Guest guest Posted December 21, 2007 Report Share Posted December 21, 2007 Ms. Stoddart, I'm the therapy coordinator at a 557 bed hospital in Tulsa, OK, and I'm also an OT. In our acute care area, I would guess that OT receives about 75% of the orders that PT receives. Quite often, the other 25% don't have the self-care and IADL deficits that would also require OT. I don't believe that OT is over-ordered here, but I think that has a lot to do with physician education as far as who is appropriate for skilled intervention and who is not. Regarding the effectiveness of OT services in the acute care setting, I'm having a co-worker run me a lit search right now and I will post that list later today. As far as triggers for OT services, we don't have any that are different from that of PT in acute care. If it's a stroke, hip, or knee replacement, that is a part of the order protocol that can be crossed out by the physician if therapy is not appropriate. For back surgeries and other diagnoses, the physician is responsible for check marking the therapies desired on the " activity orders " sheet. Regarding co-eval's, we try to limit these in acute and other areas. The list of assessment items differs too greatly between OT and PT to make it a good use of our time. However, for patients who can only tolerate a limited amount of assessment time or intervention, we will try to co-evaluate to accommodate the patient. We have been very careful not to duplicate services at our facility and it helps that all of our therapy staff office together. You mentioned that you were taking a hard look at finances and resources for next year. As you know, therapy services in acute care don't being anything to the table when it comes to revenue, we are only an expense. However, we indirectly decrease hospital expenses by impacting the patient's length of stay. It's always a challenge to determine exactly how much therapy decreases LOS because there are a multitude of variables that also play a part (medication management, pain control, and simply having time to heal post-op). I hope this information helps and once again, I will be e-mailing the research references later today. Thanks, Curtis Marti, OTR/L Inpatient Therapy Coordinator Hillcrest Medical Center Tulsa, OK (office) (pager) ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Lori Stoddart Sent: Thursday, December 20, 2007 1:36 PM To: PT Managers Subject: OT in acute care In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ======================================================================== ====== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2007 Report Share Posted December 21, 2007 productivity targets: expect 10 - 14 visits per day depending on new vs established & LOC beds:we staff a 14 bed IRF, 35 bed subacute as well as 917 bed acute hospital orders: 15-30/day in acute over-ordered?: yes, we think it is. We've been starting to track this but don't really have any numbers yet. We find some of the geriatricians order all three disciplines on all of their patients each time the patient is admitted, just in case there is something we can offer to improve safety etc. Definitely an opportunity for ongoing education with the medical staff. outcome data: none at this point although we have a project partially completed that is looking at treatment of the hemiplegic shoulder. triggers?: on the admission history administered by nursing there is a section dealing with change in function over the last two weeks. A change in ability to dress or manage ADL would trigger an OT screening request co-evals?: we do co-evals with patients in the ICU or SICU who have a low tolerance for activity and a need for more than two skilled hands for positioning, managing tubes/lines etc. Our critical care team decides whether separate or co-evals would be more effective on a case by case basis. Irene Bartlett, Rehab Director Mercy Medical Center--Des Moines ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Lori Stoddart Sent: Thursday, December 20, 2007 1:36 PM To: PT Managers Subject: OT in acute care In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ======================================================================== ====== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2007 Report Share Posted December 27, 2007 Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan Sent by: PTManager 12/27/2007 11:35 AM Please respond to PTManager To PTManager cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 I must agree with Jim. On a patient level, I wouldn't be surprised that patients and family members are finding it diffucult to respond to ADL concerns once they are home, making preparation