After the Acute Hospital ICU: Caring for the Complex Medical Patient

Gregory Wuchter, MSN, RN
In the intensive care unit, clinical care is managed on a minute-to-minute basis during the most acute phase of illness and/or injury. Yet for many patients, the acute period of an illness is only the first part of recovery.
Individuals recuperating from serious, acute medical or surgical illness, coupled with chronic conditions, often require long-term acute care and treatment after they regain stability. The same can be said for those who suffer a catastrophic illness and require integrated treatment and customized rehabilitative efforts in an acute-care setting over time. For these patients, a long-term acute care hospital (LTCH) offers ongoing acute medical care andtreatment with the introduction of rehabilitation.
At an LTCH, patients are cared for by a group of physicians and nurses specializing in medical, surgical and intensive care-level services.  In addition to doctors and nursing staff, the hospital’s expertise is rounded with the support of respiratory, physical, occupational and speech therapists, registered dieticians, case managers, psychologists and pastoral care staff experienced in caring for individuals with complex medical needs.
Using a team-based approach, health-care practitioners work together to optimize individual health outcomes by maximizing a patient's functional independence, cognitive performance and communicative skills, while minimizing clinical disability and associated discomforts. 
Regardless of their diagnosis, individuals suffering complications resulting from complex multi-system disorders can benefit from the LTCH’s evidence-based care. As part of health management at an LTCH, all patients undergo thorough and appropriate diagnostic testing and receive wide-ranging medical and functional therapies under continuous, comprehensive health supervision. Patients appropriate for an LTCH may require interventions such as cardiac and respiratory management, skin integrity and burn management, neurologic system recovery following stroke, traumatic injury or coma. Patients may also have gastrointestinal or infectious illnesses.
As patients progress toward wellness and gradually prepare for discharge, care plans are revisited to determine the safest and best plan for the patient after discharge from the LTCH. All patientsreceive individual discharge plans tailored for short-term and longer-term recovery goals.
Gregory Wuchter, MSN, RN, is the administrator for the Good Shepherd Specialty Hospital (LTCH), located in Bethlehem.  He is a licensed registered nurse with more than 14 years of clinical and administrative experience in medical-surgical intensive care and long-term post-acute care.