On Leading a Rehabilitation Unit Within an Acute Care Hospital: Q&A with Dr. Brian Brendel
Physiatrist Brian Brendel Jr., M.D., is in his fifth year as medical director of the 14-bed inpatient rehabilitation unit at Memorial Hermann Southeast Hospital. He received his undergraduate degree cum laude at Texas A&M University in College Station and completed medical school at The University of Texas Medical Branch at Galveston. He completed residency training in physical medicine and rehabilitation at the University of Washington in Seattle, where he was chief resident.
Q: What do you do to ensure well-coordinated patient care between the rehabilitation unit and the acute care hospital?
Dr. Brendel: One of my first goals after being recruited to lead the inpatient rehab unit here was to ensure a strong continuum of rehabilitation care in conjunction with acute care – beginning with arrival in the emergency department, moving up to the acute floors, transfer to the rehabilitation unit and transitioning back to participation in the community and outpatient rehabilitation, if needed.
Most patients admitted in need of rehabilitation have had strokes, orthopedic injuries or have functional issues resulting in frequent falls or weakness and debilitation. We involve ourselves in their care from day one. We developed early remobilization programs for patients who are here under observation but not officially admitted, or who are in the ICU, to prevent the rapid decline in function associated with confinement to bed. Our goal is to maintain their strength and help them get to discharge or the next level of care. We piloted a program for early remobilization after tPA that ensured medical stability and appropriate medical care during therapy. We also worked closely with the nursing staff to encourage evidence-based practice that enhances the quality of care, reduces costs and improves patient outcomes. We wanted to prevent situations in which we look at vital signs and say that patients are ready to go home but then at discharge, they are too weak to leave. Part of my role is working closely with our case management teams on each unit, doing daily rounding, discussing discharge planning and helping to coordinate that care.
Q: Memorial Hermann Southeast Hospital has expanded the services it offers patients significantly in the past year. What’s unique about your unit compared to rehabilitation units at other hospitals?
Dr. Brendel: With affiliated physicians who represent a diverse range of medical specialties and subspecialties and collaborate closely, along with excellent communication from our leadership, we are able to manage very complex patients. As a Level III trauma center and primary stroke center, we treat patients who arrive with highly complex injuries, and at the same time we still offer our patients the very personalized experience of a community-based hospital. This means that patients admitted to the rehab unit have direct access to critical care and the full range of specialists, many of whom are affiliated with Memorial Hermann-Texas Medical Center and faculty at McGovern Medical School at UTHealth, as well as the patient’s local primary providers. We can manage patients who would be transferred here from community hospitals and standalone rehabilitation facilities because of their complexity. We are expanding our stroke program and orthopedic services and at the same time achieving at the highest level with awards and recognitions. Hospital leadership recognizes the importance of rehabilitation, and we are represented on all committees.
Q: How do patients and clinicians benefit from citywide Memorial Hermann Rehabilitation Network?
Dr. Brendel: Through the network, we have care coordination and resources that would not be available to a single rehabilitation hospital. Our therapists and nurses receive advanced training. Because of consistent training, we’re able to obtain safe and efficient transfers of care between hospitals in the network. Instead of working as individual units, we work as a team across the city. We have Clinical Practice Committee meetings to ensure that we’re delivering the same level of care across the units and in the individual hospitals.
I am one of two physicians who work with physical medicine and rehabilitation case management as a utilization reviewer for the Memorial Hermann Health System. The other physician is Dr. Jacob Joseph, who is based at TIRR Memorial Hermann in the Texas Medical Center. We help with the allocation of resources throughout the system and provide advice on how to improve rehabilitation treatment options for patients. We do this system wide and on the individual patient level. For instance, I might recommend an adjustment in a patient’s medications or suggest that by providing twice-daily therapy the patient can be discharged to home.
Q: What goals have you and your team established as a rehabilitation unit?
Dr. Brendel: Our goal is to provide the highest quality of individualized care for every single one of our patients, particularly when it comes to transitional care – from admission to the hospital for acute illness, to transition to the rehabilitation unit, and ultimately back into the community. Close coordination among the medical specialties allows us to provide the highest quality care at every level. We recognize the importance of getting to know our patients and their goals, and of acknowledging each trial and triumph during the rehabilitation process.