for home discharge incomplete in the patient's view and reliance on the family members greater than those who had OT intervention. Also, out of 15 hospitals, there must be a need for OTs in the neuro population. You can eliminate the OT department to meet budget demands, but something else is being sacrificed. Arley , MS, OTR/L Phila, PA ________________________________ From: PTManager on behalf of wagner_jim@... Sent: Fri 12/28/2007 8:31 AM To: PTManager Subject: Re: OT in acute care I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan <mariemchan@... <mailto:mariemchan%40yahoo.com> > Sent by: PTManager <mailto:PTManager%40yahoogroups.com> 12/27/2007 11:35 AM Please respond to PTManager <mailto:PTManager%40yahoogroups.com> To PTManager <mailto:PTManager%40yahoogroups.com> cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart <lstodda1@... <mailto:lstodda1%40hfhs.org> > wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 Marie, I would have to agree with Mr. Wagoner's response. To take it one step further, I believe that we need to keep in mind the most appropriate person to complete specific training. As an OT, I don't make ambulatory device recommendations because I'm respectful of the physical therapist's expertise in that area. I would expect that respect to be reciprocated in the realm of ADL and IADL training. You had used the example of a THR who would not be as impaired in their ADL's once their mobility increased. That is very true. However, it's important to consider that ADL training needs to be completed prior to d/c. Meeting that need is critical considering that the average length of stay in the acute care setting is now approximately four days. The patient may not be able to " get back on their feet " to the degree that they can complete their ADL's prior to d/c. Take for example the patient who may live alone or has a disabled spouse, is medically stable enough to return home, and may not have home health services available. A hospital will not incur additional expenses by extending a patient's length of stay in the hospital simply because they have difficulty getting dressed. Could the PT complete this kind of training? Possibly. For that matter, I could possibly do gait training as well, and very poorly I might add. It is critical that we respect one another's practice domains and the skilled training that we have each received. After all, we've all heard people say " why do we need a PT when we could just have a Tech walk the patient down the hall " . That's a scary road that none of us want to go down. Thanks for your time, Curtis Marti, OTR/L, OTD Inpatient Therapy Coordinator Hillcrest Medical Center Tulsa, OK (office) (pager) ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of wagner_jim@... Sent: Friday, December 28, 2007 7:31 AM To: PTManager Subject: Re: OT in acute care I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan <mariemchan@... <mailto:mariemchan%40yahoo.com> > Sent by: PTManager <mailto:PTManager%40yahoogroups.com> 12/27/2007 11:35 AM Please respond to PTManager <mailto:PTManager%40yahoogroups.com> To PTManager <mailto:PTManager%40yahoogroups.com> cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart <lstodda1@... <mailto:lstodda1%40hfhs.org> > wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 I agree with Jim that if there's a need for OT services, then it makes sense to have the OT's provide the service. Not only because it's their expertise but we certainly don't have more PT resources than OT. Educating the docs, nurses, case mgrs, etc. on the role of an OT is easier said than done. I've tried several different approaches to this with very little success. Do you have " criteria " or guidelines that would trigger OT services? I've tried to develop them and it's very difficult to put it in writing (succinctly and reliably). As you know, there are so many considerations and judgments when determining the need for PT or OT services. It's not all based on objective findings and we certainly can't go by only the admitting diagnosis. I'm to the point now of calling the docs on every OT order to weed out the unnecessary ones and to provide them with education. I'm not getting the sense that the education piece is sticking though. Thanks for your input on this topic. Lori Stoddart, OTR Henry Ford Wyandotte Hospital Wyandotte, MI Lori >>> wagner_jim@... 