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VOL. 128 | NO. 173 | Thursday, September 5, 2013

Breathing Easy

Adams to lead new Ashton Place pulmonary unit

By Michael Waddell

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Ashton Place Rehabilitation & Health Center earlier in August opened its newly designated 14-bed private-room unit dedicated to decannulating patients with a tracheostomy due to an injury, chronic disease or other respiratory problems.

The Ashton Place Rehabilitation & Health Center recently opened its new 14-bed private-room unit for its new pulmonary program, which is being spearheaded by pulmonologist Dr. James “Bo” Adams.

(Daily News/Andrew Breig)

The new pulmonary program is spearheaded by Dr. James “Bo” Adams, a board-certified pulmonologist for the past 30 years. Adams’ previous experience includes setting up a long-term acute care hospitals (LTAC) unit at Baptist Memorial Hospital called Restorative Care, the first of its type in the city, in 1994.

“Patients need a more stable environment, a place where they can go with nursing-home level of care, with someone to manage their ventilator and hopefully wean them off of it and get them back home,” said Adams, who recently joined Ashton Place to head up the new pulmonary program.

More than 100,000 tracheostomies are performed annually in the U.S., and they are one of the most frequent procedures done in intensive care units, according to Healthcare Cost and Utilization Project 2007.

“At some point the patient will not need 24-hour care anymore and should not be tying up an ICU unit that could be available for a sicker patient,” Adams said.

Most trach patients come to Ashton Place from LTACs and face a high risk for airway obstruction, impaired ventilation, infection and other lethal complications.

Along with his team of respiratory therapists, nurses, aides, and professional restorative therapists, Adams works to reduce those risks.

“I think the most important thing is there will be a dedicated respiratory therapist and nurses who are committed to trying to get them up and out of bed, doing physical therapy and actually trying to wean them from the ventilator. It will not be a place where they just go and lay in bed,” Adams said.

Whenever possible, the focus of the pulmonary program is to wean the patient from the tracheostomy and successfully discharge them to home, but complicating the process, especially in the Mid-South, are the smoking and obesity epidemics.

“Memphis is one of the centers of smoking and obesity,” Adams said. “Smoking obviously causes lung damage, emphysema, strokes, heart disease, heart attacks – many things that can cause you to have breathing difficulties and could end up with you getting a tracheal tube at the hospital. And we are living in the obesity capital of the world. It can cause breathing troubles, sleep apnea/difficulty breathing at night, and heart trouble, so those patients have trouble weaning just from their weight.”

The obesity problem has also often led to more cost for centers such as Ashton Place. Some have needed to purchase larger bariatric beds, and more staff is often needed to lift the heavier patients.

The idea for the new pulmonary unit came about after Ashton Place’s Cleveland, Tenn.-based parent company, Health Services Management Group LLC, conducted a market study that identified an urgent need for a long-term care option for pulmonary patients that had tracheostomies.

“Sometimes the weaning process can be inhibited by multiple medical issues, many of which will not be resolved before the end of a hospital stay,” said Vinton Fleming, senior clinical liaison with Health Services Management Group. “In our setting, we will be able to address those lingering issues and still aggressively address decannulation.”

The company has future plans of providing more acute pulmonary services, including ventilator management. To meet the needs of this complex population, the facility will be retrofitted for the capacity to provide piped-in oxygen and suctioning.

The center is currently taking bids for the project.

Ashton Place Rehabilitation & Health Center is a licensed 211-bed Medicare/Medicaid-licensed skilled nursing and rehabilitation center located on Walnut Grove in Midtown Memphis near the University of Memphis.

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