” said Vanessa Gomez at the time. Jonathan survived a prolonged stay in the ICU. When he was admitted to Barlow Respiratory Hospital, he was still dangerously ill. It took formidable strength for him to work through the Barlow Respiratory Hospital Therapist-Implemented Patient-Specific “TIPS©” Weaning Protocol. His Pulmonologist and the Barlow Respiratory Therapy team helped Jonathan as he worked to be free of the mechanical ventilator that had been breathing for him – and keeping him alive – since the darkest days of his illness. Vanessa was thrilled when Jonathan was weaned from the ventilator and decannulated. “They took the breathing tube out on New Year’s Day.” That meant he was ready for the next step of his recovery journey. After discharge from Barlow Respiratory Hospital, he moved to a Rehab Facility where his 5-month old daughter would at last be allowed to visit. “I’m looking forward to getting to see my kiddo.” Said Jonathan, “We’ll learn to walk together.” And they did. 2
n early 2023, the family returned to Barlow Respiratory Hospital Los Angeles to thank our team. “I particularly want to thank Dr Jun. He advocated for us. He was instrumental in helping me wean off of the ventilator. I really appreciate all he did for us. And I want to thank several CNAs, Respiratory Therapists, Physical Therapists, and the wonderful Speech Therapist.” said Jonathan. “This was the right place for Jonny. I knew it.” said Vanessa. “Thanks to all the loving care he received at Barlow, he has fully recovered. He was able to return home and continue physical therapy with the support of our family. His strength returned, and he was able to return to work. We cannot thank Barlow enough. We thank all who cared for him. We are forever grateful.” The future looks bright for Jonathan and Vanessa as they continue their journey with a second daughter born in the spring of 2023.
Barlow Respiratory Hospital Los Angeles 2023 3
Staff Spotlight Got Beds? Behind the Scenes with our Barlow Admissions Team Barlow Respiratory Hospital admissions team includes our on-site behind-the-scenes team: Drina Quinn, Monique Toledo, and MaryAnn Martinez, and our Clinical Admissions Coordinators: Maita Gutierrez, RN; Laura Kearney, RT; Sameer Mehdi, RT; Anna Urling, RN; Ethel Coligado, RN and Angela Sandoval. The team is made up of seasoned professionals who help to facilitate admissions for patients who meet medical criteria and will benefit from rehabilitation and recovery services in a Long-Term Acute Care setting at Barlow Respiratory Hospital. They work closely with family members, Physicians, Case Managers and Discharge Planners at referring hospitals in Los Angeles, Ventura, Kern, Santa Barbara and Orange Counties to ensure qualified patients are admitted for care. “To know if the patient needs this level of care, you have to have a medical background to make a clinical decision,” says Anna Urling, RN. Each team member’s extensive experience, and strong nurturing personality, ensure potential patients can benefit from pre-admissions assessment, meet admissions criteria, and can expect a positive outcome from Barlow Respiratory Hospital expert care. Our admissions team plays an important role in patient outcomes. Before suffering a catastrophic accident or illness, many of our patients lived full and independent lives. As advocates for patients, our admissions team ensures access to expert care at Barlow Respiratory Hospital.
ADMITTING TEAM
Seated, L-R: MaryAnn Martinez, Anna Urling, Drina Quinn Standing, L-R: Sameer Mehdi, Maita Gutierrez Not Pictured: Monique Toledo, Laura Kearney, Angela Sandoval, Ethel Coligado
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Nursing News BARLOW NURSING RESIDENCY TRAINING PROGRAM Barlow Respiratory Hospital hires only registered nurses (RNs) and provides in-depth training specific to our patient population through our Nursing Residency Training Program. The program, established in 2015, is designed to ensure our newly hired and new graduate nurses attain the specialized skills needed to provide exemplary nursing care for our medically complex and mechanically ventilated patients. Our Nursing Residency Training Program is recognized as a valuable resource for our nurses, physicians, and patients at Barlow Respiratory Hospital.
total of 173 nurses. Nurses receive 80 hours of instruction over three months on topics including National Patient Safety goals, skills validation, respiratory care services, cardiac-EKG skills, medication administration, palliative care, wound care, clinical nutrition, documentation and reporting requirements. The Nursing Residency Program is designed to enhance the skills and critical thinking needed to effectively transition to working independently at patients' bedsides. Upon completion of the program and three months of unit orientation, graduate nurses are placed full-time at Barlow Respiratory Hospital's main campus, or Barlow's satellite sites at Valley Presbyterian
The program also serves the greater community, in Los Angeles and beyond, as some Barlow-trained nurses later for having exceptional skills.
at Barlow Respiratory Hospital in 2022 5
Established Expertise Volume Matters Barlow Respiratory Hospital admits and treats twice the national percentage of mechanically ventilated patients discharged from long-term care hospitals.