12/28/2007 8:31 AM >>> I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan Sent by: PTManager 12/27/2007 11:35 AM Please respond to PTManager To PTManager cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 Since this is a PT list serve, I thought that it may be beneficial to clarify the practice domain of OT in a broader sense, since all of the discussion up to now has been centered around only ADL's and IADL's. In acute care, as previously stated, the need is to focus largely on the " survival skills " of ADL training since the patient is on the unit for such a short period of time. However, when the opportunity presents, it is necessary for the OT to address areas of need such as community resource allocation, community transit options, emergency services access training, family education regarding care giving roles to assist with burden of care, visual/perceptual retraining, and various cognitive retraining tasks that contribute to safety awareness. Often, I've found that the long-term success of patients' post-d/c is just as dependent on receiving this kind of training and education as it is for self-care training. While the previously mentioned areas may be loosely addressed by PT, in my experience I haven't seen them as a focus of the PT treatment plan. It is important for OT's, regardless of the setting, to remain very well versed in these treatment options, or else we will only be contributing to the confusion of who we are as a profession. In our world of evidence-based practice, we as OT's can talk about how important we are but our impact must be measured in quantifiable, outcome-based research. I have attached a file of such research and the impact of OT in the acute care setting specifically, as well as some studies in other rehab areas. Thanks, Curtis ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Lori Stoddart Sent: Friday, December 28, 2007 10:08 AM To: PTManager Subject: Re: OT in acute care I agree with Jim that if there's a need for OT services, then it makes sense to have the OT's provide the service. Not only because it's their expertise but we certainly don't have more PT resources than OT. Educating the docs, nurses, case mgrs, etc. on the role of an OT is easier said than done. I've tried several different approaches to this with very little success. Do you have " criteria " or guidelines that would trigger OT services? I've tried to develop them and it's very difficult to put it in writing (succinctly and reliably). As you know, there are so many considerations and judgments when determining the need for PT or OT services. It's not all based on objective findings and we certainly can't go by only the admitting diagnosis. I'm to the point now of calling the docs on every OT order to weed out the unnecessary ones and to provide them with education. I'm not getting the sense that the education piece is sticking though. Thanks for your input on this topic. Lori Stoddart, OTR Henry Ford Wyandotte Hospital Wyandotte, MI Lori >>> wagner_jim@... <mailto:wagner_jim%40guthrie.org> 12/28/2007 8:31 AM >>> I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan <mariemchan@... <mailto:mariemchan%40yahoo.com> > Sent by: PTManager <mailto:PTManager%40yahoogroups.com> 12/27/2007 11:35 AM Please respond to PTManager <mailto:PTManager%40yahoogroups.com> To PTManager <mailto:PTManager%40yahoogroups.com> cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart <lstodda1@... <mailto:lstodda1%40hfhs.org> > wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ======================================================================== ====== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 If MD's feel the need to order OT, obviously we would need to provide the service. In some instances, the PT or ST may feel a OT referral is indicated for a patient. I agree that to eliminate OT in an acute setting is not recommended, and therefore have not taken that stance because there have been instances where the skills of and OTR is indicated for neuro patients. I have however downsized the dept to put OTR on call for those facilities where OTR orders are sporadic. Marie PT Glendale, CA " , Arley " wrote: I must agree with Jim. On a patient level, I wouldn't be surprised that patients and family members are finding it diffucult to respond to ADL concerns once they are home, making preparation for home discharge incomplete in the patient's view and reliance on the family members greater than those who had OT intervention. Also, out of 15 hospitals, there must be a need for OTs in the neuro population. You can eliminate the OT department to meet budget demands, but something else is being sacrificed. Arley , MS, OTR/L Phila, PA ________________________________ From: PTManager on behalf of wagner_jim@... Sent: Fri 12/28/2007 8:31 AM To: PTManager Subject: Re: OT in acute care I would have to disagree. If you find the need to have your PT's teach ADL/ILS to the patient then the need for skilled OT services is there. Educating the PT staff , MD's