RE: IP Therapy Scheduling

November 17, 2011

:

In my experiences, therapists tend to be more productive seeing patients

on the floor. Transport lateness, patient not ready when transport

arrives, medical holds, " can't locate the chart " , are some of the

reasons common in that scenario of a therapist waiting in the gym

becoming even more unproductive. We tried that approach for years and it

never took off. However, one method that was a little better required

us to do the eval bedside and determined if they were gym appropriate.

Therefore, we had 1 PT in the gym while the others recommended

appropriate patients to the gym for follow up treatment.

I hope that helps.

Arley , MS,OTR/L

Site Manager, Inpatient Rehabilitation Services, Pennsylvania Hospital

Interim Site Manager, Penn Institute of Rehabilitation Medicine

Interim Site Manager, GSPP Speciality Hospital at Rittenhouse

Tel. / Cell:

From: PTManager [mailto:PTManager ] On

Behalf Of Morrow

Sent: Thursday, November 17, 2011 2:35 PM

To: PTManager

Subject: IP Therapy Scheduling

Just wanted to see if any organization is scheduling their IP acute

rehab patients? This was pitched by one of my supervisors about

scheduling these patients on the IP floor versus just seeing them when

they are available. I see how it could possibly make the therapist more

productive, but worried about the impact on nursing and other ancillary

services. Also, remember we are a 100 bed rural hospital without a rehab

unit.

Any input would be greatly appreciated.

Thanks

Morrow, MS, ATC, LAT

Director of Consulting and Outpatient Services

Monroe Clinic

515 22nd Avenue

Monroe, WI 53566

(O)

(F)

(P)

©

November 17, 2011

-

In my last position ( in a large acute care facility) we did indeed schedule our

patients who were being seen for PT, OT or speech, even if we were seeing them

bedside. Nursing found it helpful to know when to expect us ( and coordinate

transfers, or not), respiratory could generally work with us, and we even got

sometimes to rearrange other tests. We definitely had to be flexible and

rearrange on the fly but it helped a lot.

Have you asked nursing and other services what they think?

Marcy Stalvey, PT, MS, NCS

Therapy Supervisor

Edwin Shaw Rehab

Cuyahoga Falls, OH 44221

From: PTManager [mailto:PTManager ] On Behalf Of

Morrow

Sent: Thursday, November 17, 2011 2:35 PM

To: PTManager

Subject: IP Therapy Scheduling

Just wanted to see if any organization is scheduling their IP acute rehab

patients? This was pitched by one of my supervisors about scheduling these

patients on the IP floor versus just seeing them when they are available. I see

how it could possibly make the therapist more productive, but worried about the

impact on nursing and other ancillary services. Also, remember we are a 100 bed

rural hospital without a rehab unit.

Any input would be greatly appreciated.

Thanks

Morrow, MS, ATC, LAT

Director of Consulting and Outpatient Services

Monroe Clinic

515 22nd Avenue

Monroe, WI 53566

(O)

(F)

(P)

©

November 17, 2011

Hi !

We have discussed this topic at length, especially when we also had a SNU unit.

My staff have consistently stuck by the notion that scheduling inpatients would

improve productivity (read: the bottom line) in theory, but not in practice.

Here are their arguments:

- Despite therapy schedules, acute patients are often not available - they

are undergoing diagnostics, visiting with family/friends, not yet had pain

medication, resting, eating, on the potty and a myriad of other reasons.

- Although schedules are prepared in advance and communicated to nursing,

patients still may not be " ready " for therapy; nurses have many interruptions

and delays in their day.

- If a patient is not available or ready at their scheduled time, what

next? Do you try to get a different person (obviously not at their time), or

sit idle? When do you fit in the " missed " patient?

- Probably most importantly - once patients have a schedule, some will

absolutely expect that you will keep it. (We have told a patient we will come

to see them sometime between 2:00 and 2:30, and when we arrived at 2:20, were

told we were 20 minutes late.) Any fluctuation or glitch in the system can

throw off your schedule, and you may find yourself with very upset patients.