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Barlow Respiratory Hospital is a high-volume regional weaning center. Outcome from trauma, surgery, and a variety of other medical conditions has been shown to be positively affected by providing treatment at facilities experiencing a high volume of patients with those conditions. Outcome is influenced by patient volume, with better outcome occurring in high-volume centers. For over four decades, Barlow Respiratory Hospital has focused on serving mechanically ventilated chronically critically ill patients with medically complex conditions. Recognized nationally and internationally for its published outcomes and TIPS© weaning protocol, and well-established expertise, Barlow Respiratory Hospital remains a leader among long-term acute care hospitals.
Total Patients Ventilator Weaning Program Weaning Success Rate
673 183 68%
Total Patients Ventilator Weaning Program Weaning Success Rate
8,122 2,686 60%
Total Patients Ventilator Weaning Program Weaning Success Rate
Approximately 25,000 7,563 54%
Organizational Overview The Barlow Care and Recovery Journey Barlow Respiratory Hospital is among the nation’s leading long-term acute care hospitals (LTAC/LTCH) serving the chronically critically ill. We are the destination of choice for weaning patients from prolonged mechanical ventilation. As an LTCH, Barlow is an essential step in the continuum of care from intensive care unit (ICU) through treatment, rehabilitation, and recovery. Patients are referred to Barlow from nearly 100 hospital intensive care units (ICUs) in the Los Angeles metropolitan area and Southern California. With nearly 300 physicians on our medical staff and with multiple locations in Los Angeles County, our expertise is accessible to patients and families throughout the region. Barlow Respiratory Hospital was the first hospital on the West Coast to be awarded the Gold Seal of Approval® for Disease Specific Certification for Respiratory Failure. We have also been recognized for our successful on Wound Care Program, focused maintenance and restoration of skin integrity. Barlow also holds the designation as the only West Coast Passy-Muir Center of Excellence,
awarded for treating patients with tracheostomies, on and off the ventilator. At Barlow Respiratory Hospital, patients with ventilator dependence and complex medical conditions benefit from the expertise of a multidisciplinary medical team of clinicians who specialize in pulmonary medicine, critical care medicine, and internal medicine and who work in close collaboration with physicians in a variety of medical practice specialties. This partnership promotes communication and coordination of care, informs treatment decisions and supports patient-centered goal setting. The expert skill and care provided by our interdisciplinary teams helps patients and their families through the prolonged process of recovery from critical illness, and establishes a discharge plan to progress to home or the next level of care. Barlow Respiratory Hospital serves as a clinical training site for physicians, and allied health professionals in respiratory therapy, nursing, pharmacy, and physical, occupational and speech medical professionals of the therapy. future to care for the chronically critically ill is a vital role Barlow plays in our community, and one in which we take great pride.
ONE TEAM ONE GOAL–BEST OUTCOME: 2023 UPDATE entilator Weaning, Medically Complex, Wound Care and Restoration, and Traumatic Brain In ury. We have treated over 300 survivors pneumonia, with peer-reviewed publication of a legacy of care and expertise, Barlow Respiratory ill and medically complex patients.
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V
P
WEANING SUCCESS RATE: PERFORMANCE OVER TIME
71% 58%
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62%
Weaned is defined as a patient being free of invasive mechanical ventilation at least one full calendar day prior to day of discharge. Time to wean is tallied from the day of admission through the last day of ventilator support. 2016 N=347
58%
55%
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2017 N=305
10
10
2018 N=294
2019 N=318
Weaned
NATIONAL COMPARISON: WEANING SUCCESS RATE
68%
64%
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12
2020 N=225
2021 N=240
10
2022 N=183
Median Days to Wean
More Weaned 67.2%
54.2%
40.9%
Data Source: National LTCH Database 2022 Calendar Year Barlow Respiratory Hospital
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Pacific Region
Na�on
PRESSURE INJURY RATE: PERFORMANCE OVER TIME
4.66%
Barlow Respiratory Hospital has consistently reduced the incidence of hospital-acquired pressure injuries for the past seven years with a rate of less than or equal to 1% the past three years.
The overall direc�on of the data is lower. Lower is be�er.
3.17%
3.28%
1.93%
0.98%
1.01%
2021 N = 613
2022 N=596
0.52%
2016 N=901
2017 N = 789
2019 N = 829
2020 N = 577
2.54%
NATIONAL COMPARISON: HOSPITAL-ACQUIRED PRESSURE INJURIES (HAPI) RATE Barlow Respiratory Hospital has a strikingly lower rate of hospital-acquired pressure injuries compared to both the Pacific Region and the Na�on in a na�onal LTCH database.
