Post-acute Care Respiratory Rehabilitation

Toronto Grace Health Centre has launched a novel rehabilitation program for post-acute care respiratory rehabilitation. The post-acute care respiratory rehabilitation program at TGHC is designed to accommodate patients with complex respiratory needs who require inpatient rehabilitation. The target demographic is patients needing frequent recurrent readmission due to respiratory illness. Patients will receive inpatient general rehabilitation managed under the care of a respirologist. All patients will be transitioned to an outpatient virtual pulmonary rehabilitation if indicated. The program is structured primarily to address patients with COPD who have been admitted to hospital with COPD exacerbation. Other indications include asthma, interstitial lung disease, post-covid lung disease, bronchiectasis, and pulmonary hypertension. Patient with complex medical needs and co-morbidity can be accommodated.

Patients being referred must meet the below criteria:

Inclusion Criteria

1. Patients with a primary or secondary diagnosis of COPD exacerbation will be prioritized
2. Patients with a history of recurrent exacerbations will be prioritized
3. Patients should have 24-48 hours of clinical stability at the time of referral
4. Patient should have stable or decreasing oxygen requirements over the last 24-48 hours
5. Patients should be at low risk for requiring critical care services based on referring MD’s judgement
6. Patients should be agreeable to inpatient rehabilitation with transition to outpatient services (with access to internet for virtual rehabilitation)
7. Smoking cessation is not mandatory

Exclusion Criteria

1. Severe dementia limiting ability to participate in rehabilitation
2. Inability to do exercise due to orthopedic limitations
3. Unstable cardiac disease including unstable angina, unstable PE, unstable arrhythmias, or recent acute coronary syndrome
4. Lack of reliable access to internet (for outpatient rehabilitation)
5. Resting FiO2 > 0.5
6. Patient requires urgent imaging or bloodwork more frequent than once daily
7. Behavioural or social concerns which limit the ability to participate in rehabilitation

Referrals are currently being accepted through the Resource Matching and Referrals (RM&R) application.