Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 Hi Everyone, We are again looking at our scheduling processes and practices to gain more efficiency and to better meet the needs of the patients and of course, to meet the 3 hour rule. Like many facilities, we struggle with patients being " ready " for their therapy appointments and especially for the first appointment of the day. Some facilities have appointments as early as 8:00 a.m. (not including OT ADL). I found that most start at 8:30 a.m. (out of the room appointments). Not including OT ADL at bedside, our first appointments are 9:30 a.m. Years ago, we started at 8:30 a.m. but decided to push it down to 9:30 to give the patients more time to get ready and in a functional manner. Also, to reduce the need to wake them up so early. What we found is that the same reasons that patients weren't ready at 8:30 a.m. are happening at 9:30. We want to move back to 8:30 a.m. but before we do so we need to redesign some processes related to the nursing staff's morning routine and be sure we individualize the schedules according to the patients needs and preferences. The nursing staff is very stressed out about the idea of therapy going back to 8:30. They are having a hard time getting everything done (pass meds, assessments, attend team rounds, wound care, self-care, etc.) for the 9:30 appointments. The patients have a lot of medical needs and some impairments really add to the time it takes for all activities to be completed (eating, self-care, 2 person assist transfer, etc.). My questions to the group: 1. do you follow any criteria for which patients have the earliest appointments (whatever that is for your facility). Currently, we do not. We will reschedule if we find that the patient cannot be ready that early. Our nurses will sometimes put a hold on the patients schedule ( " nursing time " in our scheduling system). 2. do your therapists select their appointment times for patients? Ours do but they frequently make changes based on patients needs/tolerance/preference. Or is it a clerical function? Or a team decision after your evaluations? 3. Do the disciplines (specifically OT and PT) coordinate their appointments? We do not on the front end but will do so as needed to meet the needs of the patient. If yes, what criteria do they use? What is it they are trying accomplish by coordinating them? Typically, our driving force for coordinating is to reduce the back and forth of patients to the unit and the gym (the transportation). 4. Typically, what is the most time (duration) a patient attends appointments? It's not unusual for us to schedule patients for 3 straight hours of therapy. If they can't tolerate it, we change it. Do they have back to back appts? We do. Our usual schedule is PT b.id. (60 min in a.m. and 60 min in p.m.) and OT one hour. 5. Do you have limits on the duration of time a patient attends appts? Only if needed, based on patient's tolerance and preference. 6. As a rule, does your nursing staff have patient's ready for their first appointment of the day? Please define the term " ready " . Does " ready " mean they are bathed, dressed and sitting in the wheelchair ready for transport? Or do the therapists take them as they are? 7. What percent of your OT and PT appts are done at bedside or on the nursing unit? Primarily, only our OT ADL in the morning. As a rule, our patients are transported to the PT/OT department for treatments. Can you share processes and practices that you find helpful with having patients ready for their first appointment of the day. e.g. Nursing schedules, therapy schedules, the role of all staff in contributing to the readiness of patients for appts, does PT staff help with self-care if it's not already completed, how many ADL's are done by OT, etc? We are looking at throwing out our whole scheduling process and starting over!! Not sure what it will look like but we need to do something very different to stop the madness! We can't keep jumping through burning hoops to ensure patients receive 3 hours of therapy, in the most quality manner. And, let's not forget, achieve patient and employee satisfaction too! Sorry, lots of questions--I really value your input and appreciate the time you take to reply to these posts! Lori Stoddart, OTR/L Inpatient Therapy Manager Physical Rehabilitation Services Henry Ford Wyandotte Hospital 2333 Biddle Avenue Wyandotte, MI 48192 734/246-8963 lstodda1@... Be kinder than necessary because everyone you meet is fighting some kind of battle ============================================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 Good morning! We do start as early as 7:30, every evening we provide the nursing staff with next day's schedule, with notes referring to wether the patient will have a feeding session or ADL session, nursing staff (night shift) copy the schedule in each patient's room so they know night before what to expect, patients are consulted on how early they want to have their therapy session, if for any reason a change needs to happen, they are made before 8:00 a.m, and changes are communicated verbally to