Extended therapy hours maximize patient gains
June 1, 1999
Extended therapy hours maximize patient gains
Providing service from 6:30 a.m. to 6:15 p.m.
Faced with having to squeeze a full regime of therapy into fewer days — a practice that often left patients exhausted by midafternoon — Genesys Regional Medical Center in Grand Blanc, MI, has extended its therapy schedule to nearly 12 hours a day.
Now therapy services start at 6:30 a.m. and continue until 6:15 p.m. The change gives patients a chance to rest during the day, makes training and educational sessions more convenient for family members, and relieves the early morning frenzy of trying to get all patients up and dressed in an hour.
When patients are admitted late in the day, they can be evaluated by the therapy staff and fitted for a wheelchair, ready to begin their therapy the next day.
The 32-bed rehabilitation unit has 20 therapists on staff. Before the change in staff hours, occupational therapists worked from 7 a.m. to 3 p.m., and physical therapy shifts were from 8 a.m. to 4 p.m.
Now on weekdays, there are two shifts of occupational therapists: one from 6:30 a.m. to 2:45 p.m. and one from 10 a.m. to 6:15 p.m. Physical therapists work either the 8:30 a.m. to 4:45 p.m. shift or the 10 a.m. to 6:15 p.m. shift.
The hospital’s administration chose the 10 a.m. arrival time for the second shift because team conferences start at 10 a.m., and they wanted all staff to be present, says Daniel Swank, MPA/CRRN, director of rehabilitation.
As the rehab center’s average length of stay dropped from 17 days to a little less than 12, the staff looked at ways to maximize patient gains in the short time they were inpatients, he says. Often, this meant staff were providing far more than the traditional three hours of therapy a day.
"We found that we were cramming all the treatment into five or six hours a day, and the patients did not have time for rest periods. They were exhausted at the end of the day," says Joy Finkenbiner, PT, administrative director of physical medicine.
Social workers trying to do group therapy at 3 p.m. complained that the patients were falling asleep. Family members complained the patients were too tired to visit in the evenings.
"If patients weren’t in therapy, they were either eating or doing other personal activities. Our new schedule allows them to rest during the day and have time for socialization with their families or go to support groups in the evenings," Swank says.
The change has allowed therapy staff to do family training activities in the late afternoon and be on hand to answer any questions families may have, Finkenbiner says. In the past, families would have to leave work to learn how to care for the patients after discharge, or the therapy staff would volunteer to stay late. "Our family reaching and training program is much more effective now," she says.
The change also has alleviated insurers’ complaints about the limited amount of therapy provided to late admissions, Swank says. "Extending the therapy hours to 6:15 p.m. ensures that initial assessments can be completed by the therapists," he says. For example, a recent patient was admitted late Friday afternoon, evaluated by physical therapy and occupational therapy before the shift ended at 6:15 p.m., and started on a full therapy treatment during the weekend. "Insurance companies and physicians really wanted it. It came down to staff availability," Swank says.
Having staff come in earlier in the mornings allows them to help the patients get up and dress themselves, rather than having staff do it for them.
"The whole emphasis of this program is to get patients to be as functional as possible. But when you have to get a lot of patients up and ready at the same time, it’s often easier to transfer them or button their clothes for them rather than letting them do it themselves," Finkenbiner says.
Now that some of the occupational therapists are coming in at 6:30 a.m., they can see more patients and provide them with the assistance they need in getting up. Patients who want to get up earlier can do so.
"What it means is that we have a ratio of two to three patients to one staff member for the 6:30 to 8 a.m. time period. It’s very manageable and allows the patients to practice their dressing and transferring skills," Swank says.
The dinner hour was changed from 5 p.m. to 6 p.m. This allows patients to rest in the afternoons and have their therapy before dinner.
Genesys started the new therapy hours in early October 1998. The administration gave the staff a month’s notice of the new shift changes so the therapists could arrange family schedules. At present, staff members rotate shifts every three months.
The biggest complaints have been from staff who do not want the later shift because they have to find a baby-sitter for their children after school, Swank reports. "We have emphasized that it’s not just something management decided to do. It was a problem identified by the patients themselves," he says.
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