A pilot project for patients with major functional decline who receive a kidney or liver transplant shows promise for positive medical outcomes. Started in August 2017 at The Johns Hopkins Hospital, the project targets medically complex patients who are in the acute hospital for early, intensive rehabilitation.

The approach starts with a physician, surgeon or other member of the primary care team who works with a physiatrist to identify a high-risk patient soon after the transplant. Traditionally, transplant patients are not evaluated by a physiatrist until preparing to transfer to a comprehensive inpatient rehabilitation program, which may not take place until several weeks into a hospital stay.

“We are anticipating the recovery path for the patient as soon as possible, which guides us throughout their hospital stay,” says physiatrist Kenneth Silver. “The goal is to ensure patients get on the road to recovery quicker.”

Each day, rehabilitation therapists work with the patient to speed activity and mobility as well as coordinate the overall rehab care with the physiatrist. Team meetings with the physiatrist, rehab advanced practitioner and the physical and occupational therapy staff take place several times per week to review and plan the patient’s recovery.

“There is evidence that when patients are more mobile and doing activities of daily living in the hospital, their outcomes improve,” says occupational therapist Annette Lavezza.

The team also attends the transplant division’s multidisciplinary rounds, during which patient progress is discussed and any related rehabilitation plans are modified.

“Despite the patients’ functional deficits and limited activity, providing more frequent therapy earlier in the process appears to be having positive outcomes,” says Silver. “This project will attempt to formally measure those outcomes.”

The focus on early rehabilitation seems to be having an effect on patient satisfaction. Richard Allison, who had a kidney transplant, says, “The rehabilitation therapists began to show me that there is a way to get better. Thanks to them, I improved immensely . . . my stay at rehab was short lived. I am now home and getting better every day.” 

Among other factors, the pilot will analyze the approach’s impact on length of stay as well as functional improvements that allow patient to go home earlier.