Special Care Unit
December 21, 2015
As a specialty FL Medicaid Health Plan for patients who suffer with severe mental illnesses, we face many obstacles in order to provide the best medical care on a regular basis. Recently, one of our members, admitted to a hospital since May 2015, was facing some serious challenges in care. Unfortunately, the physical health condition deteriorated and ended up on a ventilator at an FiO2 of 45% percent.

Four months later and despite multiple attempts, the hospital staff have remained unsuccessful in weaning the patient off the ventilator. No Skilled Nursing Facility in the area was willing to take the member and those who may have agreed to take the challenge initially, turned down the member at the last minute due to a past medical history of severe mental illness.

As a last resource, I approached the team at Special Care Unit. No LTAC provider in the area wanted to accept the member, but I still proceeded with the call. Ms. Carolyn Ambush immediately took my call, went to the hospital to review the case and transferred the member to the Special Care Unit facility within 48 hours. A week later, Ms. Ambush contacted my office to inform that the member had been successfully weaned off the ventilator, decanulated and was being transferred to a Long Term Care Nursing Home Facility under the member’s LTC Medicaid Health Plan.

I have no words to express my gratitude. On behalf of the member and the other 40K plus members suffering of a severe mental illness, I want thank the Special Care Unit team who despite other people’s beliefs, took their time to care for our member and give a second chance. It is so refreshing to know that we still have excellent dedicated professionals within our community who will go the extra-mile, promoting our mission of care, compassion and commitment.


Case Study

On May 15, 2015 a 62 year old male was admitted to a Level 1 Trauma Center in South Florida with diagnoses of:

  1. Acute Respiratory Failure
  2. Decompensated Chronic Obstructive Pulmonary Disease (COPD)
  3. Left Upper Lobe Pneumonia
  4. Left Lower Lobe Atelectasis (complete or partial collapse of lung)
  5. Status Post Craniotomy (bone flap temporarily removed from the skull) due to a fall

The patient was intubated and placed on a ventilator. During his initial hospital course of treatment he underwent tracheostomy due to his long term ventilator requirement and PEG placement for tube feeding. After numerous failed attempts to wean the patient from the ventilator, it was evident that the patient would require long term ventilator management. The patient was insured by a Managed Care Medicaid Provider, however there were no Long Term Acute Care Hospital (LTACH) benefits, and considering his high FIO2 ventilator requirements, discharge options were minimal. There were only 1 Skilled Nursing Facility and 2 Long Term Care Facilities who were even willing to consider, all of which denied admission due to his high oxygen requirements and continued inability to wean from the ventilator.

After 138 Acute Care inpatient days and numerous attempts to wean had failed, and the inability to place the patient in either a SNF or LTACH, the Medical Director of the Health Plan reached out to Special Care Unit. The Physician had referred patients to the unit in the past and could attest to the success of those patients. He stated, "If anyone can get him off the ventilator, you guys can!"

All clinical information for the patient was reviewed by the SCU Clinical Team and it was determined that SCU would accept the patient for a period of 3 weeks in an aggressive attempt to wean the patient. The patient was admitted to the SCU on the evening of September 29, 2015. He was stable upon admission, on the ventilator with the following settings:

  • Mode: SIMV
  • Ventilator Rate: 6
  • FIO2: 50%
  • Tidal Volume: 500
  • PEEP: 5

On October 9th, after 10 days of quality nursing care and aggressive multi-disciplinary rehabilitation including Respiratory Therapy, Physical Therapy, Occupational Therapy and Speech Therapy, the patient had been successfully weaned and Passy Muir Valve placed allowing him to speak. On October 13, 2015 after the patient’s tracheostomy had been capped for 24 hours, he was successfully discharged to the Skilled Nursing Facility where he had previously resided.