and other allied staff to what an appropriate referral is to OT is essential. I would check with the AOTA for evidenced based outcome studies on OT in the acute setting. This may change your mind. Then maybe you could use your OT's more effectively. OT helps to make appropriate decisions about safe home D/C's from acute settings and for essential serviecs. Jim Wagner OTR/L,CHT,CSCS Marie Chan <mariemchan@... <mailto:mariemchan%40yahoo.com> > Sent by: PTManager <mailto:PTManager%40yahoogroups.com> 12/27/2007 11:35 AM Please respond to PTManager <mailto:PTManager%40yahoogroups.com> To PTManager <mailto:PTManager%40yahoogroups.com> cc Subject Re: OT in acute care Hi Lori, Firstly, I oversee about 15 acute hospitals so here's the best info. I can provide you. Hope it helps: Productivity 75% Average bed: Hospitals with 120 beds: Ave. 2 orders per year 284 beds: Ave. 5 orders per day which includes orders from 12 bed TCU 384 beds: Ave. 10 orders per day which includes orders from 24 bed TCU Orders are often over-ordered and those that are appropriate 50% can be performed by PT. Also, OT orders ard ordered way too soon. Right after THR? I find that once the patient is more mobile their ADLS are not as impaired. FYI...we no longer give our adaptive equipment so you can save on costs there too. No outcome studies We only do screens for OT on TCU. No screens on acute. Co-evals are rarely done. Maybe 1% I have also have taken a hard look at the services. I am not sure what your mix of patients are at your facilities as this will impact the volume too. Just an FYI...on my 120 bed facilties, I went from 2 FTE OTR to now on-call with no problems. On my 282 bed facilities, I went from 3 FTE to about 1 FTE. Also found that I was able to use a COTA every other day to help with the budget vs. OTR daily. By educating the MD's and your PT to possibly incorporate ADLS into their daily treatment would also help decrease the possible need for OT. Marie PT Glendale, CA Lori Stoddart <lstodda1@... <mailto:lstodda1%40hfhs.org> > wrote: In regards to an acute care hospital that employs OT, I'm looking for some benchmark data: What are your productivity targets How many beds What is your volume of OT orders (either by number or percentage of beds) Do you find that is OT is " over-orderd " at your hospital If yes, what percent of your total orders Do you have any outcome data on the effectiveness of OT services Do you have any triggers or screens for OT services. If yes, what are they Do you perform PT/OT co-evals? If yes, what percent of your OT orders? Can you tell that we are taking hard look at resources and expenses for next year! Thank you in advance for any info you can provide. Lori Stoddart,OTR Henry Ford Wyandotte Hospital Wyandotte, MI 734/246-8963 Lori ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 Let's not start a turf war here ADLs deal with patient function - PTs are FULLY qualified to address deficiencies in function It really is not any more complex than that *********************** BTW - PTManager is not just a PT list serv - it is now and always has been open to all rehab administrative and managerial topics ****************** Kovacek Physical Therapist Harper Woods, MI > > It is no 'secret' that since the APTA published The Guide to PT Practice > (2000?), State PT associations are trying to incorporate self-care, work > community reintegration, etc into their acts. In almost every instance, > state OT associations have 'lobbied' to limit such inclusion on the > grounds that PT's are trained in ADL, self-care and community > reintegration only as they relate to physical movement. I believe that > in most, maybe all, instances, OT has successfully limited PT " ADL " > scope to the sub-domain of physical movement. > > If a practice act specially states that PT's address the physical > movement of " ADL's " , I believe that addressing anything outside physical > movement is outside the scope of PT practice. > > Thanks, > > Ron > > -- > Ron Carson MHS, OTR/L > Hope Therapy Services, LLC > www.HopeTherapyServices.com > > ===============<Original Message>=============== > > On 12/28/2007, mkeehn@... said: > > > It seems though at least somebody needs to chime in that incorporating > > tasks that fit into the category of ADL's is hardly outside the scope of > > PT practice. And while I am aware that some state OT organizations have > > attempted to remove (and succeeded in some cases) the words from PT > > practice acts I don't think that means something is outside of the scope > > of PT practice. Practice is limited at the state level for many reasons > > -often political in my opinion. > > > In the year 2007 we need to realize that task