New therapy groups maximize therapists’ time

Outcomes, patient satisfaction remain high

Pressured by managed care to cut costs and operate more efficiently, administrators at Crittenton Hospital in Rochester Hills, MI, redesigned the way it rehabilitates certain patients.

It now treats total joint replacement patients in group therapy instead of one-on-one sessions, says Audrey Boyles, PT, inpatient rehabilitation coordinator, who is also overseeing outpatient therapy.

By reducing the number of the more time-consuming and costly one-on-one sessions, the hospital expects to save money, Boyles explains. She cannot provide an exact cost-savings now because the program, launched in June 1996, is too new.

Crittenton targeted total joint replacement patients for the program following an analysis of outpatient referrals to determine what patients would be eligible for group treatment and provided sufficient volume to make the program cost-effective, Boyles says. They were also chosen because they are usually highly motivated and free from psychological issues that sometimes affect the therapy of patients who are injured in accidents.

Patients begin rehabilitation one-on-one for two or three sessions with a physical therapist (PT). The PT decides when the patient is ready to move to the group setting and at that time develops the treatment regime he or she will receive there. The PT continues to see each patient once a week to monitor his or her progress.

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

The sessions accommodate up to eight patients who are supervised by two staff members.

The therapy groups are monitored by a physical therapy assistant (PTA) and a rehab tech. Four patients are scheduled every half hour to begin the one-hour sessions. The sessions last one hour, but patients are charged for only 30 minutes of treatment.

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.

To further streamline procedures, the staff has designed a simple form to reduce paperwork. Instead of writing individual progress notes, the staff checks off the stations the patient completed and signs the form. Patients also wear color-coded name tags to indicate their weight-bearing status.

Since group therapy began, outcomes, patient satisfaction, and physician satisfaction have remained high, Boyles says.

She also says the group therapy has resulted in an added benefit: the camaraderie patients and their families develop among themselves.

Boyles says patients encourage each other in their exercises and family members swap ways to accommodate crutches or walkers at home.

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