Shorter LOS means new ways of providing care
Weekend, evening sessions boost outcomesHere are some of the ways St. Luke’s Rehabilitation Institute in Spokane, WA, maximizes patient gains during their shorter lengths of stay.
• Weekend therapy.
Initially, patients at St. Luke’s received treatment Mondays through Fridays and limited therapy on Saturdays. There were no weekend admissions. Now, patients who are admitted on Thursdays and Fridays or those who are expected to have a short length of stay, receive their full regime of therapy on weekends. Other patients, who need ongoing treatment, also receive weekend therapy.
• Evening therapy.
The hospital set up an evening shift for therapists, who come in at noon and stay until 8 p.m. This puts therapists on the floor during the evening shift to treat patients and assist with undressing, bathing, or eating. It also gives the evening nursing staff a chance to exchange ideas with the therapists. The program is still in the early stages and is staffed by two therapists.
• Cross-functional therapy groups.
The hospital has established cross-functional group therapy sessions, which are conducted seven days a week. In some cases, the groups have replaced individual therapy. Since group therapy began, Functional Independence Measure scores and the return-to-home rate have remained consistent.
Newly admitted patients receive one-on-one therapy initially because they are being evaluated. When the therapists feel it is appropriate, they will place patients in therapy groups.
"If we can add more groups, the patients can actually get more therapy at a similar charge," says Nancy Hughes, director of inpatient and day rehab programs.
For instance, stroke and traumatic brain injury patients still receive the requisite three hours of individual therapy and participate in the groups on top of that.
Orthopedic patients receive one-on-one therapy initially, then receive some group therapy to enhance their rehab program.
• Standardization of scheduling.
When reorganizing the rehab unit, the staff realized that patient scheduling systems varied from department to department, so they worked on standardization. Now everyone uses the same scheduling system, which eventually will be done by computer.
The continuum of care is set up so the staff can rotate among programs if needed. The hospital has systems for cross-training and a clinical professional advancement system to help employees advance clinically. There are built-in incentives so employees are willing to rotate among sites.
"We don’t mandate that they have to rotate," Hanks says. " Staff may choose their primary site. Many are able and willing to work in different sites, and those are the ones who will rotate in and out."