Program Admission Criteria

General Admission Criteria

• Infants and children with chronic respiratory insufficiency, including ventilator weaning
• Failure to thrive, feeding disorders and short bowel syndrome
• Central nervous pathology
• Orthopedic conditions
• Impairments from congenital/genetic anomalies
• General de-conditioning due to chronic illness

Medical Stability

• HR/RR/BP stable, either by normative for age or deemed stable by identifiable cause and without severe acute fluctuations.
• Afebrile for at least 24 hours prior to admission or, if febrile, the patient is either under active treatment for known etiology of fever or has been diagnosed with central nervous system fevers with negative infectious workup..
• All patients will have documented CBC within 48 hours of admission, and WBC values of 15-20 K  need documented explanation and WBC values of >20K have had to have infectious workup.
• All patients will have documented Basic Metabolic Panel within 48 hours of admission.
• For ventilated patients, acceptable blood gas (ABG or CBG) on current ventilator settings.
• No endotracheal tubes are accepted. For tracheostomy patients, first tracheostomy tube change must occur at the referring hospital.
• For patients with oxygen requirements, patient’s oximetry must be stable per patient’s baseline on current level of support to allow for intermittent activity such as weighing , bathing, handling or transferring patient without sustained decrease in oxygen saturations of <90% unless cardiac condition warrants change in saturation criteria.
• Patients must not require respiratory treatments (CPT/aerosols) more frequently than q 3 hours and must not have an FiO2 requirement of >40% to maintain above saturations.
• Recently placed gastrostomy tubes must have been used successfully for formula feeding for at least 24 hours prior to admission.
• Patients with seizure disorder must have documented therapeutic levels of anticonvulsants and be seizure-free within 48 hours prior to admission. Exceptions may be established for patients with chronic seizure disorders who have had long-standing tendency toward breakthrough seizures that can be managed within the abilities of the SPIRIT program .
• Patients with diabetes must be under reasonable control (no DKA) and manageable without insulin drip.
• Patient condition should allow for safe, appropriate care with a staffing  ratio no less than patient:nurse ratio of 2:1.
• Patients with infectious diseases may be admitted at the discretion of the admitting attending physician in consultation with nursing leadership and infectious disease specialist as needed.
• The referring source shall clearly delineate eventual patient discharge destination, and any DFCS or guardianship arrangements. 

Acute Comprehensive Rehabilitation Program

• Children who are appropriate for this program include, but are not limited to, children with central nervous system pathology, orthopedic conditions, and/or general deconditioning due to prolonged severe illness that result in functional deficits.
• Children in this program are in need of intensive inpatient rehabilitation therapy, medical care management and rehabilitative nursing.
• Children in this program must be able to benefit from three or more hours of therapy per day and have identifiable and achievable therapy goals involving at least two or more therapy disciplines. Steady progress toward goals is expected.
• Children admitted to this program should be recovered from medical conditions and surgical procedures adequately enough to be cleared for participation in therapies and tolerate ordered therapies.
• Children admitted to this program benefit from patient/family education, home/school reintegration and discharge planning.
• The attending physician for these patients is a physiatrist or specialist in physical medicine and rehabilitation.

Pulmonary Management Program

• Children who are appropriate for this program include, but are not limited to, children whose primary reason for admission is related to goals surrounding subacute respiratory management including mechanical ventilation, ventilator weaning, CPAP/BiPAP, complex pulmonary management of complicated airway problems such as tracheal stenosis/tracheomalacia. These children frequently require concurrent medical management of associated problems.
• Children admitted to this program will receive appropriate rehabilitation therapies depending on individual needs but do not meet the requirements of the Acute Comprehensive Rehabilitation program.
• Children admitted to this program benefit from family/caregiver training and education, home/community integration, and discharge planning.
• The attending physician for these patients is a pulmonologist.

Complex Medical Program

• Children who are appropriate for this program include, but are not limited to, children with feeding disorders/dysphagia, failure-to-thrive, short bowel syndrome, congenital abnormalities, and complex medical problems requiring medical management with concurrent rehabilitation therapies as appropriate and family education/discharge planning.
• Children admitted to this program have goals related to feeding/nutritional management, simplification and coordination of medical care plan, and caregiver training for discharge.
• The attending physician is most commonly a pediatrician/developmental pediatrician but may be any of the pediatric specialists.