← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Dr. Erika Trovato on Advancing Brain Injury Care and Access at Burke Rehabilitation Hospital
00:22:08
Loading summary
Transcript15 lines
- [00:00]
A
Hello, I'm Elizabeth Gregerson. Welcome back to the Becker's Healthcare Podcast. Today I'm joined by Dr. Erica Travato, Associate Chief Medical Officer at Burke Rehabilitation Hospital in White Plains, New York, where she also serves as director of the Brain injury medicine program. Dr. Trabato, thank you for being here. It's a pleasure to have you on the podcast.
- [00:23]
B
Thank you so much, Elizabeth, for having me. I'm really quite excited to be here and to talk more about brain injury.
- [00:31]
A
Amazing. So I guess to start things off, could we just learn a little bit more about you and your organization? Maybe you could share a bit about your background, your role and kind of just tell our audience what makes Burke Rehabilitation Hospital so unique.
- [00:47]
B
Absolutely. So, as you pointed out, I am associate Chief Medical Officer of Burke Rehabilitation Hospital. Burke is a nationally recognized and accredited not for profit healthcare provider, really specializing in rehabilitation treatment research and also graduate medical education. We really provide a full continuum of inpatient and outpatient services which allows us to care for patients throughout every single stage of their recovery journey. I started here at Burke about eight years ago, and in that amount of time we have really grown at as a national and international presence in regards to acute inpatient rehabilitation, specifically in the realm of brain injury medicine and neuro rehabilitation. Like I said, I had come here about eight years ago. @ that time I signed on as a physiatrist. So I did my residency in physical medicine and rehabilitation and then I also completed a one year fellowship in brain injury medicine. So when I joined here at Burke, I came on as an attending physician. And in that time I've also been able to have the opportunity to expand our graduate medical education department by adding on a brain injury fellowship program here at Burke. Additionally, I was about two years ago started as Associate Chief Medical Officer to really serve with more understanding from an administrative side of health care and how we can incorporate excellence into our clinical commitment to our patients. Perfect.
- [02:33]
A
Well, nearly 3 million Americans sustain a traumatic brain injury each year. And an estimated 5.3 million Americans live with a long term disability resulting from a tbi. So in your view, where does brain health stand in the public consciousness today? Is, is it getting the attention it deserves or do you feel like it tends to be overlooked?
- [03:01]
B
I think that's a great, great question. And I do believe that overall we have seen greater acknowledgement, research efforts and education efforts when it comes to brain injury. We know that the incidence and the prevalence of brain injury only continues to increase. A lot of this has to do with the fact that our population is aging. And with that, we have a greater number of patients in their elderly years who are sustaining falls. And falls are the number one cause for a traumatic brain injury. We also see high incidence of traumatic brain injury in our younger population, and especially in males of that higher risk taking behavior cohort more in their later teens and early twenties. We also see a lot more acknowledgement and resources being put forth when it comes to concussion, which is a type of mild traumatic brain injury. We know that from everywhere, from the NFL to our high school sports teams, even to conversations around the dinner table, our family members, our community members, and even our legislatures are more aware of what a traumatic brain injury is, the need for diagnosis, as well as the awareness in regards to treatment protocols, and that gradual return to work and play when it comes especially to a concussion. So it really comes down to one is knowing that these types of injuries can occur, what you can do to try to prevent them as much as possible. But when an injury does occur, where do you go? What do you do? And I think that there's more of a directive in regards to community resources transcending to healthcare resources. And so if a patient, depending upon what type of a brain injury they are diagnosed with, then requires hospitalization, or if they require outpatient follow up in a concussion clinic, that will kind of set the trajectory in regards to what types of management they will require in the acute inpatient rehab world. With what we're seeing at Burke, our patients are increasingly medically complicated, A lot of that having to do with other medical conditions that they have while sustaining a traumatic brain injury. But we also know that our imaging resources are, are getting better. And in regards to rehab, we have increasing awareness from, and I think resource utilization when it comes to different research and innovation and technology that's really looking at being applied to this realm and sphere of brain injury medicine. We continue to also see the acknowledgement of our caregivers and our family members who oftentimes have to step up for their loved one when such an injury does occur, and the burden that we want to be able to best prepare our patients for as they will transcend from a hospital setting into the community, and really working with them to expand upon their ability to have a meaningful quality of life and reintegrate into the community and ensuring that we are really patient focused and focused on what matters to that particular patient. Additionally, I think that there's been fantastic efforts, you know, to name one would be the brain injury Association. They have a state chapter in New York state. So the brain injury association of New York State that I work with. They advocate heavily on the legislative side of resourcing and funding for our community members once they are discharged from the hospital. And so having that advocacy, having that awareness and bringing that to our legislature is also a vital component of brain health awareness, which I think is really something that we continue to work on. And it's not perfect, but there's a lot of efforts that are going forward with that. Amazing.
