Re: Aide utilization in acute hospital

[Guest guest]

I guess you have a different appreciation of the qualifications of " helpers " . I

tend to view my staffing as one non-professional helper to 2.5 licensed

professionals vs your view of 1.5 non-PTs to 2 PTs. Sorry, but I don't consider

them equivalent. I've worked with both Aides and Assistants since 1972 and have

participated actively in the development and support of more than one PTA

program over that time. In my view, using a 1:2.5 ratio on my inpatient unit

and a 1:5 ratio on the outpatient unit is reasonable, but I certainly don't

consider it the same as the 1:1 ratio to which I was responding.

I willingly admit that back in the 70's I tended to staff a department on a 1:1

or even 2:3 ratio of therapists to aides due to the high volume of modality-type

treatment which could be performed under relatively standard guideliines. Times

have definitely changed. My aides today have very little independent patient

contact and are generally used as a adjunct to the direct therapist intervention

which occurs on a daily basis.

In any event, I would disagree than 1:2.5 = 1:1

Ken Tuley, PT

Rehab Services Manager

Cape Canaveral Hospital

Cocoa Beach, FL

>>> 08/02/99 10:44PM >>>

In a message dated 8/2/99 9:34:59 PM Eastern Daylight Time,

ktuley@... writes:

<< In the inpatient and wound care area of the 150 bed hospital I staff, we

have 2 PTs, one half-time PTA and one aide. >>

This seems to me as the same ratio, only using a PTA vs a tech as one of the

helpers.

Steve Marcum PT

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[Guest guest]

Yes, you are safe in that assumption at this time. At the time I took over this

dept 9 years ago, there was virtually no historical info available. My first

year set a baseline of 90% inpatient and 10% outpatient. Using my FY1992

baseline year, inpatient business has doubled and outpatient business is now 6x

what it was in that year. In addition, last year we opened a separate

outpatient area connected to a hospital-owned health club and moved most of our

non-wound-care outpatients to that location.

The figures I quoted are for my hospital staff (inpatient and outpatient wound

care only) and includes only a portion of my own time which is apportioned over

the various sites for which I am responsible. My own current clinical contact

is not more than about 0.2FTE of clinical time at the hospital.

ken

>>> " Carol Rehder " 08/03/99 03:58PM >>>

Am I safe in assuming outpt. is the bulk of your business? Are you included in

those staff numbers?

>>> " Ken Tuley " 08/02 8:25 PM >>>

That ratio is higher than I have been using in my area. In the inpatient and

wound care area of the 150 bed hospital I staff, we have 2 PTs, one half-time

PTA and one aide. In the separate outpatient area, I have one aide to 5 PTs.

There is also 1 SLP and 1.5 FTEs OT floating between the two areas as volume

dictates.

8/ 2 1:52p >>>

I would appreciate hearing from others in the group on this topic. We staff

a 300 bed hospital with 4 to 5 PT's and almost always utilize one aide per

therapist. Each team provides an average of 12 treatments (20 to 25 UOS) per

8 hour day. We see a fairly typical mix of ortho, neuro, cardiac and

general med-surg referrals. Lately, I have taken quite a bit of heat due to

the high ratio of aides to therapists. However, we get no assistance from

nursing in the way of patient preparation, and any attempt to schedule is an

exercise in futility. Also, there is no facility-wide transport. Patients

are therefore seen in their rooms and in the halls, and have the multiple

lines that would be expected (IV's, catheters, O2, etc) with this

population. Without an aide to act as the " equipment caddy " (along with the

usual set up and clean up....no real direct care), we would accomplish

little in the way of functional mobility. There is simply too much " stuff "

for one person to deal with.

Thoughts? Ideas?

Thanks,

Trager, PT

Rehabilitation Services Manager

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[Guest guest]

Our volunteers are primarily assisting with extra lines or bringing up chairs

for patients or running to get walkers or oxygen tanks. We use our aide for any

patients where we need mod to max assist to prevent any injuries with the

volunteers. Surprisingly enough, we find that even this amount of assist with

the volunteers allows the rest of our team access to the one PT aide we have for

much needed assist vs just " manning the lines " .

Kim s, PT

>>> 08/03/99 08:25AM >>>

Kim,

How do you handle liability issues that may arise with potential for injury

with volunteers?

