Not many physiatrists outside Pennsylvania know that MossRehab shares its 60-acre suburban campus with a full-service acute-care hospital. Yet the relationship between these two entities, both part of Albert Einstein Healthcare Network (AEHN), makes MossRehab one of the most unique rehab hospitals in the country and provides the basis for its continued level of national excellence.

For nearly 100 years, MossRehab’s flagship facility had been located on the campus of Albert Einstein Medical Center, a large acute-care academic hospital in North Philadelphia. By 2004, it had become obvious that MossRehab’s patient base was quickly outgrowing the space. When a small community hospital only four miles away was offered for sale later that year, MossRehab purchased the building and transferred 130 of its beds to the new location.

The newly purchased facility was a for-profit acute-care hospital with 160 acute-care beds, an Emergency Department, operating suites and full-service ancillary departments, including an onsite laboratory and radiology services. Under the direction of AEHN, the building was transformed to a 130-bed rehabilitation facility with an imbedded acute-care hospital. The arrangement between MossRehab, which occupies the majority of the building, and the imbedded hospital, now called Einstein at Elkins Park, is highly unique. Whereas almost every rehabilitation facility in the country is either imbedded within a larger acute-care hospital or operates as a freestanding facility, MossRehab is a large, complex rehabilitation provider that encompasses a full-service acute-care hospital.

MossRehab holds the majority of licensed beds in the building—currently 130 of 196 total—which allows for a high degree of specialization and the dedicated space and resources consistent with a freestanding rehab facility. For example, 32 beds are reserved for stroke patients alone, as are a team of specialized physicians, therapists and speech pathologists who work exclusively with stroke survivors. Other diagnoses, such as traumatic brain injury, amputation, or spinal cord injury, are all serviced by dedicated care teams. “Such specialization would not be possible if MossRehab were a small rehab unit located within a larger hospital,” said Alberto Esquenazi, MD, MossRehab’s Chief Medical Officer. “We offer our patients the best of both worlds: the supporting services of an acute-care hospital combined with the specialization and expertise of a large, freestanding tertiary rehabilitation provider,” he said.

Acute-Care Support Available Onsite

Patients who develop complications at freestanding rehab facilities are often transferred via ambulance to an acute-care hospital for treatment. In contrast, patients who develop a complication at MossRehab remain on the premises and are simply transferred to an acute-care unit within the same building. Physiatrists remain active in their patient’s treatment.  Some patients with medical issues are able to remain in a MossRehab bed because of the close proximity of ancillary and other services. “Our patients and their families avoid the anxiety of an ambulance trip and remain in the environment to which they’ve grown accustomed, which has improved our patient satisfaction scores,” Dr. Esquenazi said. “The transition to acute care happens with the push of an elevator button. On the next floor, the acute-care services provide all the backup for a cardiac, pulmonary or infectious process, or changes in neurological status. And at the same time, the physiatrist maintains close supervision of the rehabilitation staff on the acute care side, helping guide the decision on when to return to the rehabilitation program.”

Infusing the Rehab Philosophy

Dr. Esquenazi added that MossRehab’s majority presence on the campus has helped bridge the cultural gap between acute care and rehabilitation, creating a unique environment in which rehabilitation has become a major focus for the institution as a whole. “In acute care, the expectation is that you’ll be cured, whereas in a rehabilitation hospital, the expectation is that you’ll make the best use of your abilities to function. We’ve been able to infuse that rehabilitation philosophy through the whole building in a meaningful way,” he said. MossRehab discharges 15 percent of its patients into acute care, and Dr. Esquenazi has observed a remarkable level of adoption of rehabilitation techniques and approaches by the acute-care staff.  “If a stroke patient is sent to acute care because he had a neurological change, the acute-care staff will be thinking from a neurological and rehabilitation perspective,” he said. “They will be aware the patient has had a stroke before, and will look at all the issues that are important in the rehabilitation process.”

The acute-care facilities have been redesigned with the needs of rehabilitation patients in mind. Office counters are low enough for patients in wheelchairs to interact with staff face-to-face. Waiting rooms and bathrooms are spacious and wheelchair accessible, and the exam tables in every physician’s office can be mechanically raised and lowered to accommodate disabled patients. Valet parking is complimentary, and the major ambulatory services—PM&R, neurology, orthopedics and outpatient therapy—are all located on the ground floor for easy access.

Surgery Suites and ED Benefit Patients

For rehab patients undergoing surgery or other invasive procedures, several onsite operating suites provide the necessary equipment and specialized staff to ensure successful outcomes. Michael Saulino, MD, director of the intrathecal medication program at MossRehab, has run successful trials of intrathecal drugs despite the added difficulty of implanting catheters into his patients’ spines, which are often deformed due to scoliosis or traumatic injury. “We have not only the imaging techniques to guide the catheter placement, but we also have a whole staff that serves as a backup to any complication that can arise,” he said.

Finally, the presence of an onsite 24-hour Emergency Department provides an extra level of safety for MossRehab’s patients. Rehab patients who develop a critical condition, caused by a heart attack or sudden respiratory distress, are quickly and expertly intubated. A patient with dysphagia who starts to choke will be treated by a physician specialized in emergency medicine. “In a very stressful situation, an ER physician—not a resident or generalist—arrives in less than a minute and begins a life-saving procedure. Having an Emergency Department onsite has given us a higher level of access to expert acute emergent care,” Dr. Esquenazi said.

Having an acute-care hospital imbedded within MossRehab provides benefits for its patients every day. The following case studies demonstrate this valuable relationship in action.

Harry Schwartz, MD, Physiatrist, MossRehab
“A patient of mine was admitted to MossRehab as a transfer from an outside hospital. The diagnosis was incomplete paraplegia due to a thoracic spinal cord mass. She had an operation at the referring hospital. During her rehabilitation stay, she accidentally choked on a piece of food during her breakfast. She lost consciousness and was given the Heimlich maneuver by a nurse and successfully managed by the hospital’s code blue team. Upon resuscitation she had a very fast heart rate; this was due to the temporary low oxygen content of her blood during the choking episode. She was transferred to the Einstein at Elkins Park Emergency Department and then admitted to the telemetry unit for observation and cardiac evaluation. After being deemed stable by the cardiology team in the PCU, she was readmitted to the MossRehab Spinal Cord Program three days following this episode. The presence of emergency and critical care services in the same building as the rehabilitation units was crucial in this patient’s survival and recovery.”

Jeanne Pelensky, MD, Physiatrist, MossRehab
“I recently had a patient with traumatic brain injury who went to the Einstein at Elkins Park Emergency Department (ED) because of decreased responsiveness and possible cardiac issues. He had multiple medical co-morbidities that needed to be considered in the evaluation and our ability to directly discuss the case with the ED staff was of great utility to that department.  Evaluation was accomplished in the ED, including MRI scanning and a cardiology consult. As a result, the patient could be safely returned to the rehabilitation unit a few hours later. In the absence of this unique onsite capability for rapid medical evaluation and treatment, the patient would have had to be transferred via ambulance to another ED, and likely admitted for further work-up as the hospital’s staff would not have had familiarity