- [07:26]
A
Yeah. And I think our audience will appreciate that. Those efforts, you know, they're never perfect, but they're always moving in the right direction. And I really appreciate the insight you brought here where, you know, these traumatic brain injuries and these conditions don't just happen. And right to one set of the population, it can happen at any time in a patient's life. Their treatment, their recovery, it's all going to look different. I'd be interested to hear kind of about your day to day. You lead a multidisciplinary team focused on some of the most complex neurological cases ranging from that traumatic brain injury like we were talking about, or to stroke. So could you kind of walk us through what a day looks like for you and for your team at Burke and maybe share some of the more challenging or more rewarding parts?
- [08:15]
B
Absolutely. So at Burke, we have a 30 bed locked unit. And it is a unit that is really tailored toward personalizing our care for our patients who have sustained a brain injury. We also have another unit at the hospital that we call our stroke unit. So it's more for a different type of a stroke or a different type of a brain injury. But on our unit in particular, we are very attuned to being sensitive for changes in patients behaviors and in emotional, what we call dysregulation, and really trying to maintain safety for our patients at all times. I lead a group of, as you had described, interdisciplinary disciplines. So what I mean by that is it's myself as a physician. We have our graduate education department as well. So I have residents that rotate. We also have fellows. And then we work very closely with our rehabilitation nursing. We work with case management and social work. We work with neuropsychologists who are such assets to our team, as well as our therapists. So we have physical therapists, occupational therapists, and speech language pathologists. What we do so well is that we look at every facet, every component of a patient's current status, what they were prior to having sustained an injury, and then what we want that future to look like for them. What do we want to emulate what are our goals? And really incorporating and keeping the patient at the focus of every single thing that we do. What matters to one patient may not be the same for another patient. And so we really do hone down on what is important. So a lot of what I do with my team is really making sure that what we're doing on a daily basis is mirroring that of what matters to the patient and then also for the caregiver. I like to say that in the acute care hospital, a lot of our patients are medically stabilized, but there is an absolute recognition that the patient is not at their baseline functional status. They're not able to currently do what it is that they were able to do before this injury. So they come to a place such as Burke, in order for us to enhance those deficits, to get them as close to baseline as possible. This involves daily therapy. Here at Burke, they get at least three hours of therapy, at least five days a week. They will get services such as neuropsychology, therapeutic recreation. They will be seen by a physician at least five days a week, as well as medical staff. They get 24 hour a day rehabilitation nursing who have undergone specialized training to be able to, you know, take care of these rehabilitation patients. And in our cohort of the hospital, we also have staff that are gone through specialized training to ensure that they're able to anticipate and protect and safeguard our patients in regards to challenges in the way in which they're handling some of their emotions, or perhaps they have something called post traumatic amnesia and they're easily become dysregulated from a behavioral standpoint. Our team meets daily to discuss how each one of our patients is doing and again, keeping that idea of what are the goals for the patient and making sure that we're progressing towards those. And if we're having any barriers or if we're having any complications, the team works together to really make sure that we are doing the best by the patient. Another key component to what we do on a daily basis is making sure that the patient's caregiver is involved as early as possible in regards to education, understanding what the patient currently is able to do and what they're not able to do. But again, what are the goals? What do we anticipate that the patient's going to be able to do by the time they leave here at birc. So it's a lot of knowing and trying to understand where the patient was before an injury occurred, understanding where they're at and meeting them where they're at right. Not having these unrealistic expectations for patients either. And that's part of what we do on that daily basis while they're here in rehab, and then making sure that when they leave and they transition, hopefully to home environments, we make sure that we're set up for success, making sure that they have appointments with their physicians set up, making sure that they're going to get continued rehabilitation services after they leave the hospital. We know that this patient population, a lot of them have cognitive deficits. And in that regard, we want to make sure that they don't slip through the cracks of our health care system. And so putting in layers of support, our case management and social work team is fantastic at utilizing community resources and making sure that patients have that support when they leave here and they don't feel as though they're discharged from the hospital and that's it. We want them to stay in contact with us. We want to be able to troubleshoot issues or any concerns that come up along the way. Burke has done a really fantastic job with expanding our faculty group practice and making sure that we have available services from our physicians in an outpatient clinic setting to also meet the needs of our patient population. And again, that is to maintain touch points with all of our patients as much as possible. Fact.
