RE: RE: Patient orientation class

January 12, 2008

and group-

If I may digress and pick up on another related topic....

I am curious about your daily patient orientation class. We have toyed with

this for our rehab patients . One of our patient satisfaction questions is

about how well " you were informed about what your stay would be like " .

Could you tell me : who attends this ( patient and or family, diagnoses) )?

what diagnoses are you seeing? who teaches it? and what time of the day do you

offer it? is a " required " activity for families?

Do you also do a family conference and is that " mandatory " .

Thanks for letting me digress

Marcy Stalvey, PT, NCS

Edwin Shaw Rehab

Akron, OH

>>> jweiss@... 01/11/08 03:39PM >>>

Agree with Curtis. We also have an established discharge time of 11:00 from our

rehab. One thing that helps (but does not completely resolve the issue) is that

we inform both the patients upon admission (we have a patient orientation class

daily) of the 11:00 discharge. Then we tell their families on the first phone

call from our discharge planners when calling with the discharge date (usually

within a few days of admission) that 11:00 is our discharge time. That way they

aren't surprised later, and hopefully don't feel like we are kicking them out.

This is reinforced to the family again when they come in for a family

instruction day. That is not to say we still don't have families who refuse to

come get their relatives until later due to not wanting to take time off of

work, but we do our best and it usually works out. Docs and equipment issues are

generally not a problem for us with regards to the time of discharge.

Hope this helps-

Weiss, PT

Inpatient Rehab Coordinator

Ingalls Memorial Hospital

Harvey, IL

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Curtis Marti

Sent: Friday, January 11, 2008 1:58 PM

To: PTManager

Subject: RE: Medicare question / 11 am discharge

Ms. Rehder,

We've pushed for a while now to get discharges from our IRF before 11:00

a.m. but several obstacles have prevented doing so. 1) The patient

wanting to stay for lunch before leaving, 2) The patient not having the

necessary transportation to go home until mid-afternoon, 3) hold ups

receiving the necessary d/c orders, adaptive equipment, etc. I see it

as a customer service issue. If you " boot " them too early it may put a

sour note on an otherwise positive rehab stay.

Thanks,

Curtis

________________________________

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

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

Behalf Of Carol Rehder

Sent: Friday, January 11, 2008 1:24 PM

To: ptmanager <mailto:ptmanager%40yahoogroups.com>

Subject: Re: Medicare question / 11 am discharge

Your intermediary is correct.

On another note, how many inpatient facilities out there established

expected patient discharge times of 11 am (for example) and if so, how

is it going over? How did you get the docs all on board? Have you seen a

positive impact on LOS and increase in available beds as the research

indicates? What problems has it caused?

Carol Rehder, PT

Manager, Physical Therapy

Genesis Medical Center

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

<mailto:genesis%40genesishealth.com>

>>> " Jeff LePage " <fcpt@...<mailto:fcpt%40mtaonline.net>

<mailto:fcpt%40mtaonline.net> >

1/11/2008 1:01 PM >>>

I have this situation: A rural health clinic has an M.D. medical

director

that is not there every day. Staff is primarily LPN's and PA-C's.

Patient

comes in to my clinic telling me that their " doctor " is one of the

LPN's. 2

months ago the patient went to see the LPN and was referred to PT. For

various reasons the patient held on to the script for 2 months and then

called to schedule. I told her that too much time had gone by and that

she

should schedule another appointment with her " doctor " since so much time

had

gone by. She did; the LPN wasn't available this time around so she was

seen

by the by the M.D. who filled out a new script with the identical

wording as

the initial script by the LPN for PT. I send the Eval to the MD and am

told

that it this isn't their patient and to send it to the LPN. If I send

the

Plan of Care to the LPN as the referring provider and she signs it do I

still need a new script from the LPN...This is a Medicare patient.

Another question: Can a " non M.D. " provider refer a Medicare patient for

outpatient PT?

Just talked with my intermediary and was told that only an M.D. is

authorized to refer a Medicare beneficiary for outpatient PT???

Jeff LePage, PT

First Choice Physical Therapy

Wasilla, Alaska

January 14, 2008

Marcy-

Our orientation class is scheduled daily M-F with each patient on the day

following their admission (or Monday for Fri/Sat/Sun admits). Families are also

welcome and encouraged to come, but often they are not there. We only schedule

this with cognitively intact (at least relatively) patients, although we do

invite families of cognitively-impaired patients to come. We go over everything

from what to expect while they are here, what a typical day will be like, what

kinds of " extras " are available to them during their stay (i.e. daily newspaper,

chapel services, how to order different choices from the menu, etc etc), how and

when things will be communicated regarding discharge, who the key members of the

team are.... Things like that. Patients are not separated with regards to

diagnoses - generally we have therapy or RT groups that are more

diagnosis-specific during their stay.

We also have a Family Instruction and Conference scheduled with EVERY patient

prior to discharge (usually several days prior). It is usually scheduled in the

afternoon, and essentially the family member or caregiver goes to each therapy

with the patient, where they receive training (or just observe and learn how

patient is doing if no specific training is needed) from each different

discipline, including a session with nursing and RT, and finally ending last

with the discharge planner to go over final details about discharge and

follow-up therapy/equipment/transportation needs. You ask if it is mandatory...

well, it is scheduled with everyone, but that is not to say we don't have

sessions where the families don't show up! We do not allow that to hold up

discharge.

Hope that helps, and let me know if you have any other questions.

Weiss, PT

Inpatient Rehab Coordinator

Ingalls Memorial Hospital

Harvey, IL

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Marcy Stalvey

Sent: Saturday, January 12, 2008 7:48 AM

To: PTManager

Subject: RE: RE: Patient orientation class

and group-

If I may digress and pick up on another related topic....

I am curious about your daily patient orientation class. We have toyed with this

for our rehab patients . One of our patient satisfaction questions is about how

well " you were informed about what your stay would be like " .

Could you tell me : who attends this ( patient and or family, diagnoses) )? what

diagnoses are you seeing? who teaches it? and what time of the day do you offer

it? is a " required " activity for families?

Do you also do a family conference and is that " mandatory " .

Thanks for letting me digress

Marcy Stalvey, PT, NCS

Edwin Shaw Rehab

Akron, OH

>>> jweiss@...<mailto:jweiss%40ingalls.org> 01/11/08 03:39PM >>>