Barlow Respiratory Hospital

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Barlow Respiratory Hospital
BarlowRespiratoryHospitalHospital.jpg
Barlow Respiratory Hospital
U.S. - Los Angeles Metropolitan Area location map.svg
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Location in Los Angeles
Geography
Location2000 Stadium Way, Los Angeles, California, United States
Coordinates 34°04′34″N118°14′53″W / 34.076°N 118.248°W / 34.076; -118.248
History
Opened1902
Links
Lists Hospitals in California
Official nameBarlow Sanitorium
DesignatedOctober 9, 1990 [1]
Reference no.504

The Barlow Respiratory Hospital is a hospital located in the Elysian Park neighborhood of Echo Park, near Dodger Stadium in Los Angeles, California. The hospital operates satellite sites in Van Nuys, California and in Whittier, California. It is formerly known as Barlow Sanitorium.

Contents

Originally a tuberculosis sanatorium, Barlow Respiratory Hospital is a long-term acute care facility and a regional weaning center in Los Angeles that specializes in weaning chronically critically ill patients from mechanical ventilation and also treats respiratory diseases and related secondary ailments. The hospital treats approximately 900 patients a year and specializes in ventilator weaning.

Population

The hospital serves an ethnically diverse population that mirrors the diversity of Los Angeles County. Eighty percent of patients are from Los Angeles County while the remaining 20% are admitted from surrounding counties, national and international medical facilities. Patients are primarily older, suffer from medically complex conditions and are admitted after hospitalization in ICU and when a longer hospital stay is needed before discharge to a non-hospital setting or home.

Programs

The hospital has four primary treatment programs. Through these programs, it is able to care for conditions that are often associated with respiratory diseases, thus promoting a holistic model of treatment.

Ventilator Weaning Program

Barlow's TIPS Ventilator Weaning Protocol / Ventilator Weaning: Barlow Respiratory Hospital is recognized for a ventilator weaning success rate of nearly 60%, among the highest rate in the nation. The Barlow TIPS (Therapist-Implemented Weaning Protocol) Ventilator Weaning Protocol was developed by Barlow board-certified pulmonologists based on years of specialized respiratory care practice.

Barlow TIPS protocol has been adopted as a standard of excellence in hospitals nationwide [ citation needed ]. The Barlow team of health care professional helps patients previously unable to be liberated or "weaned" from the ventilator at other hospitals. Patients are guided through a step-by-step method, implemented and monitored by respiratory care practitioners, to recover independent breathing. [2]

Wound care program

Many patients entering the hospital have been bedridden for long periods of time. This often requires specialized care in order to treat the resulting bed wounds. [3]

Care for chronically critically ill

Led by board-certified physicians, the Barlow team provides care for chronically critically ill patients. On-site physicians and consulting specialists guide the care of patients with: cardiac (heart) diagnoses, neurological conditions, infectious diseases, kidney disease, and blood disorders, as well as those with complex respiratory care needs. Through assessment and intervention, Barlow's team strives to resolve acute medical conditions, allowing patients to move from the acute care setting to another level of care, or home. [4]

ReBuild Barlow

Barlow Respiratory Hospital CEO Amit Mohan announced a Master Plan to ReBuild Barlow. [5] The multi-phased plan, which began in 2018, includes a major seismic upgrade and brings a long-planned hospital expansion and modernization project to fruition. Hospital structures built between 1902 and 1983 required seismic reinforcement and additional upgrades. The ReBuild Barlow [5] project concludes the required major seismic retrofit and allows the hospital to continue to operate while a new hospital is being constructed.

Academic Partner

Barlow has served as a teaching hospital for medical students at the Keck School of Medicine of USC and the David Geffen School of Medicine at UCLA and as a clinical training site for respiratory therapy, nursing, physical, occupational, speech therapy and clinical nutrition allied health professionals.