- [14:18]
A
And I think that kind of maintaining the touch points, you know, not letting patients slip through the crack is definitely a trend we've been seeing in the healthcare industry at large, you know, kind of helping the patient navigate through the. Through the system. I'd love to zoom out a bit and see if there are any other trends or developments specifically in brain health that you think our listeners, especially our healthcare industry listeners, who might be outside of the post acute care space, those types of trends that you think they might want to be paying attention to.
- [14:54]
B
Absolutely. So I do think, as I had mentioned a bit earlier, is that there is a lot of research going into technology and innovation and how we can diagnose brain injury earlier. How does that translate to treatment and management? And then how does this really transcend into ways in which patients who have sustained a brain injury are able to continue their therapeutic modalities and compensatory strategies at home? And, you know, a lot of this can be challenging or a lot of this can also be, in a sense, what motivates due to lack of equitable access for patients across the country? You know, even within New York State, the resources that are available in the southern part of the state looks different than what's available in the western part of New York state. And so that access to medicine and the variation in that standpoint really makes it so that we want to make our modalities and our interventions universally available to patients who have sustained a brain injury. Something that I think a lot of people have likely heard about and have likely seen segments on are looking at available biomarkers in patients blood that would signify if a patient has sustained a brain injury or not. And so that initial means by which you can diagnose a brain injury, something such as a concussion. Right. So right now, if someone who is suspected to have sustained a concussion while playing sport would have to have access to a hospital setting where they could go and they could have a CAT scan and then have it read, and then to have someone who's qualified to be able to evaluate their symptoms. There's a lot of research and innovation looking at being able to do testing right at the sideline and to basically take a blood sample and to test to see if there's elevated biomarkers that would indicate if someone has sustained a concussion or any other type of brain injury. So that's one area where I think we will continue to see a lot of resources and research going into looking at diagnosis. There's also been a lot of research and I think innovation from private tech and industry looking at different modalities of stimulating areas of the brain that were thought to be, quote, unquote, shut off from an injury. Some of these are not necessarily new in regards to their applicability, but looking at different ways to stimulate the brain, Whether through a magnetic current or electrical stimulation, different modalities by which we can try to wake up parts of the brain to make it so that patients have greater potential at recovery after sustaining a brain injury. And then I also think that there's a wave of looking at how brain injuries are viewed and educated about and enhanced in regards to when something does happen and reintegrating, like I said, back into play or back into work and trying to really streamline those efforts and make it so that, you know, the greatest frustration a lot of our patients have is that they've had this, quote, unquote, invisible injury, right? So something that's happened that the rest of the population may or may not be able to see and appreciate. And so their frustration comes from being able to reintegrate back into their community or their job or even their social circle. And so I think more and more efforts, too, are going to into education and kind of normalizing the fact that these types of injuries do occur and how can we best support them as they continue their road to recovery?
- [18:59]
A
Thank you for sharing that. I think so many of the trends and developments you touched on, they really are seen across the industry with biomarkers and an access to care. So I appreciate you kind of bringing those to the forefront to, to see how they're affecting the post acute care aspect of the industry as well. Before we wrap up, were there any final thoughts or maybe messages you'd like to share with our audience of hospital and health system leaders?
- [19:30]
B
Well, I think I really appreciate all of these questions and I think really one of the biggest things that I want to make sure that we're making ourselves aware of is just that education continues to be key and supporting our patients along the continuum of care and making sure that they're really accessing services such as acute inpatient rehab in order to ensure that they receive every ounce of potential that they possibly can towards their road to recovery. We know the notion of neuroplasticity. We know that timing matters. We know that the amount of, you know, exercise for the brain is vital towards their recovery. And we really want to make sure that we're giving our patients and fighting for patients to have access to these services along their continuum of care. Being here at Burke has really allowed for, you know, a greater light on where those barriers to access can occur. And it's right in our backyard. And so making sure that we are continuing to advocate on behalf of our patients and making sure that we are supporting our caregivers. You know, my, myself as a healthcare provider, I sometimes have difficulties with accessing my healthcare providers and the systems. And I want to make sure that we always remain that, you know, brain injuries can be an invisible injury. And so while on the surface patients may seem to be coping and doing well, really accessing into how they've integrated back into the community. Are we meeting what matters most to our patients and are we supporting each other through their continued recovery and helping them live with this chronic disease and making sure that it's part of our daily check ins with patients and their loved ones.
- [21:31]
A
Thank you for sharing that call out and those reminders. I know our audience will appreciate it.
- [21:37]
B
Absolutely. Elizabeth, thank you again for this opportunity. It's really been great to be able to shed some more light on brain injury awareness and what we can do on behalf of our patients and caregivers moving forward.
- [21:49]
A
Thank you, Dr. Travato, for joining us and for your time and your insights today. And thank you to our audience for tuning in. You can find more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.