specific training is an > > obvious part of physical therapy practice. This doesn't mean that I > > don't think that OTs should provide OT services but I definitely don't > > agree that working on ADLs is outside of the scope of PT practice. > > > T. Keehn, PT, DPT, MHPE > > Director of Physical Therapy & Rehabilitation Unit Manager - UI Medical > > Center > > Assoc. Dept. Head and Clinical Assoc. Professor - College of Applied > > Health Sciences > > 1740 W. St. m/c 889 > > Chicago, IL 60612 > > phone > > fax > > > > Re[2]: OT in acute care > > > Many state practice acts do not allow PT to incorporate ADL's because > > it's outside their scope of practice. Those states with recent practice > > act changes have only limited ADL scope. > > > While cutting OT services may be good for the bottom line, I suspect > > it's not good for patients. > > > Ron > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 It's much more complex than " ADL's deal with function " . In my opinion, this is not a turf war; it is simply one difference between OT and PT. Thanks, Ron -- Ron Carson MHS, OTR/L Hope Therapy Services, LLC www.HopeTherapyServices.com ===============<Original Message>=============== On 12/28/2007, pkovacek@... said: > Let's not start a turf war here > ADLs deal with patient function - PTs are FULLY qualified to address > deficiencies in function > It really is not any more complex than that > *********************** > BTW - PTManager is not just a PT list serv - it is now and always has > been open to all rehab administrative and managerial topics > ****************** > Kovacek > Physical Therapist > Harper Woods, MI > >> >> It is no 'secret' that since the APTA published The Guide to PT > Practice >> (2000?), State PT associations are trying to incorporate self-care, > work >> community reintegration, etc into their acts. In almost every > instance, >> state OT associations have 'lobbied' to limit such inclusion on the >> grounds that PT's are trained in ADL, self-care and community >> reintegration only as they relate to physical movement. I believe > that >> in most, maybe all, instances, OT has successfully limited PT " ADL " >> scope to the sub-domain of physical movement. >> >> If a practice act specially states that PT's address the physical >> movement of " ADL's " , I believe that addressing anything outside > physical >> movement is outside the scope of PT practice. >> >> Thanks, >> >> Ron >> >> -- >> Ron Carson MHS, OTR/L >> Hope Therapy Services, LLC >> www.HopeTherapyServices.com >> >> ===============<Original Message>=============== >> >> On 12/28/2007, mkeehn@... said: >> >> > It seems though at least somebody needs to chime in that > incorporating >> > tasks that fit into the category of ADL's is hardly outside the > scope of >> > PT practice. And while I am aware that some state OT > organizations have >> > attempted to remove (and succeeded in some cases) the words from > PT >> > practice acts I don't think that means something is outside of > the scope >> > of PT practice. Practice is limited at the state level for many > reasons >> > -often political in my opinion. >> >> > In the year 2007 we need to realize that task specific training > is an >> > obvious part of physical therapy practice. This doesn't mean > that I >> > don't think that OTs should provide OT services but I definitely > don't >> > agree that working on ADLs is outside of the scope of PT > practice. >> >> > T. Keehn, PT, DPT, MHPE >> > Director of Physical Therapy & Rehabilitation Unit Manager - UI > Medical >> > Center >> > Assoc. Dept. Head and Clinical Assoc. Professor - College of > Applied >> > Health Sciences >> > 1740 W. St. m/c 889 >> > Chicago, IL 60612 >> > phone >> > fax >> >> >> > Re[2]: OT in acute care >> >> > Many state practice acts do not allow PT to incorporate ADL's > because >> > it's outside their scope of practice. Those states with recent > practice >> > act changes have only limited ADL scope. >> >> > While cutting OT services may be good for the bottom line, I > suspect >> > it's not good for patients. >> >> > Ron >> > In ALL messages to PTManager you must identify yourself, your > discipline and your location or else > your message will not be approved to send to the full group. > PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and > participate now! > Visit the NEW and IMPROVED www.InHomeRehab.com. