VA Palo Alto Health Care System
SCI - Inpatient Services
The SCI inpatient team includes physicians, rehabilitation nurses, physical therapists, occupational therapists, respiratory therapists, speech therapists, nutritionists, recreational therapists, social workers, psychologists, clinical nurse specialists, case managers, and nurse practitioners.
The SCI inpatient service provides state-of-the-art services to include comprehensive rehabilitation for acute injuries as well as for other conditions (tendon transfer surgeries and fractures etc.) requiring rehabilitation throughout the individuals lifespan, annual evaluations for health maintenance and prevention of secondary complications, care for acute medical and surgical problems, and a comprehensive wound care management program.
The SCI Center is located in building 7 on the campus of the VA Palo Alto Health Care System. It was designed and dedicated specifically to serve the health care needs of individuals with SCI/D. A majority of SCI-related care is provided on an inpatient or outpatient basis at the Center. If other specialized diagnostic, surgical, acute, or emergent care is needed, this is readily available and accessed onsite in the adjacent buildings on the VA Palo Alto Health Care System Palo Alto campus.
Rehabilitation services include a compendium of services from initial rehabilitation for an acute spinal cord injury to focused rehabilitation for problems that arise from secondary complications due to SCI. Our facility is accredited by CARF, the Rehabilitation Accreditation Commission as Spinal Cord System of Care and has been designated a Center for Excellence in SCI care by the Department of Veterans Affairs. Our team promotes maximal independence, prevention of complications, patient and family education, productivity and the highest quality of life. Our rehabilitation program is tailored to individual and family needs within a supportive atmosphere. Associated medical and surgical issues are addressed and equipment needs are provided. We have a training apartment designed for preparing to transition back into the home environment that is available to patients and their family/caregivers for training and therapy needs. Continuity of care is provided through our outpatient programs. Social workers and case managers assist with discharge planning and teach patients and families how to obtain appropriate personal care assistance.
As a SCI Center, we provide annual wellness check-ups to our patients, as mandated by the Veterans Health Administration. Services are provided on an inpatient or outpatient basis depending on the needs of the individual. This yearly evaluation addresses spinal cord injury, mobility issues, and general health care issues in areas such as cardiovascular, urological, respiratory, and sexual health, as well as other medical and psychosocial needs. Equipment needs to improve function are evaluated by physical and occupational therapists. The emphasis of the annual evaluation is prevention of complications, early identification of problems, and continuance of optimal health. Both inpatient and outpatient annual evaluations are prescheduled in advance in order to ensure the check-up is efficient and comprehensive. The inpatient check-ups are scheduled based on a pre-planned 3-5 day "clinical pathway." Outpatient evaluations are also prescheduled over 2-3 days at the convenience of the patient. For patients who are independent and live a distance, arrangements can be made to stay at no cost at the VA Palo Alto Hometel adjacent to the SCI Center. We also provide a list of nearby motels and their accessibility information.
We manage all medical issues that can be associated with an acute spinal cord injury such as cardiovascular, pulmonary, musculoskeletal issues, depression or a concomitant traumatic brain injury. We frequently manage ventilator/tracheostomy dependent patients and successfully wean appropriate patients from the ventilator. The treatment team is multidisciplinary and is directed by the physician. Numerous consulting services are available and their support is utilized as needed. For the non-acute SCI patient, secondary medical conditions such as urinary tract infections, stone disease, and respiratory infections are treated. Other acute and chronic medical conditions such as diabetes, hypertension, dyslipidemia, and vascular disease are also managed. We also treat patients with spinal cord disorders such as those with multiple sclerosis, amyotrophic lateral sclerosis (ALS), post polio syndrome and transverse myelitis.
Pressure ulcers are a devastating secondary complication of SCI and, at our Center, are one of the primary causes of prolonged hospitalizations. This can take a toll on Veterans and their families. Our goal at the SCI Center is to provide state-of-the-art treatment and education to reduce recurrence of pressure ulcers.
