What is a Critical Illness Recovery Hospital?

Stacy Bortel couldn’t have imagined the nightmare that lie ahead when she went to her local urgent care after experiencing shortness of breath. Stacy, then 49, assumed it was anxiety; she’d just lost someone she loved.

Stacy’s symptoms were actually caused by a fungal pneumonia that led to acute respiratory failure and nearly took her life. She spent 104 days in various Ohio hospitals, the last of which provided long-term acute care in a critical illness recovery hospital.

Upon arriving at Select Specialty Hospital – Columbus Victorian Village*, Stacy was stable but relied on a ventilator to breathe. She couldn’t talk, was malnourished from being fed by a tube for so long and was too weak to walk or even stand. She faced a lengthy recovery and a critical illness recovery hospital was exactly the place she needed to be.

What is long-term acute care?

When a patient experiences a critical illness or injury, their journey usually begins in a traditional hospital, often in an intensive care unit (ICU). These hospitals manage the immediate crisis and stabilize the patient. But some individuals require a longer period of specialized care to fully recover and that’s where critical illness recovery hospitals, licensed as long-term acute care hospitals (LTACHs), can make a difference in a patient’s recovery.

CIRHs are designed for patients who are still acutely ill but don’t require the intensive monitoring and care of an ICU. They aren’t yet ready for inpatient rehabilitation or to return home. Think of a CIRH as a step down from the ICU. A critical illness recovery hospital helps patients get back to what RUSH Specialty Hospital calls the Five Whys – breathing, eating, walking, talking and thinking clearly again.

Patients who can benefit from a CIRH include those with:

• Ventilator dependence
• Respiratory and heart failure
• Emphysema, pneumonia or chronic obstructive pulmonary disease
• Severe infection, such as sepsis or infectious disease
• Post-surgical complications
• Bladder or bowel impairments
• Neurological or post-trauma conditions
• Wounds, burns or pressure ulcers

What to expect at a long-term acute care hospital

Patients within a RUSH Specialty Hospital benefit from 24/7 physician, nursing and respiratory care coverage. At admission, our multidisciplinary care teams develop individualized treatment plans to meet each patient’s needs, with a goal to improve over time and return to their daily lives.

Patients benefit from:

• Physical, occupational, speech and respiratory therapies
• Nutritional care
• Dialysis
• Specialized nursing care, such as wound care specialists
• Speaking devices for ventilator patients
• Patient/family education

The goal is for patients to participate in daily mobilization and rehabilitation sessions.

The Five Whys

We focus on areas of recovery that are vital to each patient’s well-being and journey toward independence. These skills may seem simple but for those recovering from catastrophic illness or injury, they often need to relearn them.

Ventilator liberation: Medical advances allow more patients to survive critical illness or injury in an ICU.  But some struggle to breathe on their own again. Most inpatient rehabilitation hospitals and skilled nursing facilities will not accept patients who are on a ventilator.

Why choose a critical illness recovery hospital for ventilator liberation?

• Care is specialized, coordinated and closely monitored by pulmonologists and respiratory therapists
• Multidisciplinary rounds improve communication about each patient's care plan
• CIRHs implement evidence-based strategies for liberating from prolonged mechanical ventilation. They emphasize reducing adverse ventilator-associated events including pneumonia and infection and ensuring personal nutrition needs.

Mobility: While a patient is being stabilized in an ICU, they lose muscle mass which impacts all aspects of recovery, including their ability to breathe, walk and talk. From day one, our goal is to get patients out of bed and moving again.

Focusing on mobility can decrease:

• Time on the ventilator
• Confusion
• Length of stay in the hospital
• Chance of readmission

Cognitive rehabilitation: ICU patients will commonly experience memory and cognitive function impairments due to medication, prolonged bedrest, pain and stress.

Focusing on cognitive rehabilitation:

• Improves their ability to think clearly, including making decisions
• Increases overall function (e.g., coordination, balance)
• Prepares patients for their return home, allowing them to experience improved quality of life

Speaking: Restoring communication for patients is a top priority. Speech-language pathologists (SLPs) use devices and techniques to help patients speak again, including the use of a Passy-Muir valve. The valve attaches to a patient’s ventilator and/or tracheostomy tube, and pushes air over the vocal cords permitting the patient to speak.

What is the importance of restoring speech?

• Speech provides basic dignity, allowing patients to participate in care, express their wishes and communicate with family members
• Patients who can speak are less likely to experience depression and anxiety

Eating: Chronic clinical conditions – heart failure, anemia, malnutrition, fluid and electrolyte imbalances – tax a patient’s ability to meet their metabolic needs. Critically ill patients have significant nutritional requirements that need constant monitoring to promote healing.

What is the importance of restoring eating?

• Optimized nutrition prevents muscle loss and enhances energy to participate in therapy
• Dietitians and SLPs work together to help restore the ability to eat by ensuring patients can safely swallow
• Customized meal plans transition patients from feeding tubes and intravenous nutrition to a regular diet

Each of the five focus areas of recovery significantly impacts a patients’ physical and mental well-being. After discharge from a CIRH it is common for patients to continue working on skills and building strength in an inpatient rehabilitation hospital.

Criteria for admission

Patients admitted to an CIRH must have complex medical needs that require specialized care and supervision. Admission is based on specific criteria that determine the medical necessity and severity of a patient’s condition. 

If you think that RUSH Specialty Hospital is right for you or your loved one, talk to your doctor or contact us.

How does a critical illness recovery hospital (LTACH) differ from a rehabilitation hospital or skilled nursing facility?

*Access to services may vary by location.

CIRHs provide a higher level of care for patients after severe injury or illness. The teams in RUSH Specialty Hospital are able to support patients who require more intensive care, monitoring, treatment and equipment, including those who rely on a ventilator to breathe. Patients receive daily visits from a physician.

Our CIRHs also provide daily rehabilitation to regain strength and motion. 

Celebrating our patient’s success

We take pride in being a crucial part in each patient’s recovery journey. 

Like many of our patients, Stacy relied on a ventilator to breathe upon admission. One of her first goals – and accomplishments - was learning to breathe on her own again. Every day she participated in breathing trials. Respiratory therapists closely monitored her while she went off the ventilator for increasing amounts of time. One week after admission, the ventilator was gone.

Following that milestone, Stacy’s therapy focused on communication, swallowing and movement. She made quick strides. Only three weeks later, Stacy was back walking, talking and eating. Ready to go home and continue to build her strengths through outpatient rehabilitation.

Stacy was thankful for the care she received at Select Specialty Hospital, calling her care team “heroes.”

We think Stacy is the real hero, pushing herself daily to meet new milestones. Our critical illness recovery hospital gave her the tools, support and expertise she needed.

Read Stacy’s story here or view more patient success stories.

Interested in learning more about RUSH Specialty Hospital?

*RUSH Specialty Hospital and Select Specialty Hospital are part of Select Medical's nationwide network of critical illness recovery hospitals.