Diagnostic competencies develop special skills

Self-study program gives everyone special skills

Interdisciplinary competency programs for special diagnostic populations ensure everyone on the rehab staff at Cedars Sinai Medical Center has the basic skills and knowledge to treat special populations as soon as the patients arrive on the unit.

"Therapists and other staff may not have specialized knowledge in every single diagnosis. We needed a faster, systematic way for staff to have access to the resources they need to treat these patients," says Pam Roberts, OTR, MSHA, supervisor at the Los Angeles facility.

Staff have completed development of a competency program for spinal cord injury and are working on similar programs for stroke, traumatic brain injury, amputation, and chronic pain.

"It will allow the staff to start treating patients quicker. In today's health care environment, we have no choice," Roberts says.

Staff at the 32-bed rehab unit are divided into three treatment teams, each of which treats a mix of patients.

Information readily available

With the new competency program, when a new spinal cord patient comes to the treat -ment team, members don't have to scramble for resources. They can utilize the resource manual and find out the core information they need to treat the patient. For instance, the manual contains sample letters to insurers to justify wheelchairs.

"This is something the therapists didn't have to know a few years ago, but now it's the norm. Now they have a sample that shows the information they need to provide," Roberts says.

There are three components to the competencies: A self-study guide, which is divided into specific learning modules; a written test; and a practical competency.

Staff are expected to demonstrate each practical skill for their supervisor or mentor. They first demonstrate the skill, then perform it on a certain number of patients, depending on their skill level. After they have completed the competencies, the supervisor or mentor signs off on that section of the competency checklist.

The competencies were designed as self-study so staff can pace their own learning, Roberts says. The time required will vary with the staff member's experience and level of skill. The hospital allots four hours during work time for staff to work on the competencies; they may have to put in additional hours on their own. One group of employees started its own study group at lunch to help each other go through the program.

Employees must make a grade of 80% to pass the written test. Those who don't pass may retake it in two weeks.

Training is both basic and specialized

Staff rotate through the competencies based on their background and the type of patients their team will be expected to treat. For instance, an employee whose team typically treats traumatic brain injury patients must go through the TBI competency.

"We try to make sure all therapists have a basic level of knowledge. That way, if the experienced staff members aren't available, those who are treating the patient have some information and a resource available to them," Roberts says.

The competencies are interdisciplinary and designed for each team member to have basic knowledge. To develop them, Roberts and colleagues put together an interdisciplinary team that determined the needs, goals, and best way to attain the goals. The group met at lunchtime so participation wouldn't affect the members' workloads. Participation was voluntary and included all levels of staff.

"We included people who had little experience treating each diagnosis as well as the experts on the staff. Those who weren't familiar with the diagnosis gave us excellent input on what we needed to teach them," Roberts says.

Creating the curriculum took about six months.

"First, we agreed on a format that would be used for all the competencies. We also decided to limit the amount of information. It's not everything you wanted to know about a particular diagnosis; it's the foundation for the treatment of each diagnosis," Roberts says.

[For additional information on Cedars Sinai's competency assessment, contact Pam Roberts at (310) 855-6660.] n