Risks of after-surgery rehab care at a rehabilitation hospital
Studies show that going home from the hospital and getting outpatient rehab has benefits
Every year in the United States, over a million people have knee or hip replacement surgeries.
When it comes to learning what you can do after a joint replacement surgery to increase your odds of a good outcome, the American Academy of Orthopaedic Surgeons clinical practice guidelines are a good place to start.
The Academy’s guidelines contain a number of recommendations related to the benefit of immediate physical therapy after joint a total knee replacement surgery:
- Strong evidence supports that rehabilitation started on the day of the surgery reduces length of hospital stay.
- Moderate evidence supports that rehabilitation started on the day of surgery compared to rehabilitation started on the day after the surgery reduces pain and improves function.
- Moderate evidence supports that a supervised exercise program during the first two months after the surgery improves physical function.
- Limited evidence supports that a supervised exercise program during the first two months after the surgery decreases pain.
Where should you receive physical therapy?
I found it interesting that the American Academy of Orthopaedic Surgeons clinical practice guidelines make no recommendation on whether post-surgical physical therapy should be done in a rehabilitation hospital versus at an outpatient clinic at home.
Based on my experienced as a Texas medical malpractice lawyer, I was not surprised to read the conclusion of a recent study about which of these two options is better.
The study results were presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons. Researchers found that, even for people who live alone, that the overwhelming majority of patients recover equally well, and may even experience fewer complications, if they go straight home after a knee or hip replacement surgery.
A new Australian study came to the same conclusion, when comparing home-based knee surgery rehabilitation patients to those who spent 10 days admitted to a rehabilitation facility. Six months after their surgeries, there was no difference in pain, function, mobility, or quality of life.
Medical and nursing errors in rehabilitation hospitals and nursing homes
As a Houston medical negligence attorney, I represented patients and families who were concerned about bad experiences that they had at a rehabilitation hospital or skilled nursing home.
It turns out that inpatient rehab is not always as straightforward and uneventful as many patients expect. In 2016, the Office of the Inspector published a report of its study of Medicare patients, and found that 29% experienced adverse events during a stay in rehabilitation hospitals, which is in line with what is seen in regular hospitals (27%) and skilled nursing facilities (33%). Most of those errors were found to be clearly or likely preventable.
Are there enough doctors and nurses to care for the patients?
When Painter Law Firm investigates cases involving potential health care negligence, we hire medical experts to review the relevant medical records and give their opinions on what happened.
Through our investigations of rehab hospitals and nursing homes, I have seen the issue of physician and nursing staffing levels come up over and over again, from patients, families, and our retained medical experts. In other words, the question is whether there are enough doctors and nurses on duty to take care of the patients.
In rehabilitation facilities, physical medicine doctors usually oversee rehabilitation care and serve as the attending physician. Depending on the circumstances, they may also bring in a hospitalist to manage the medical care of patients. Hospitalists have internal medicine training and treat patients in a hospital, nursing home, or rehabilitation facility setting.
After deposing a lot of hospitalists and nurses, I have learned that they take care of a lot of patients in an average day. When we are investigating cases, we always look at whether they are seeing too many patients to be able to care for them all properly.
That was an allegation that the plaintiffs made in a case that our firm filed, in 2014, against St. Luke’s Sugar Land Hospital and hospitalist Dr. Dominic Sreshta.
While working on that case, I reviewed Dr. Sreshta’s resume and something caught my eye. Dr. Sreshta’s resume said that he had treated 125,000 patients, in ten nursing homes, ten hospitals, and his clinic, over a 14-year period.
That is a lot of patients. I got my calculator out. That works out to seeing 24 patients a day, 365 days a year, without a single day off, for 14 years.
When I took Dr. Sreshta’s deposition, on February 24, 2016, I asked him if my calculation surprised him. He said, “It won’t surprise me.” Later in his deposition, he explained that, “A lot of hospitals don’t require the doctor to see them every day, so we would go and eyeball the patients that were already being seen all the time.”
What is the significance of nursing and physician staffing levels to rehab patients? When a patient goes to the a rehabilitation hospital, he or she has a sense of security—sometimes a false sense of security—that the trained professionals are there to ensure that nothing goes wrong. When there not enough doctors and nurses to take care of the patients properly, then things can fall through the cracks.
From my experience in handling medical malpractice cases, there are a number of things that I have repeatedly seen fall through the cracks by many doctors, nurses, and rehab facilities.
Some of the things that may fall through the cracks include missed medications and nurses not keeping doctors informed of changes in patient status. Another significant problem is doctors and nurses overmedicating patients, or giving excessive medications to keep them quiet, rather than investigating the underlying cause of altered mental status, pain, or nausea, for example.
What you can do when it comes to rehab care
If you are in a situation where you may need rehabilitation services, ask your doctor whether it is absolutely necessary to go to a rehab hospital. Sometimes it is, but most of them time outpatient care is sufficient.
Being discharged to home means that you, and family members or friends, are responsible for monitoring your condition and getting help if something goes wrong. In my experience, this is actually a good thing because it allows you to skip over the potentially inattentive providers at a rehab facility, and get prompt care from your surgeon or regular doctor, or at an emergency room, if needed.
If you do have to get admitted to an inpatient rehabilitation facility, do not be lulled into a false sense of security. You, or a family member of friend, should keep track of medications that have been ordered, to make sure the doctors and nurses stay on track. Speak up and get medical attention if something seems off, which means do not allow an overworked, busy nurse or doctor to shrug off your concerns.
If you are still getting ignored, remember that you can still call 911. We have had clients who had to do that and it ended up getting them the much-delayed care that they needed.
We are here to help
If you or someone you care for has been seriously injured, or worse, from substandard care at a rehab facility, skilled nursing home, or other hospital, then call 281-580-8800 for a free consultation with a medical malpractice lawyer at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
Some doctors are prescribing medications for babies that are not FDA approved for children less than one year old
Nurse anesthetists frequently start, monitor, and end general anesthesia, with an anesthesiologist physician in the room
To sue a public hospital for medical malpractice, you need a lawyer who knows the notice requirements and how to meet the tangible personal property requirement