Rehab tech program expands, adapts
Cross-training promotes better patient care
What started out as a way to meet competency evaluation requirements for accreditation, has turned into a popular rehab technician education program for Twelve Oaks Hospital in Houston.
The rehab technicians’ cross-training program also has improved the skills of the rehab techs, allowing them to perform a wider variety of tasks and assist the licensed staff with patient care in an era of downsizing.
At Twelve Oaks, rehab techs assist with physical therapy in the acute care hospital and with physical therapy and occupational therapy in the rehab unit.
"When we started looking at meeting Joint Commission [on Accreditation of Healthcare Organizations] competency standards, we realized there was a lot we could do with licensed staff but were in a quandary as to how we were going to prove the competency of our technicians," says Diana Alcorn, BS, PT, MSPH, director of rehabilitation services at Twelve Oaks.
Compounding the dilemma was a high degree of variability in the skill levels of the five techs on the hospital staff. Some had as much as 10 years of experience. Others were newly hired with a goal of later becoming physical therapists and wanted as much training as they could get.
The licensed staff came up with a core curriculum to teach the first class of rehab techs. The first group of graduates suggested expanding the course to cover topics such as prosthetics, whirlpool treatments, and other modalities. (For a list of skills that are covered, see chart, p. 12.)
Now, to meet further Joint Commission standards, the course will include age-specific competencies. For example, what might be appropriate when dealing with a young child might be offensive to a teenager.
"It’s always going to be an evolving process," Alcorn says.
In 1994, the first year the class was given, the 12-hour course was open only to the hospital’s rehab technicians. The next year, other people in the hospital, such as personal care assistants (nurses’ aides) from the nursing department, were allowed to attend. Some of the personal care assistants who completed the course have expressed an interest in becoming rehab techs when an opening occurs, Alcorn says.
In 1996, the hospital opened the course to members of the community and had a number of participants who work in personal care homes or wanted jobs as rehab techs but didn’t have the skills to get hired. Participants who are not employed by Twelve Oaks paid a modest fee and received a certificate.
The cross-training program gives the hospital’s five rehab technicians the skills and knowledge necessary to offer patients a high level of care. For example, the technicians learn that stroke victims sometimes aspirate fluid. Because the technicians know to observe the patient drinking water and understand the warning signals for this problem, they can report the situation to the speech pathologist for further evaluation.
The cross-trained technicians also enhance staffing by being available after hours on a rotating basis. The techs share beepers and rotate being on call for traction setup.
Whenever they’re called in after hours, technicians are paid for a minimum of two hours, no matter how short their shift is at the hospital, says Alcorn. However, most are on duty for far longer, she adds.
The cross-training program has saved the hospital money by avoiding temporary staffing because the techs can rotate between inpatient rehab and the acute care hospital. For example, if the census is high in the rehab unit, instead of calling in temporary workers at a high per diem rate, Alcorn can shift rehab techs from acute care.
This crossover has created an atmosphere of collaboration between the acute therapy and rehabilitation therapy departments, says Alcorn. The cross-training program has fostered better communication between the departments, as they work together to teach technicians important duties from each section.
This program works only because of a thorough training program, and technicians must take the course every year in order to maintain their certification, Alcorn stresses.
Participants must attend 12 one-hour sessions, held once a week and taught by licensed staff at the hospital.
Originally the training was two hours per session and two sessions per week. However, after the first year, the course was extended to alleviate having so many staff tied up for four hours a week, Alcorn says.
Teachers use handouts and demonstrations to help students gain a thorough understanding of each topic.
All technicians take a pretest before the course begins to be used as a baseline for measuring their progress. Anyone who earns 100% on the pretest is exempt from the cross-training course.
Alcorn points out, with this year’s emphasis from the Joint Commission’s age-specific competencies, it’s unlikely that the techs, who have not had age-specific training, will be able to score high enough on the pretest to be exempt from the training.
Students must earn a score of at least 80% on the post-test to earn their cross-training certificate. A member of the licensed staff works individually with those who do not make the minimum score.
Test anxiety and poor reading skills are common factors in low performance on the post-test. Individual remediation is usually effective in overcoming those problems.
The test results give therapists a tangible way to determine technicians’ competence, and proven ability to complete a variety of tasks inspires confidence.
"Before, we really had no way to assess the competency of the technicians," says Alcorn. "We had never re-reviewed their skills, unless we saw somebody doing something incorrectly."
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