patients and changes are made on room boards. If we have patients that required to be fed or are low levels, nursing will communicate that during daily rounds and/ or Team conference, so therapists will accommodate for a later appt. We implemented this about 18 months ago, and made a great difference . Hope this information is helpful!! Leonor , R.P.T Manager, Inpatient Rehabilitation Services Pager 317 diazlm@... >>> " Stoddart, Lori " 5/4/2011 9:07 AM >>> Hi Everyone, We are again looking at our scheduling processes and practices to gain more efficiency and to better meet the needs of the patients and of course, to meet the 3 hour rule. Like many facilities, we struggle with patients being " ready " for their therapy appointments and especially for the first appointment of the day. Some facilities have appointments as early as 8:00 a.m. (not including OT ADL). I found that most start at 8:30 a.m. (out of the room appointments). Not including OT ADL at bedside, our first appointments are 9:30 a.m. Years ago, we started at 8:30 a.m. but decided to push it down to 9:30 to give the patients more time to get ready and in a functional manner. Also, to reduce the need to wake them up so early. What we found is that the same reasons that patients weren't ready at 8:30 a.m. are happening at 9:30. We want to move back to 8:30 a.m. but before we do so we need to redesign some processes related to the nursing staff's morning routine and be sure we individualize the schedules according to the patients needs and preferences. The nursing staff is very stressed out about the idea of therapy going back to 8:30. They are having a hard time getting everything done (pass meds, assessments, attend team rounds, wound care, self-care, etc.) for the 9:30 appointments. The patients have a lot of medical needs and some impairments really add to the time it takes for all activities to be completed (eating, self-care, 2 person assist transfer, etc.). My questions to the group: 1. do you follow any criteria for which patients have the earliest appointments (whatever that is for your facility). Currently, we do not. We will reschedule if we find that the patient cannot be ready that early. Our nurses will sometimes put a hold on the patients schedule ( " nursing time " in our scheduling system). 2. do your therapists select their appointment times for patients? Ours do but they frequently make changes based on patients needs/tolerance/preference. Or is it a clerical function? Or a team decision after your evaluations? 3. Do the disciplines (specifically OT and PT) coordinate their appointments? We do not on the front end but will do so as needed to meet the needs of the patient. If yes, what criteria do they use? What is it they are trying accomplish by coordinating them? Typically, our driving force for coordinating is to reduce the back and forth of patients to the unit and the gym (the transportation). 4. Typically, what is the most time (duration) a patient attends appointments? It's not unusual for us to schedule patients for 3 straight hours of therapy. If they can't tolerate it, we change it. Do they have back to back appts? We do. Our usual schedule is PT b.id. (60 min in a.m. and 60 min in p.m.) and OT one hour. 5. Do you have limits on the duration of time a patient attends appts? Only if needed, based on patient's tolerance and preference. 6. As a rule, does your nursing staff have patient's ready for their first appointment of the day? Please define the term " ready " . Does " ready " mean they are bathed, dressed and sitting in the wheelchair ready for transport? Or do the therapists take them as they are? 7. What percent of your OT and PT appts are done at bedside or on the nursing unit? Primarily, only our OT ADL in the morning. As a rule, our patients are transported to the PT/OT department for treatments. Can you share processes and practices that you find helpful with having patients ready for their first appointment of the day. e.g. Nursing schedules, therapy schedules, the role of all staff in contributing to the readiness of patients for appts, does PT staff help with self-care if it's not already completed, how many ADL's are done by OT, etc? We are looking at throwing out our whole scheduling process and starting over!! Not sure what it will look like but we need to do something very different to stop the madness! We can't keep jumping through burning hoops to ensure patients receive 3 hours of therapy, in the most quality manner. And, let's not forget, achieve patient and employee satisfaction too! Sorry, lots of questions--I really value your input and appreciate the time you take to reply to these posts! Lori Stoddart, OTR/L Inpatient Therapy Manager Physical Rehabilitation Services Henry Ford Wyandotte Hospital 2333 Biddle Avenue Wyandotte, MI 48192 734/246-8963 lstodda1@... Be kinder than necessary because everyone you meet is fighting some kind of battle ============================================================================== Quote Link to comment Share on other sites More sharing options...
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