2018 N = 685
1.89% Lower is Be�er
1.01%
Data Source: National LTCH Database 2022 Calendar Year
Barlow Respiratory Hospital
Pacific Region
Na�on
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Experience of Care Better patient care and family experiences are associated with greater levels of adherence to treatment processes, improved clinical outcomes, and enhanced patient safety. Barlow Respiratory Hospital is committed to providing care that is respectful of and responsive to individual patient preferences, needs and values. Even during the challenges of the COVID-19 pandemic, Barlow Respiratory Hospital responses to the Experience of Care survey have continued to select a high level of satisfaction with care. Overall, how would you rate your satisfaction with your experience at Barlow? 94%
PATIENT AND FAMILY EXPERIENCE OF CARE Overall satisfaction with the experience of care at Barlow Respiratory Hospital was ranked in the top tier by nearly 90% of patient and families. Data Source: Patient and Family Satisfaction with Care Inpatient Survey Report 2022 Calendar Year
6% Very Sa�sfied/Sa�sfied
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Other Responses
Center for Outcomes & Value Outcomes are key components in defining the value of healthcare. Barlow Respiratory Hospital maintains the largest longitudinal dataset in the nation with reported outcomes of chronically critically ill (CCI) patients admitted to an LTCH for weaning from prolonged mechanical ventilation. Established in 1988, the Ventilation Outcomes Dataset (VOD), a performance improvement dataset, includes data on more than 7,500 patients over 35 consecutive years. The advantage of our robust longitudinal dataset is that we can measure change. The dataset allows us to analyze the impact of various processes, protocols, and policies on improvement in patient outcomes. Barlow has played an active and vital role in shaping health-care decisions and establishing national benchmarks for LTCH quality measures. By engaging in outcomes and health sciences research, Barlow Respiratory Hospital serves as a valuable resource for patients who become ventilator-dependent and have weaning and rehabilitative potential, the chronically critically ill, those with chronic lung and medically complex disease processes, their families, and the medical community entrusted with their care.
Publications and Presentations PUBLICATIONS Dolinay T, Jun D, Chen L, Gornbein J. Mechanical ventilator liberation of patients with COVID-19 in long-term acute care hospital. Chest 2022 Jun; 161(6): 1517-1525 Hassenpflug MS, Nelson DR, Steckart J. Chronic critical illness: continuous improvement at a regional weaning center. Am J Respir Crit Care Med 2022; 205:A4303 Hassenpflug MS, Nelson DR, Steckart J. Post-COVID recovery: outcomes of chronically critically ill patients admitted to a regional weaning center. Am J Respir Crit Care Med 2022; 205:A2935 PRESENTATIONS Post-ICU Mechanical Ventilation: Weaning Outcomes in the Setting of Renal Replacement Therapy. Slide presentation by David R. Nelson, M.D., at the National Association of Long Term Hospitals (NALTH) Clinical Education Meeting, April 21, 2022, Glendale AZ. Post-COVID Recovery: Outcomes of Chronically Critically Ill Patients Admitted to a Regional Weaning Center. Poster presentation by David R. Nelson, M.D. at ATS 2022 International Conference, San Francisco, May 17, 2022. Authors: Meg Stearn Hassenpflug, MS, RD, Barlow Respiratory Hospital; David R. Nelson, MD, Barlow Respiratory Hospital; M. Jillisa Steckart, MEd, PsyD, UCLA David Geffen School of Medicine Outcomes in Chronic Critical Illness: Continuous Improvement at a Regional Weaning Center. Poster presentation by David R. Nelson, M.D at ATS 2022 International Conference, San Francisco, May 17, 2022. Authors: Meg Stearn Hassenpflug, MS, RD, Barlow Respiratory Hospital; David R. Nelson, MD, Barlow Respiratory Hospital; M. Jillisa Steckart, MEd, PsyD, UCLA David Geffen School of Medicine Prolonged Mechanical Ventilation in the (Post) COVID-19 Era. Slide presentation by Dale Jun, M.D., at Harbor-UCLA Grand Rounds, May 24, 2023, Los Angeles.
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Thank You Former Barlow Respiratory Hospital patient
Respiratory Hospital admits and treats patients
Barlow Respiratory Hospital patients benefit from our Outcomes-based approach to clinical care. Recent notes of appreciation to our doctors:
beyond. patients contact us today.
“Dr. Wu recommended Barlow and I trusted his recommendation.”
“Doctors, Especially Dr. Karapetian and Dr. Sasse, were always there for my mother and for me.”
“Dr. Nelson cares about his patients and he is very loving, very dedicated.”
“Dr. Kashani was way above. And all the doctors – Dr. Hakimi, Dr. Vadgama, Dr. Adelson, they were all very nice. Thank you!”
Barlow Respiratory Hospital locations are in e are
Barlow Respiratory Hospital is the only not-for-profit Long Term Acute Care Hospital (LTCH) in California. Our mission is to make a difference in the lives of individuals with chronic critical illness and complex respiratory conditions in postacute settings.
“Dr. Nelson and Dr. Karapetian are so compassionate. They both take the time to talk to you and help care for your loved one.”
“Thank you to Dr. Bardawhaj, he was really the best…”
It was important to us to be in Dr. Nelson’s care. We came here because of him, to be in his care.”
I want to thank Dr. Vadgama for being positive.”
www.barlowhospital.org
“The entire staff have been incredibly caring and kind. Thank you Dr. Kramer Dr. Karapetian Dr. Chilingarian.”
“Dr. Nelson was a ray of sunshine.”