Outpatient groups maximize therapists’ time

Outcomes, patient satisfaction remain high

Instead of seeing a therapist one on one, total joint replacement patients at Crittenton Hospital in Rochester Hills, MI, attend therapy groups of up to eight patients supervised by two staff members.

The hospital began the therapy groups in response to pressure from managed care to cut costs, says Audrey Boyles, PT, inpatient rehabilitation coordinator, who is also overseeing outpatient therapy.

Patients who participate in the hour-long group sessions are charged for only 30 minutes of treatment.

It’s too soon to determine exactly how much money the groups will save the hospital, but Boyles points out that having one physical therapy assistant (PTA) see four patients every half hour, as opposed to one-on-one treatment, will clearly increase staff productivity.

Outcomes, patient satisfaction, and physician satisfaction have remained high since the therapy groups began, Boyles adds.

Before the groups were instituted in June 1996, joint replacement patients were treated individually by physical therapists or PTAs, depending on their level of independence.

Therapy begins with one on one sessions

Now, patients begin with two or three one-on-one sessions with a physical therapist (PT) who decides when the patient is ready to go to the group setting. The PT develops the treatment regime each patient receives during the therapy groups and continues to see each patient once a week to monitor his or her progress.

Like the individual therapy, the group therapy typically lasts four-to-six weeks, with patients attending three times a week.

The therapy groups, which can accommodate eight patients at a time, are monitored by a PTA and a rehab tech. Four patients are scheduled every half hour to begin the 60 minute group sessions.

The patients spend most of their time in independent work, rotating through as many as eight stations in the gymnasium, depending on their individual treatment plan.

Stations include exercises on a mat, weight shifting on parallel bars, and stretching. Patients are scheduled, as needed, for individual treatments, such as scar massage, with the PTAs, Boyles says.

Paperwork reduced

At the time the groups were developed, the staff came up with a simple form to reduce paperwork. Instead of writing individual progress notes, the staff checks off the stations the patient goes through and signs the form. Patients also wear color-coded name tags to indicate their weight-bearing status.

The therapy groups were begun as a way to cut costs and create efficiency, Boyles says.

The staff analyzed outpatient referrals for a year to determine what patients might be eligible for group treatment and if enough patients were enrolled to make the program cost-effective.

Joint replacement patients were chosen for a pilot program because the hospital regularly performs these procedures. These patients also are usually highly motivated and free from psychological issues that sometimes affect the therapy of patients who are injured in accidents.

One additional benefit is the camaraderie that has developed among the patients and the family members who accompany them, Boyles adds.

Patients encourage each other in the exercises. Family members swap ways to accommodate crutches or walkers at home, she says.

[For more information on Crittenton Hospital’s therapy groups, contact Audrey Boyles at (810) 652-5315.]