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2007 Report Share Posted December 28, 2007 Mr. Kovacek, I agree with what you wrote regarding " turf war " , that's the last thing that we need in our therapy professions. My position is and always has been that the most skilled professional should be the one to deliver the care. Perhaps the best question to ask here is, " who is the best, most qualified person to provide the care? " In PAM's, gait training, neuromuscular re-education, and several other areas, it is often the PT. OT's have their own areas of expertise that make them the more appropriate clinician to deliver certain aspects of care. I'm just very fortunate that I work in a facility where there is a great deal of mutual respect between all of the therapy disciplines. We all work very well together and when that happens, the patient wins. Thanks, Curtis Marti, OTR/L Inpatient Coordinator of Therapies (office) (pager) cmarti@... ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Kovacek Sent: Friday, December 28, 2007 5:01 PM To: PTManager Subject: Re: OT in acute care Let's not start a turf war here ADLs deal with patient function - PTs are FULLY qualified to address deficiencies in function It really is not any more complex than that *********************** BTW - PTManager is not just a PT list serv - it is now and always has been open to all rehab administrative and managerial topics ****************** Kovacek Physical Therapist Harper Woods, MI > > It is no 'secret' that since the APTA published The Guide to PT Practice > (2000?), State PT associations are trying to incorporate self-care, work > community reintegration, etc into their acts. In almost every instance, > state OT associations have 'lobbied' to limit such inclusion on the > grounds that PT's are trained in ADL, self-care and community > reintegration only as they relate to physical movement. I believe that > in most, maybe all, instances, OT has successfully limited PT " ADL " > scope to the sub-domain of physical movement. > > If a practice act specially states that PT's address the physical > movement of " ADL's " , I believe that addressing anything outside physical > movement is outside the scope of PT practice. > > Thanks, > > Ron > > -- > Ron Carson MHS, OTR/L > Hope Therapy Services, LLC > www.HopeTherapyServices.com > > ===============<Original Message>=============== > > On 12/28/2007, mkeehn@... said: > > > It seems though at least somebody needs to chime in that incorporating > > tasks that fit into the category of ADL's is hardly outside the scope of > > PT practice. And while I am aware that some state OT organizations have > > attempted to remove (and succeeded in some cases) the words from PT > > practice acts I don't think that means something is outside of the scope > > of PT practice. Practice is limited at the state level for many reasons > > -often political in my opinion. > > > In the year 2007 we need to realize that task specific training is an > > obvious part of physical therapy practice. This doesn't mean that I > > don't think that OTs should provide OT services but I definitely don't > > agree that working on ADLs is outside of the scope of PT practice. > > > T. Keehn, PT, DPT, MHPE > > Director of Physical Therapy & Rehabilitation Unit Manager - UI Medical > > Center > > Assoc. Dept. Head and Clinical Assoc. Professor - College of Applied > > Health Sciences > > 1740 W. St. m/c 889 > > Chicago, IL 60612 > > phone > > fax > > > > Re[2]: OT in acute care > > > Many state practice acts do not allow PT to incorporate ADL's because > > it's outside their scope of practice. Those states with recent practice > > act changes have only limited ADL scope. > > > While cutting OT services may be good for the bottom line, I suspect > > it's not good for patients. > > > Ron > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2007 Report Share Posted December 29, 2007 Curtis, What a wonderful sentiment! Let's all try to remember that the focus is the PATIENT, and not our personal agendas of professional development. We can (or should) all agree that BOTH PT's and OT's can provide care status-post RTC cuff repair, and can both provide functional training and/or ADL training . . . the issue isn't one of scope of practice, but rather " SCOPE OF EXPERTISE. I'd take that one step further in saying that scope of expertise IS NOT necessarily profession dependent. SCOPE OF EXPERTISE is a bit more complicated. For example, there are some CHT/PT's that I've seen that can rehab the pants off of a non-CHT OT doing hand rehab . . . and some OT's that can rehab a RTC status post surgery better than a PT who works primarily with children, or neuro patients. Let's take a breath and realize that the therapy provider of optimal choice in one setting, situation, hospital or clinic with specific human resource options MAY NOT be the same from setting to setting, hospital to hospital, or department to department. SCOPE OF EXPERTISE is a term that BOTH professions