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Long Term Respiratory Care
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Adult Chronic Respiratory Care Department
Background
In 1998, the Herzog Hospital undertook to establish a long term respiratory care unit. This was based on our experience and success in treating older patients with chronic problems, including respiratory and supporting them for extended periods of time.
Chronic respiratory care presents a unique set of problems. In addition to the medical and physiological issues that are inherent in such a patient, there are major psychological and sociological issues.
The patients represent a cross section of etiologies, ranging from acute events (such as anoxic brain damage) to slowly progressive diseases (such as ALS). Each has its own unique characteristics and issues.
The first unit opened with just four beds. Within a short time the number of patients grew progressively. Now ten years later the original unit has grown to become the largest in the country with over 80 adults and now 24 children in its own dedicated unit.
The special circumstances of these patients require that the staff in the unit work not only to care for each patient as an individual, but also to provide support to their families. These include doctors, nurses, social workers, para professionals, and psychological trauma therapists. As such, this health care team derives great satisfaction from their work, despite the great difficulty, developing close relationships with the patients and their families.
The Need for Expansion
Since its establishment, the demand for the facility has exceeded its capacity by far.
It first expanded to a capacity of 12-14 beds and then, due to constant pressure and demand for more beds, it continued to grow and expand into adjacent departments. In the last year alone there have regularly been 10-15 patients on the waiting list to be hospitalized. The need is growing rapidly as a result of medical technology’s rapid advance, enabling doctors to treat victims of accidents and disease where previously there was no help. This is especially true in the case of ALS. At any given time there are a number of patients awaiting a bed and yet, because of lack of room and services, they cannot be admitted and have to remain in the general hospitals. Chronic Care Respiratory services still need to be expanded. Additional Respiratory beds will be an integral part of the new Samson Medical Pavilion now being constructed.
New Department construction
The need to expand the capacity of the hospital to cope with the additional demand, as detailed above, is clear and therefore urgent. A new, larger and custom designed department will be housed in the new Samson Pavilion under construction at the hospital and will occupy a dedicated facility. It will offer much needed space and facilities for the growing number of patients that require the specialized care of the Herzog Hospital staff.
The proposed unit is being designed as a centralized area dedicated to the treatment of ALS patients who are dependent on respirators and other technology. The unit will comprise sub units of 12 beds each, with an option to expand further as the need arises. Each sub unit will be built around a central core, which will house the nurses’ station, treatment facilities and preparation area. Around this central core the beds will be arranged in such a way as to permit direct observation of each bed from the nursing station. The beds will be separated by a transparent partition which will reduce cross infection by airborne infectious agents on the one hand, but will not obstruct the direct view of each bed from other locations, on the other.
As the primary purpose of the new units will be the care of ALS patients, the units will be provided with facilities for families to visit and spend time with the patients. Also, as many of these patients are conscious, they will have facilities to enable them to communicate, watch TV, use computers etc’, each according to his/her capabilities. There will be complete flexibility to enable variations according to the actual need at any given time.
The full department of two such subunits will also have additional departmental facilities. These will include the following:
1. Physiotherapy and occupational therapy – a room for the physiotherapy and occupational therapy equipment will be attached to the department. This will enable the patients, where suitable, to receive such therapy close by to their unit without having to transport them to another location. Where necessary, therapy can, of course, also be administered by the bedside.
2. “Snoezlen” Room – this is a special facility, a multi-sensory stimulating environment, used to stimulate the senses of the patient. The idea behind this is that even in a state of reduced consciousness the sensory faculties of the individual are still usually functioning. By stimulating them there is a greater chance of reviving dormant functions in the brain and keeping it active. We have observed marked changes in patients, otherwise unconscious, when treated by multi-sensory stimulation.
3. General offices such as rooms for the doctors, staff meetings, the head nurse, social workers etc.
4. A small dining room for those who are able to eat sitting up and to socialize at the same time.
5. Family and day room – will act as a meeting place for families as well as to enable those patients, who can do so, to visit with them in a quiet environment as well as watch television etc.
The Patients
The nature of this department will be quite unique and no department of its type exists in the whole of the country. It is actually quite rare in the world altogether. This facility, when built, will probably be the most advanced facility of its type anywhere!
As mentioned above, the patients admitted into this department will usually fall into one of three basic categories:
1. Motor Neuron Diseases (predominantly ALS)
2. High spinal injuries such as neck injuries
3. Anoxic Brain damage.
Other patients, such as those with COPD may also be admitted on a space available basis but they will usually be admitted to one of the existing units.
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Another Site Built by [ Telerom C.S. ] ,Israel -
2001