- Having said that, we do give a very loose schedule to Ortho (post-THA

and TKA) patients by telling them they will be seen sometime mid-morning and

again mid-afternoon.

Because they have argued so strenuously against scheduling patients, I've

challenged my staff to come up with ideas to maximize efficiency for inpatient

therapy. Their methods include sending an aide ahead of the therapist to check

for patient availability while the therapist reviews the chart and speaks with

the nurse. If the patient is not available, they contact the therapist by

Vocera, and the therapist tells them who to check on next, reviews that chart,

etc, until they find an available patient.

I hope you are well. Best of luck and have a great Thanksgiving,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL

From: PTManager [mailto:PTManager ] On Behalf Of

Morrow

Sent: Thursday, November 17, 2011 1:35 PM

To: PTManager

Subject: IP Therapy Scheduling

Just wanted to see if any organization is scheduling their IP acute rehab

patients? This was pitched by one of my supervisors about scheduling these

patients on the IP floor versus just seeing them when they are available. I see

how it could possibly make the therapist more productive, but worried about the

impact on nursing and other ancillary services. Also, remember we are a 100 bed

rural hospital without a rehab unit.

Any input would be greatly appreciated.

Thanks

Morrow, MS, ATC, LAT

Director of Consulting and Outpatient Services

Monroe Clinic

515 22nd Avenue

Monroe, WI 53566

(O)

(F)

(P)

©

November 18, 2011

How did you come up with a way to get everyone to agree to a schedule? Rehab is

not an issue, but acute care is a whole different animal for us.

Carol Rehder, PT

Manager, Physical Therapy

Genesis Medical Center

rehder@genesis@...

>>> Marcy Stalvey 11/17/2011 2:00 PM >>>

-

In my last position ( in a large acute care facility) we did indeed schedule our

patients who were being seen for PT, OT or speech, even if we were seeing them

bedside. Nursing found it helpful to know when to expect us ( and coordinate

transfers, or not), respiratory could generally work with us, and we even got

sometimes to rearrange other tests. We definitely had to be flexible and

rearrange on the fly but it helped a lot.

Have you asked nursing and other services what they think?

Marcy Stalvey, PT, MS, NCS

Therapy Supervisor

Edwin Shaw Rehab

Cuyahoga Falls, OH 44221

From: PTManager [mailto:PTManager ] On Behalf Of

Morrow

Sent: Thursday, November 17, 2011 2:35 PM

To: PTManager

Subject: IP Therapy Scheduling

Just wanted to see if any organization is scheduling their IP acute rehab

patients? This was pitched by one of my supervisors about scheduling these

patients on the IP floor versus just seeing them when they are available. I see

how it could possibly make the therapist more productive, but worried about the

impact on nursing and other ancillary services. Also, remember we are a 100 bed

rural hospital without a rehab unit.

Any input would be greatly appreciated.

Thanks

Morrow, MS, ATC, LAT

Director of Consulting and Outpatient Services

Monroe Clinic

515 22nd Avenue

Monroe, WI 53566

(O)

(F)

(P)

©

November 18, 2011

We scheduled each day, each therapist through our rehab secretary. We tried to

schedule the evening before and have the secretary call that evening or early

early morning to alert nursing. I know I usually ended up having to spend about

20 mins each am juggling and letting nursing know especially in the ICUs, and

coordinating with respiratory. The ICUs really appreciated it. We were usually

the ones who did the accommodating but it went a long way in making my day

easier to have some semblence of a plan. I typically would leave 1-2

unscheduled/flexibly scheduled that I could circle back and get when someone

else wasn't available. We tried to educate patients, family and nursing that

we might be late or early depending on unforseen happenings.

My experience was based on large cardiovascular and pulmonary ( medical and

surgical chest) population and acute neurology and neurosurgery services in a

1000 bed teaching hospital.

If there is a master electronic scheduling system available that special tests,

respiratory and therapies might all use and view in acute care, may be that

could be utilized, as we do on rehab . We did not have an electronic scheduling

system in my last facility.