Carol Lewando

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[Guest guest]

We have our volunteers go through an orientation where they are instructed

regarding confidentiality. I do not feel that having our volunteer informed is

any different than when we take student interns regarding confidentiality

concerns since our volunteers are all college students trying to get into a PT,

MD or PA program. The patients are introduced to the volunteers in this way and

they can choose not to have them present.

>>> " , " 08/03/99 11:06AM >>>

I hope patient confidentiality is always used. Volunteers, or anyone else

for that matter should not be allowed to have information regarding

diagnosis without the formal consent of the patient. Confidentiality is

always a major issue and often people don't always realize small things they

are doing to " breach it " (but accrediting agencies do!).

, PT

Director, Physical Rehabilitation Services

East Orange General Hospital--New Jersey

-----Original Messag e-----

From: Kim s

Sent: Tuesday, August 03, 1999 9:06 AM

To: ptmanageregroups

Subject: Re: Aide utilization in acute hospital

I work in a 400 bed hospital. We utilize our volunteer who are all looking

at becoming PTs, PTAs, MDs, or PAs. Our staff could not work without these

volunteer since we only have one aide for our acute care team and she also

is responsible for the hydrotherapy. I have a team of 4 PTs and 1 PTA. It

is obvious to see that 1 aide would not be enough to assist all without our

volunteer support. We make it a wonderful experience for the

volunteers--like they are a student with explanations re: diagnosis and

treatment. We feel very lucky to have volunteers and they feel that they

are lucky to have access to such a wonderful educational experience. This

way it is a win-win situation.

Kim s, PT

Wisconsin

>>> " Trager, " 08/02/99 12:52PM >>>

I would appreciate hearing from others in the group on this topic. We staff

a 300 bed hospital with 4 to 5 PT's and almost always utilize one aide per

therapist. Each team provides an average of 12 treatments (20 to 25 UOS) per

8 hour day. We see a fairly typical mix of ortho, neuro, cardiac and

general med-surg referrals. Lately, I have taken quite a bit of heat due to

the high ratio of aides to therapists. However, we get no assistance from

nursing in the way of patient preparation, and any attempt to schedule is an

exercise in futility. Also, there is no facility-wide transport. Patients

are therefore seen in their rooms and in the halls, and have the multiple

lines that would be expected (IV's, catheters, O2, etc) with this

population. Without an aide to act as the " equipment caddy " (along with the

usual set up and clean up....no real direct care), we would accomplish

little in the way of functional mobility. There is simply too much " stuff "

for one person to deal with.

Thoughts? Ideas?

Thanks,

Trager, PT

Rehabilitation Services Manager

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[Guest guest]

4 PTs , 1 PTA, and 1 aide provide service 5 days/week. We have almost a 1.0 FTE

to cover vacations. Our staff are typically scheduled to do 12-13 visits/day.

We see ortho BID and appropriate neuro patients BID. Otherwise, everyone is

typically qd unless deemed appropriate for BID. We rotate weekends with a

larger staff and have scheduled fill-in therapists to cover " comp " time on Mon

and Tues. We do have access to other staff if the census is overwhelming but

the majority of the time we are able to cover the acute care load with our

primary staff.

Kim s, PT

>>> " Carol Rehder " 08/03/99 03:06PM >>>

I'm in awe! 5 staff for 400 beds? How do you do it, and what kind of volumes

do you see on a daily basis and intensity of service do you provide? Are you

there 7 days a week?

>>> " Kim s " 08/03 8:06 AM >>>

I work in a 400 bed hospital. We utilize our volunteer who are all looking at

becoming PTs, PTAs, MDs, or PAs. Our staff could not work without these

volunteer since we only have one aide for our acute care team and she also is

responsible for the hydrotherapy. I have a team of 4 PTs and 1 PTA. It is

obvious to see that 1 aide would not be enough to assist all without our

volunteer support. We make it a wonderful experience for the volunteers--like

they are a student with explanations re: diagnosis and treatment. We feel very

lucky to have volunteers and they feel that they are lucky to have access to

such a wonderful educational experience. This way it is a win-win situation.