History

Walter Jarvis Barlow founded the Barlow Sanatorium in 1902. He received his MD degree in 1892 from Columbia University. Though he was born and raised in New York, he was forced to move west in search of a dry and sunny climate after contracting tuberculosis in 1895 and moved to Sierra Madre, California. The sanatorium was founded on 25 acres (10 ha) of meadowland next to the city-owned Elysian Park on Chavez Ravine Road. The location seemed ideal because the surrounding configuration of hills provided for clean air and the neighboring Elysian Park seemed to insure against any future development. The land was purchased for $7,300. Patients were housed in tent cottages that were constructed so that patients would have maximum exposure to fresh air and sunlight; at that time these elements were of primary importance in order to recover from tuberculosis. [6] In the early days of the Barlow Sanatorium patients lived by strict rules; one document read:

Patients must not expectorate anywhere except in cups provided for that purpose. Cloths are to be used as handkerchiefs and burned morning and evening. Patients must not discuss their ailments or make unnecessary noise. Patients must not put anything hot on glass tables. Lights out at 9 p.m. Cold plunge every morning; hot baths Tuesday and Saturday. Patients are forbidden to throw water or refuse of any kind on the ground. When doctors think them able, every patient must do some work about the Sanatorium or go away. Patients disobeying these rules will be dismissed. [7]

As the century continued, medical advances made tuberculosis a less serious threat in the United States. Because of this, the tuberculosis sanatorium shifted its focus towards chronic respiratory diseases and secondary related diseases. [8]

The site was named a Los Angeles Historic-Cultural Monument in 1990. [1]

Timeline

Buildings on the campus

Buildings on campus
BarlowRespiratoryHospitalLibrary.jpg
The library
BarlowRespiratoryHospitalguildhouse.jpg
The Guildhouse

Barlow Respiratory Hospital maintains a 25-acre campus with cottages, a library, the main hospital, and a community hall. Old chicken coops are still standing on the outskirts of the campus. This layout can be attributed to the hospital's history as a tuberculosis sanatorium where patients lived for several years.

Cottages on the campus

Originally tuberculosis patients lived in tent cottages in order to be exposed to free flowing air. As time went on permanent cottages were added to the campus by donors. The architecture of the bungalows is in the California bungalow style. [26] During World War I many servicemen contracted tuberculosis and were sent to the Barlow Sanatorium. Because of this the Los Angeles Chapter of the American Red Cross built and furnished four four-room cottages for military patients, some of which are still in use today.

The library

Dedicated to the sanatorium on May 6, 1922, this stucco and red tiled library is still in use. It was paid for by the Los Angeles Optimists Club and has stained glass windows donated by James Slauson and a second by Mrs. Helena Torrance in memory of her husband, Jared Sidney Torrance. Jared Sidney Torrance had served on Barlow's Board of Trustees since 1910 as vice president and president. The library underwent renovations in 1992. [11]

The Guildhouse

The Guildhouse was originally the "Men's Help" quarters, where the men working in the hospital would live. In 1975 the old building was converted into a gift and plant shop. This was funded by the Barlow Guild, a large group of ex-patients dedicated to philanthropy, and the Guildhouse opened in April of that year. [27] The Guildhouse closed in 2014. After an extensive renovation the Guild House reopened in 2021 as adaptive reuse of a historically significant building to serve as administrative offices and communications hub. [28]

The hospital

In 1903, the original hospital of the Barlow Sanatorium was a permanent cottage with 13 rooms, two baths and 12 patient beds. It was built with donations from Mr. and Mrs. Alfred Solano, and was consequently named the Solano Infirmary. [29] In September 1925, the Solano Infirmary burned down. In 1927 Alfred's wife, Mrs. Ella Brooks Solano, provided for the creation of a new infirmary, the Ella Brooks Solano Infirmary, a building that is still in use as the main hospital today. In 2018, the hospital announced a Master Plan to ReBuild Barlow including a seismic reinforcement of the existing historic facility. A new hospital will be built within the walls of an existing, adjacent hospital building.

Related Research Articles

<span class="mw-page-title-main">Ventilator</span> Device that provides mechanical ventilation to the lungs

A ventilator is a type of breathing apparatus, a class of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators may be computerized microprocessor-controlled machines, but patients can also be ventilated with a simple, hand-operated bag valve mask. Ventilators are chiefly used in intensive-care medicine, home care, and emergency medicine and in anesthesiology.

<span class="mw-page-title-main">Mechanical ventilation</span> Method to mechanically assist or replace spontaneous breathing

Mechanical ventilation or assisted ventilation is the medical term for using a ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical ventilation and people who require ventilators are typically monitored in an intensive care unit.

<span class="mw-page-title-main">Intensive care medicine</span> Medical care subspecialty, treating critically ill

Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.

<span class="mw-page-title-main">Extracorporeal membrane oxygenation</span> Technique of providing both cardiac and respiratory support

Extracorporeal membrane oxygenation (ECMO), is a form of extracorporeal life support, providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of oxygen, gas exchange or blood supply (perfusion) to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation. The device used is a membrane oxygenator, also known as an artificial lung.