Not a perfect system but worked fairly well.

Marcy Stalvey, PT, NCS

Edwin Shaw Rehabilitation Institute

Cuyahoga Falls, OH 44221

From: PTManager [mailto:PTManager ] On Behalf Of

Carol Rehder

Sent: Friday, November 18, 2011 10:53 AM

To: 'PTManager '

Cc:

Subject: RE: IP Therapy Scheduling

How did you come up with a way to get everyone to agree to a schedule? Rehab is

not an issue, but acute care is a whole different animal for us.

Carol Rehder, PT

Manager, Physical Therapy

Genesis Medical Center

rehder@genesis@...<mailto:genesis%40genesishealth.com>

>>> Marcy Stalvey

<Marcy.Stalvey@...<mailto:Marcy.Stalvey%40akrongeneral.org>>

11/17/2011 2:00 PM >>>

-

In my last position ( in a large acute care facility) we did indeed schedule our

patients who were being seen for PT, OT or speech, even if we were seeing them

bedside. Nursing found it helpful to know when to expect us ( and coordinate

transfers, or not), respiratory could generally work with us, and we even got

sometimes to rearrange other tests. We definitely had to be flexible and

rearrange on the fly but it helped a lot.

Have you asked nursing and other services what they think?

Marcy Stalvey, PT, MS, NCS

Therapy Supervisor

Edwin Shaw Rehab

Cuyahoga Falls, OH 44221

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of Morrow

Sent: Thursday, November 17, 2011 2:35 PM

To: PTManager

Subject: IP Therapy Scheduling

Just wanted to see if any organization is scheduling their IP acute rehab

patients? This was pitched by one of my supervisors about scheduling these

patients on the IP floor versus just seeing them when they are available. I see

how it could possibly make the therapist more productive, but worried about the

impact on nursing and other ancillary services. Also, remember we are a 100 bed

rural hospital without a rehab unit.

Any input would be greatly appreciated.

Thanks

Morrow, MS, ATC, LAT

Director of Consulting and Outpatient Services

Monroe Clinic

515 22nd Avenue

Monroe, WI 53566

(O)

(F)

(P)

©

November 18, 2011

Scheduling inpatients is one of my big " soap box " issues ---- I think that

patients deserve a schedule. I know that therapists resist it, and unless all

of the people seeing the patient are on a schedule it doesn't work well (ie DI,

respiratory, PT/OT/SLP, hospitalists). But if we are really thinking about

patient centered care we should let them know what to expect of their day in the

hospital, who they will see and when. This allows them to be an informed

patient and to have their caregivers there when appropriate. One of the worst

things you can do to a patient is have them in bed just waiting for something to

happen and never knowing what or when ----it's all a surprise and often not a

welcome one. In our hospitals we schedule inpatient therapies as much as

possible, and it works pretty well in IRF and ortho units. There are always

emergencies and unexpected happenings with inpatients, but I think we owe it to

our patients to figure this out and make it work.

RSusick

PPMC

Portland, OR

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November 18, 2011

We print out floor lists of all patients in the hospital (average daily census

360) and put therapy scheduled times on the sheet. This gets faxed up to the

individual nursing units by 815 every day. Nursing units have learned to look

for it and we have worked hard to have them complete baths and to pre medicate

prior to our arrival. We have not been so successful in having them call us

with conflicts (CT/MRI etc). Many of the units find it helpful so that the

nurses can plan mobility or the patients schedule for the day. Often if they do

not have the time they call down to see if the patient is going to be seen.

Some clinicians are better about scheduling then others, but overall the system

does work well especially in the ICU's and orthopedics.

Johanne Fradette PT

Acute Therapies Supervisor

Rehabilitation Therapies

Fletcher Health Care

MCHV Campus - Shep. 2

Mailstop 275SH2

phone:

Fax:

Beeper 258

Johanne.Fradette@...

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Marcy Stalvey

Sent: Friday, November 18, 2011 12:52