To effectively treat high-risk, ventilator-dependent patients in place — reducing hospital readmission rates while successfully weaning patients from ventilator support.
Case Summary & Outcomes
Placing a patient with respiratory needs is one of the more challenging decisions on a hospital discharge planner's desk. For a 61-year-old female patient with chronic respiratory failure and a history of tracheostomy, finding post-acute care was further complicated by a COVID-positive diagnosis and ventilator dependency. Prior skilled nursing stays at other regional providers had repeatedly resulted in multiple hospital readmissions due to clinical complications.
The patient was admitted to Ohman Family Living at Briar's specialized Breathe Easy program. The clinical plan was built on two core objectives: treating high-acuity needs in place without transferring back to the hospital, and initiating active ventilator weaning protocols.
Clinical Complication: Bedside Sepsis Treatment
On the ninth day of her stay, the patient experienced a severe clinical change. She became acutely tachycardic, hypotensive, and febrile. In a typical skilled nursing facility, this clinical shift triggers an immediate emergency call and a readmission transfer back to the hospital.
At Briar, the response was managed entirely on-site. Using continuous monitoring via **Masimo remote sensors**, the team identified vital changes early. The clinical nurse supervisor and respiratory therapist immediately conducted a comprehensive bedside assessment: EKG, stat x-ray, and blood work. Sepsis was identified, and the clinical team immediately initiated IV protocols in place.
| Vital Sign / Lab Metric | Baseline on Admission | Day 9 Sepsis Presentation |
|---|---|---|
| Blood Pressure | 125/68 mmHg | 78/44 mmHg (Hypotensive) |
| Temperature | 98.1°F | 101.2°F (Febrile) |
| Heart Rate | 67 bpm | 140–160 bpm (Tachycardic) |
| SpO₂ (Oxygen Saturation) | 95% | 98% (Supported) |
| Blood Sugar | — | 700 mg/dL |
| BUN (Blood Urea Nitrogen) | 15 mg/dL | 63 mg/dL (Acutely Elevated) |
| WBC (White Blood Cells) | 9.3 K/uL | 13.4 K/uL (Leukocytosis) |
Multidisciplinary Care and Weaning
By treating the sepsis in-place with Levaquin, Vancomycin, and IV hydration, the patient stabilized. The respiratory therapist performed critical bedside trach changes to address mucous plugging, and commenced speaking valve PO trials. Once stabilized, our speech therapy team initiated advanced swallowing and communication protocols.
On Day 28, the physician-led team initiated active ventilator weaning protocols. The team adjusted ventilator levels based on blood gas evaluations and Masimo remote metrics, helping the patient transition away from mechanical support.
Restoring Voice & Swallow
The patient progressed from completely voiceless — communicating only through head nods and gestures — to speaking in full sentences and sustaining vowels for 6–7 seconds. Over the course of rehabilitation:
- Swallowing safety and efficacy improved from 10% on admission to 65%, allowing for PO trials.
- Communication ability improved to 60–70% effectiveness.
- The patient was fully weaned from the ventilator and is now breathing independently on **4 LPM of oxygen** with a Passy-Muir Valve (PMV).
- Her physical and emotional recovery culminated in her singing for the nursing and therapy staff.
Conclusion
By assembling a specialized clinical team — hospitalists, pulmonologists, on-site respiratory therapists, acute-trained nurses, and speech-language pathologists — and equipping them with advanced technology (VOCSN Ventilators, Masimo SafetyNet, Telehealth), Briar demonstrates that ventilator weaning and acute in-place sepsis management are highly achievable in a skilled nursing setting. Sepsis early-detection protocols prove that high-acuity respiratory patients can be treated without returning to a hospital bed.