<span class="mw-page-title-main">Acute respiratory distress syndrome</span> Respiratory failure due to widespread inflammation in the lungs

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). For those who survive, a decreased quality of life is common.

<span class="mw-page-title-main">Pulmonology</span> Study of respiratory diseases

Pulmonology, pneumology or pneumonology is a medical specialty that deals with diseases involving the respiratory tract. It is also known as respirology, respiratory medicine, or chest medicine in some countries and areas.

Tracheobronchitis is inflammation of the trachea and bronchi. It is characterised by a cough, fever, and purulent sputum and is therefore suggestive of pneumonia. It is classified as a respiratory tract infection.

Ventilator-associated pneumonia (VAP) is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals. As such, VAP typically affects critically ill persons that are in an intensive care unit (ICU) and have been on a mechanical ventilator for at least 48 hours. VAP is a major source of increased illness and death. Persons with VAP have increased lengths of ICU hospitalization and have up to a 20–30% death rate. The diagnosis of VAP varies among hospitals and providers but usually requires a new infiltrate on chest x-ray plus two or more other factors. These factors include temperatures of >38 °C or <36 °C, a white blood cell count of >12 × 109/ml, purulent secretions from the airways in the lung, and/or reduction in gas exchange.

<span class="mw-page-title-main">Intensive care unit</span> Hospital ward that provides intensive care medicine

An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.

<span class="mw-page-title-main">Hospital-acquired pneumonia</span> Pneumonia contracted by a hospital patient

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The International Ventilator Users Network (IVUN) is a nonprofit network of mechanical ventilation users, respiratory health professionals, and ventilatory equipment manufacturers. Its focus is on the health and independent living of ventilator users, whether they are using assisted ventilation long-term – at home or in nursing facilities—or short-term in emergency rooms and critical care units.

<span class="mw-page-title-main">Rockcastle Regional Hospital and Respiratory Care Center</span> Hospital in Kentucky, United States

Rockcastle Regional Hospital and Respiratory Care Center is a not-for-profit acute and long-term care hospital located in Mt. Vernon, Kentucky. The facility primarily serves Rockcastle and surrounding counties with its 26-bed acute care facility, but receives referrals for its 143-bed ventilator facility nationwide It is an eleven-time winner of the Kentucky Hospital Association Quality Award and is accredited by the Joint Commission.

Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome. The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups. Writing a mode is most proper in all capital letters with a dash between the control variable and the strategy.

The rapid shallow breathing index (RSBI) or Yang Tobin index is a tool that is used in the weaning of mechanical ventilation on intensive care units. The RSBI is defined as the ratio of respiratory frequency to tidal volume (f/VT). People on a ventilator who cannot tolerate independent breathing tend to breathe rapidly and shallowly, and will therefore have a high RSBI. The index was introduced in 1991 by Karl Yang and Martin J. Tobin.

Intermittent Mandatory Ventilation (IMV) refers to any mode of mechanical ventilation where a regular series of breaths are scheduled but the ventilator senses patient effort and reschedules mandatory breaths based on the calculated need of the patient. Similar to continuous mandatory ventilation in parameters set for the patients pressures and volumes but distinct in its ability to support a patient by either supporting their own effort or providing support when patient effort is not sensed. IMV is frequently paired with additional strategies to improve weaning from ventilator support or to improve cardiovascular stability in patients who may need full life support.

There are many modes of mechanical ventilation. In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing.

<span class="mw-page-title-main">Hawkmoor Hospital</span> Hospital in England

Hawkmoor Hospital, originally known as Hawkmoor County Sanatorium, was a specialist hospital near Bovey Tracey in Devon, England, founded in 1913 as a pulmonary tuberculosis sanatorium as part of a network of such facilities, instigated by the Public Health 1912. From 1948, the hospital catered for patients with a range of chest ailments, as well as chest surgery, and mental disability patients. From 1973, the facility dealt solely with mental health problems until its closure in 1987.

A respiratory driven protocol is an algorithmic medical process applied by respiratory practitioners as an extension of the physician. Respiratory-driven protocols are implemented in hospitals for treatment of people suffering from asthma, bronchiolitis, and other respiratory illness. Respiratory-driven protocols are most widely applied in intensive-care units. Respiratory practitioners are not utilized globally, so most application of respiratory practitioners as physician-extenders in this fashion is in the United States.