should be using to RESOLVE conflict not only among ourselves, but between ourselves and other subordinate paraprofessions such as massage therapy and athletic training, to define our practice scope to healthcare professionals outside the realm of traditional care with overlapping techniques and alternative treatment philosophies (such as chiropractors), and establish professional autonomous interdependence with MD, DO, and DPM's. M. Ball, PT, DPT, MBA/PhD Doctor of Physical Therapy - Carolinas Medical Center - Northeast, Concord, NCAssociate Faculty Member - University of Phoenix MBA Program, School of Graduate Business and Management, Charlotte, NC Continuing Education Faculty - Mobility Research Education Department (Makers of the LiteGait partial weight bearing treadmill training system) To: PTManager@...: cmarti@...: Fri, 28 Dec 2007 17:36:09 -0600Subject: RE: Re: OT in acute care Mr. Kovacek,I agree with what you wrote regarding " turf war " , that's the last thingthat we need in our therapy professions. My position is and always hasbeen that the most skilled professional should be the one to deliver thecare. Perhaps the best question to ask here is, " who is the best, mostqualified person to provide the care? " In PAM's, gait training,neuromuscular re-education, and several other areas, it is often the PT.OT's have their own areas of expertise that make them the moreappropriate clinician to deliver certain aspects of care. I'm just veryfortunate that I work in a facility where there is a great deal ofmutual respect between all of the therapy disciplines. We all work verywell together and when that happens, the patient wins. Thanks,Curtis Marti, OTR/LInpatient Coordinator of Therapies (office) (pager)cmarti@...________________________________From: PTManager [mailto:PTManager ] OnBehalf Of KovacekSent: Friday, December 28, 2007 5:01 PMTo: PTManager@...: Re: OT in acute careLet's not start a turf war hereADLs deal with patient function - PTs are FULLY qualified to address deficiencies in functionIt really is not any more complex than that***********************BTW - PTManager is not just a PT list serv - it is now and always has been open to all rehab administrative and managerial topics****************** KovacekPhysical TherapistHarper Woods, MI>> It is no 'secret' that since the APTA published The Guide to PT Practice> (2000?), State PT associations are trying to incorporate self-care, work> community reintegration, etc into their acts. In almost every instance,> state OT associations have 'lobbied' to limit such inclusion on the> grounds that PT's are trained in ADL, self-care and community> reintegration only as they relate to physical movement. I believe that> in most, maybe all, instances, OT has successfully limited PT " ADL " > scope to the sub-domain of physical movement.> > If a practice act specially states that PT's address the physical> movement of " ADL's " , I believe that addressing anything outside physical> movement is outside the scope of PT practice.> > Thanks,> > Ron> > --> Ron Carson MHS, OTR/L> Hope Therapy Services, LLC> www.HopeTherapyServices.com> > ===============<Original Message>===============> > On 12/28/2007, mkeehn@... said:> > > It seems though at least somebody needs to chime in that incorporating> > tasks that fit into the category of ADL's is hardly outside the scope of> > PT practice. And while I am aware that some state OT organizations have> > attempted to remove (and succeeded in some cases) the words from PT> > practice acts I don't think that means something is outside of the scope> > of PT practice. Practice is limited at the state level for many reasons> > -often political in my opinion. > > > In the year 2007 we need to realize that task specific training is an> > obvious part of physical therapy practice. This doesn't mean that I> > don't think that OTs should provide OT services but I definitely don't> > agree that working on ADLs is outside of the scope of PT practice. > > > T. Keehn, PT, DPT, MHPE> > Director of Physical Therapy & Rehabilitation Unit Manager - UI Medical> > Center> > Assoc. Dept. Head and Clinical Assoc. Professor - College of Applied> > Health Sciences> > 1740 W. St. m/c 889> > Chicago, IL 60612> > phone> > fax> > > > Re[2]: OT in acute care> > > Many state practice acts do not allow PT to incorporate ADL's because> > it's outside their scope of practice. Those states with recent practice> > act changes have only limited ADL scope.> > > While cutting OT services may be good for the bottom line, I suspect> > it's not good for patients.> > > Ron> Quote Link to comment Share on other sites More sharing options...
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