Treatment modalities include both non-surgical and surgical management depending on the individual patient and circumstances. We tailor treatment to the type and stage of the sores and use appropriate agents for debridement, excessive secretions. Infection or decreased granulation. Various treatments we use include vacuum-assisted closure (VAC) therapy and modalities such as ultrasound, pulsed lavage, electrical stimulation coupled with the latest wound care treatment.
The SCI Center has a strong partnership with Plastic Surgery and weekly rounds are conducted at the patient bedside to discuss and develop a management plan for inpatients with pressure ulcers requiring surgery. Appropriate patients undergo flap closure of the sore by plastic surgery. After surgery we follow a protocol progressing from bed rest in a specialty bed, to gradual range of motion, and then wheel-chair sitting guided by our therapists.
For many years we have investigated all pressure ulcers in our patients to identify causes and implement preventive measures. Based on our findings, there are a variety of causes of pressure ulcers and a high incidence of recurrence. While it is difficult to clearly delineate the risk factors, persons who have experienced one pressure ulcer are at great risk of a repeat occurrence in the future. Prevention is of paramount importance. Thus, we provide substantial education about both pressure ulcer management and prevention to both patients and family. Evaluations and equipment are offered to help with the prevention of pressure ulcers.
What can the Veteran and family expect from the inpatient social work service? Inpatient social workers provide a broad list of services to Veterans, Military Service Members, and their families. Veterans can expect social workers to be involved with starting and managing programs that help support their healing and adaptation after spinal cord injury. Inpatient social workers support Veterans to identify their personal strengths and the various options available to them. They help Veterans and family caregivers to develop a safe discharge plan using available VA and community resources geared toward maintaining preventative health care, self reliance/independence, and overall life satisfaction. Veterans can expect individual support and advocacy that enables their personal preferences to be incorporated into their care plan for re-entering the community following a spinal cord injury. While on the spinal cord injury inpatient unit, social work service will serve as the Veteran’s advocate and liaison with the interdisciplinary spinal cord injury team as well as the VA Health Care System.
Veterans can expect social workers to provide education and information regarding both VA and community resources, and VA and public benefits that can assist with financial, social, housing, transportation, legal, and disability rights issues. There is also resource counseling for reintegration into employment and community. Social Workers provide education about how to recruit, interview, hire and manage in-home supportive care provided by personal care attendants or other social supports. Inpatient social workers also provide individual, family, and group counseling services for many social and psychological issues. An example of this may be to help a Veteran to better understand how their spinal cord injury/disorder has changed their social role in their family and community. The social worker supports the Veteran as he/she develops new personal goals and may encourage seeking support from experienced Veterans living with spinal cord injury. Social workers may also talk with Veterans and family caregivers about grief and adjustment to new functional limitations. There is also help offered as the Veteran deals with altered self-image and other personal issues that arise during the inpatient stay. Lastly, inpatient social workers are available to discuss common financial and social stressors related to spinal cord injury/disorder.
Veterans and their families may request a chaplain visit if they would like support through prayer or conversation in order to find hope, discover guidance, to grieve, get help when feeling alone, broken, sad, angry, confused, afraid or doubting, or when they just need to talk with someone who cares, and even to share in the victories.
Our chaplains represent many faith groups, and minister to patients of all religious traditions. Chaplains have Board Certified clinical skills, and have been approved by their faith communities to serve in this multi-faith and multi-cultural hospital environment.
The goal of Chaplain Services is to provide a safe and confidential atmosphere in which Veterans and their families can find support in maintaining optimal spiritual well-being. As part of the SCI Interdisciplinary Care Team, chaplains seek to meet spiritual needs through an initial pastoral visit. However, if a Chaplain is needed before then, please ask any of the health care practitioners to contact Chaplain Services for you. Chaplains will make every effort to respond to a request expediently. Chaplains are available 24/7. It is with the patient’s invitation that Chaplains are honored and a privilege to journey with the Veteran during this challenging time.