A negative pressure ventilator (NPV) is a type of mechanical ventilator that stimulates an ill person's breathing by periodically applying negative air pressure to their body to expand and contract the chest cavity.

References

  1. 1 2 Department of City Planning. "Designated Historic-Cultural Monuments". City of Los Angeles. Archived from the original on June 9, 2010. Retrieved October 4, 2012.
  2. ↑ "Barlow Respiratory Hospital". Archived from the original on July 25, 2011. Retrieved July 6, 2009.
  3. ↑ "Barlow Respiratory Hospital". Archived from the original on December 14, 2009. Retrieved July 6, 2009.
  4. ↑ "Barlow Respiratory Hospital". Archived from the original on July 25, 2011. Retrieved July 6, 2009.
  5. 1 2 "ReBuild Barlow – the Master Plan – the Campaign to ReBuild Barlow".
  6. ↑ Finegan, 1992.
  7. ↑ Finegan 1992, p. 11.
  8. ↑ "Barlow Respiratory Hospital". Archived from the original on July 25, 2011. Retrieved July 6, 2009.
  9. ↑ "DR. WALTER J. BARLOW DIES IN LOS ANGELES; Ex-Dean of the University of California Medical College Had Practiced 40 Years". The New York Times. September 5, 1937.
  10. ↑ "Keck : Patient Care : Major Affiliated Institutions". www.usc.edu. Archived from the original on 2003-03-20.
  11. 1 2 Finegan 1992, p. 53.
  12. ↑ "Tuberculosis". Archived from the original on February 28, 2009. Retrieved July 6, 2009.
  13. ↑ "Barlow Respiratory Hospital". Archived from the original on December 23, 2008. Retrieved July 6, 2009.
  14. ↑ "Barlow Respiratory Hospital". Archived from the original on July 25, 2011. Retrieved July 6, 2009.
  15. ↑ Scheinhorn, D. J.; Artinian, B. M.; Catlin, J. L. (February 1994). "Weaning from prolonged mechanical ventilation. The experience at a regional weaning center". Chest. 105 (2): 534–539. doi:10.1378/chest.105.2.534. ISSN   0012-3692. PMID   8306758.
  16. ↑ "Presbyterian Intercommunity Hospital changes its name". October 2012.
  17. 1 2 "Barlow Respiratory Hospital". Archived from the original on July 25, 2011. Retrieved July 6, 2009.
  18. ↑ Scheinhorn, D. J.; Chao, D. C.; Stearn-Hassenpflug, M.; Wallace, W. A. (January 2001). "Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol". Chest. 119 (1): 236–242. doi:10.1378/chest.119.1.236. ISSN   0012-3692. PMID   11157610.
  19. ↑ Scheinhorn, David J.; Hassenpflug, Meg Stearn; Votto, John J.; Chao, David C.; Epstein, Scott K.; Doig, Gordon S.; Knight, E. Bert; Petrak, Richard A.; Ventilation Outcomes Study Group (January 2007). "Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation". Chest. 131 (1): 76–84. doi:10.1378/chest.06-1079. ISSN   0012-3692. PMID   17218559.
  20. ↑ Scheinhorn, David J.; Hassenpflug, Meg Stearn; Votto, John J.; Chao, David C.; Epstein, Scott K.; Doig, Gordon S.; Knight, E. Bert; Petrak, Richard A.; Ventilation Outcomes Study Group (January 2007). "Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study". Chest. 131 (1): 85–93. doi:10.1378/chest.06-1081. ISSN   0012-3692. PMID   17218560.
  21. ↑ https://www.barlowhospital.org/about- barlow/accreditation-awards/
  22. ↑ "Barlow Outcomes Book" (PDF).
  23. 1 2 "ReBuild Barlow – The Master Plan – The Campaign to ReBuild Barlow - Barlow Respiratory Hospital". www.barlowhospital.org.
  24. ↑ "An Evening Under the Stars".
  25. ↑ "Outcomes | Barlow Respiratory Hospital". www.barlowhospital.org. Retrieved August 6, 2019.
  26. ↑ "Archived copy" (PDF). Archived from the original (PDF) on October 7, 2008. Retrieved July 8, 2009.{{cite web}}: CS1 maint: archived copy as title (link)
  27. ↑ Finegan 1992, p. 57.
  28. ↑ "Barlow Guildhouse". www.facebook.com. Retrieved May 29, 2017.
  29. ↑ Finegan 1992, p. 7.

Sources

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