Weekend therapy pleases patients, payers

Creative scheduling, not more staff

When payers raised the issue of weekend therapy, the therapy staff at Saratoga Community Hospital in Detroit put their creativity to work.

They developed a program that allows two staff to treat the 18-bed rehab unit’s patients in just four hours. The hospital has been able to provide weekend therapy for patients in its 18-bed inpatient bed rehab unit without hiring more people.

"In our area, we are just beginning to feel the effects of managed care. During the preadmission process, payers have been asking if we offer a weekend program. We decided to jump the gun and offer a reduced rehab program on weekends," says Carole Lohrstorfer, RN, BSN, CRRN, CNA, administrative director, rehab services.

Saratoga Community Hospital is a 200-bed acute care hospital with an 18-bed inpatient rehab unit. The rehab staff provides therapy in the rehab unit as well as to patients in the acute care hospital.

Saturday therapy is provided only to patients on the rehab unit. Plans for the next year call for exploring ways to provide weekend therapy in the acute hospital, especially for patients who could go home on Saturday or Sunday if they received instruction.

Staff rotations

The new Saturday therapy program, begun in October 1996, lasts from 8 a.m. to noon and is staffed by one person from occupational therapy and one from physical therapy. A recreational therapist works with patients every other weekend. Everyone on the therapy staff rotates through the Saturday therapy.

During the week, the hospital’s rehab needs are filled by four occupational therapists and a certified occupational therapy assistant, three physical therapists, two physical therapy assistants (PTAs), and one physical therapy aide.

The nonlicensed staff are also part of the rotation, but the staff ensures there is at least one licensed therapist working each weekend.

"The staff isn’t crazy about working Saturdays, but they know it’s going to be necessary and that they have to go along with the changes," Lohrstorfer says.

The Saturday therapists meet on Friday afternoon to review the patient load, decide who is appropriate for group treatment, and plan the next day’s activities. If they need equipment that is not on the nursing unit, they assemble it on Friday so everything will be ready when they arrive on Saturday.

Instead of taking the patients to the gymnasium for modalities, the weekend therapy staff stays on the unit.

To maximize patient gains during the Saturday therapy, the staff look at what the patients need to work on from a functional aspect. For instance, if a patient is having trouble getting in and out of bed or transferring to the toilet, the therapists work on that during the Saturday session.

If a patient is functioning at a lower level, the therapists may schedule a joint treatment at the bedside in hopes that two therapists working together can create some functional gains.

The Saturday therapists may conduct wheelchair level exercise sessions or take a group of patients for a walk down the hall to work on their gaits. Nursing assistants help with the gait group.

When there were several amputees on the unit, the weekend staff conducted a lesson on stump care.

Communication increased between staffs

The weekend component has greatly increased communication between nursing and the therapists since the therapists spend their time on the floor instead of in the treatment areas, Lohrstorfer says.

"The therapists get feedback from nursing on what the patients need. They are there to help with issues of concern, such as transfers," Lohrstorfer says.

It’s too soon to know if outcomes have improved with the Saturday therapy but the patients love it, Lohrstorfer reports.

"We no longer get complaints about how bored they are on weekends because they have nothing to do. Patients say they look forward to the Saturday sessions," she says.

Most patients get 30 to 45 minutes of therapy on a Saturday, usually 30 minutes of individual therapy and 15 or 20 minutes of group therapy.

Payers are billed at the same rates as weekday therapy for 30 or 45 minutes of therapy.

Staff get compensatory time off for their weekend work if the case load and staffing allows it. Recently, when one physical therapist was on maternity leave and two resigned, Lohrstorfer paid overtime for the weekend work.

The PTAs and physical therapy aide are in a union, which means Lohrstorfer has to follow the union rules in assigning weekend duty. For instance, if the therapist is taking comp time to make up for the Saturday duty, Lohrstorfer has to make sure it is within the same pay period so the employee doesn’t exceed the maximum working time allowed by the union.

So far, having two staff taking compensatory time hasn’t affected the rest of the rehab services. The only difference the weekend therapy has made in the day-to-day operations of rehab services is that there is a push to get evaluations and treatment plans finished quickly for patients who are admitted on Friday so the nonlicensed staff can treat them on Saturday.

The staff began brainstorming the idea of weekend therapy in the spring of 1996 and had the program in place by October.

All levels of staff, as well as union representatives, were included in the planning process.

The entire department met every two weeks for about 21¼2 months to create the plan which was sent to the administration for approval.

The therapy staff has decided on the schedule among themselves and has posted the weekend schedule through July to allow employees to make vacation plans.

The staff has been supportive of each other in switching Saturday duty when something else comes up, Lohrstorfer says.