Ensure weekend program isn't half-baked therapy
Keep patients' best interests in mind
When you set up your weekend therapy rehab program, you should think more about your patients' routines and schedules than what is convenient for your staff, asserts Nancy Beckley, MS, MBA, principal at Bloom ingdale Consulting Group, a rehab consulting firm in Valrico, FL.
"Seven-day coverage means that therapy can start any day of the week," she says. "It doesn't mean that we hurry up and squeeze everything into two hours on Saturday."
Like the critical pathway, the seven-days-a-week rehab program should be neutral as far as the day is concerned, she says.
Beckley recounts the story of an orthopedic surgeon who says that if his hip replacement patients have surgery on Monday, they are ready for discharge in five days. If the surgery is on Friday, it takes seven days until discharge, even if the patient has what providers call "weekend therapy."
"He calls weekend therapy 'half-baked' therapy because it doesn't follow the critical pathway and because the patients don't get the kind of intensive one-on-one treatment that they get on weekdays," Beckley says.
Days should be neutral
To meet payer requirements for weekend coverage, many providers have a limited staff on duty for only a few hours on Saturday and Sunday mornings. That practice isn't always best for the patients, Beckley asserts.
"If you look at the intent of CARF [The Rehab ilitation Commission], they say seven-day coverage, not half-baked coverage. The intent is that the days are neutral," Beckley says.
She points out that other parts of the hospital routinely provide the same care on weekends as on weekdays. For example, nursing care, lab tests, meals, and physician rounds are not just limited to the early morning hours, she adds.
"It's true we have a limited number of days for inpatient rehab, but this doesn't mean we have to drag a 70-year-old stroke patient out of bed and into the therapy gym early Saturday morning," Beckley says.
It's not always possible for rehab providers to come up with enough staff to provide full treatment for all patients on weekends. Because of staffing shortages in the area, it's difficult for the Rehabilitation Institute at Santa Barbara (CA) to find enough therapists to provide full treatments seven days a week for all patients, explains Melinda Staveley, MS, RN, vice president of clinical services/chief operating officer at the rehabilitation institute.
"To do so, we would need to carry a staffing pattern that is really not supportable from a financial perspective," she says.
At present, the rehabilitation institute provides therapy only one weekend day routinely for all patients. When it is clinically indicated for the patient, the institute arranges to provide full treatments on both Saturdays and Sundays. Patients who receive full treatment on Saturdays and Sundays may be young energetic patients, those who are admitted later in the week, or those who would lose a lot of ground by skipping a day of therapy. Everyone else gets Saturday or Sunday treatment.
Arrangements are made to compensate therapists who come in to provide weekend treatment.
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