Kim s, PT

Wisconsin

>>> " Trager, " 08/02/99 12:52PM >>>

I would appreciate hearing from others in the group on this topic. We staff

a 300 bed hospital with 4 to 5 PT's and almost always utilize one aide per

therapist. Each team provides an average of 12 treatments (20 to 25 UOS) per

8 hour day. We see a fairly typical mix of ortho, neuro, cardiac and

general med-surg referrals. Lately, I have taken quite a bit of heat due to

the high ratio of aides to therapists. However, we get no assistance from

nursing in the way of patient preparation, and any attempt to schedule is an

exercise in futility. Also, there is no facility-wide transport. Patients

are therefore seen in their rooms and in the halls, and have the multiple

lines that would be expected (IV's, catheters, O2, etc) with this

population. Without an aide to act as the " equipment caddy " (along with the

usual set up and clean up....no real direct care), we would accomplish

little in the way of functional mobility. There is simply too much " stuff "

for one person to deal with.

Thoughts? Ideas?

Thanks,

Trager, PT

Rehabilitation Services Manager

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[Guest guest]

In a message dated 08/05/1999 3:50:41 PM Eastern Daylight Time,

Rehder@... writes:

<< 4 PTs , 1 PTA, and 1 aide provide service 5 days/week. We have almost a

1.0 FTE to cover vacations. Our staff are typically scheduled to do 12-13

visits/day. We see ortho BID and appropriate neuro patients BID. >>

Would you mind sharing your salary ranges for the PT's PTA's and aide. How

many units each visit generates. It has been hard for me to compare apples

to apples when important factors such as Total Cost of services and Contract

arrangements are missing. I guess what I am saying is , that given that all

patients needs are being met, with the reimbursements as they are it is hard

to meet salary expectations of therapists without using some sort of care

provider extendors.

Steve Marcum PT

[Guest guest]

How large is your facility, and how many units are you budgeted to do in 1 year?

>>> " Kim s " 08/05 7:39 AM >>>

4 PTs , 1 PTA, and 1 aide provide service 5 days/week. We have almost a 1.0 FTE

to cover vacations. Our staff are typically scheduled to do 12-13 visits/day.

We see ortho BID and appropriate neuro patients BID. Otherwise, everyone is

typically qd unless deemed appropriate for BID. We rotate weekends with a

larger staff and have scheduled fill-in therapists to cover " comp " time on Mon

and Tues. We do have access to other staff if the census is overwhelming but

the majority of the time we are able to cover the acute care load with our

primary staff.

Kim s, PT

>>> " Carol Rehder " 08/03/99 03:06PM >>>

I'm in awe! 5 staff for 400 beds? How do you do it, and what kind of volumes

do you see on a daily basis and intensity of service do you provide? Are you

there 7 days a week?

>>> " Kim s " 08/03 8:06 AM >>>

I work in a 400 bed hospital. We utilize our volunteer who are all looking at

becoming PTs, PTAs, MDs, or PAs. Our staff could not work without these

volunteer since we only have one aide for our acute care team and she also is

responsible for the hydrotherapy. I have a team of 4 PTs and 1 PTA. It is

obvious to see that 1 aide would not be enough to assist all without our

volunteer support. We make it a wonderful experience for the volunteers--like

they are a student with explanations re: diagnosis and treatment. We feel very

lucky to have volunteers and they feel that they are lucky to have access to

such a wonderful educational experience. This way it is a win-win situation.

Kim s, PT

Wisconsin

>>> " Trager, " 08/02/99 12:52PM >>>

I would appreciate hearing from others in the group on this topic. We staff

a 300 bed hospital with 4 to 5 PT's and almost always utilize one aide per

therapist. Each team provides an average of 12 treatments (20 to 25 UOS) per

8 hour day. We see a fairly typical mix of ortho, neuro, cardiac and

general med-surg referrals. Lately, I have taken quite a bit of heat due to

the high ratio of aides to therapists. However, we get no assistance from

nursing in the way of patient preparation, and any attempt to schedule is an

exercise in futility. Also, there is no facility-wide transport. Patients

are therefore seen in their rooms and in the halls, and have the multiple

lines that would be expected (IV's, catheters, O2, etc) with this

population. Without an aide to act as the " equipment caddy " (along with the

usual set up and clean up....no real direct care), we would accomplish

little in the way of functional mobility. There is simply too much " stuff "

for one person to deal with.

Thoughts? Ideas?

Thanks,

Trager, PT

Rehabilitation Services Manager

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