Program-specific teams build staff expertise

Communication, specialization improve outcomes

Before the merger that created St. Luke’s Rehabilitation Institute in Spokane, WA, staff were departmentalized by discipline with some diagnostic-related treatment teams. Now, staff are aligned among program-specific teams such as traumatic brain injury, spinal cord injury, and stroke.

Team members include the physician, nurses, physical therapists, occupation therapists, speech therapists, social workers, recreation therapists, and pharmacists. Even the housekeepers and other support personnel are assigned to specific program areas.

"This is very beneficial, because people recognize who their support services are," says Nancy Hughes, director of inpatient and day rehab programs.

Originally, the social workers were assigned to specific treatment teams. The staff found, however, that it was overwhelming for a social worker to deal strictly with the more intensive diagnosis groups, such as traumatic brain injury.

For a while, social workers were assigned to patients randomly, as they were admitted, but a staff survey showed that method has its shortcomings. For instance, staff felt that some discharge issues were not being dealt with in a timely manner and that communication was lacking.

Now each social worker is assigned to three treatment teams. A social worker can work with an orthopedic team, a stroke team, and a spinal cord injury treatment team, for example. This way, they can hone in on diagnosis-specific problems, such as community resources needed after discharge, but still avoid being overwhelmed by the intense needs of certain types of patients.

Each social worker sees a caseload of six or seven patients per team for an average caseload of 18 patients at a time.

"Even though the social workers do not have program-specific assignments, just having the team designation helped improve the response time and communication," Hughes says.

Having all the disciplines located on the unit has enhanced productivity, she says. Staff have a better understanding of what is going on with patients and often have informal team meetings to look at patient needs and make minor adjustments in therapy to accommodate them.

The management staff on each unit checks the expected census and schedules patients as needed.

"One of the major things we have seen is an improvement in communication. The team is located close to the patients and to the nursing staff," Hughes says. "Having a core group work with the same patients improves continuity of care."