Communication is the key to coordinating services

Hospital uses overlapping shifts, written forms

Improving communication among all members of the team, including patients and families, on all shifts is the crux of setting up a 24-hour-a-day rehab program, says Linda Peterson, MS, MBA, vice president of InteRehab at RehabLink/Marianjoy Rehabilitation Hospitals and Clinics in Wheaton, IL.

At RehabLink/Marianjoy, extending the same rehab concepts across all three shifts seven days a week has been part of care for years. The facility uses written forms and overlapping shifts as a way of making sure all staff members communicate with each other.

Staff, nursing schedules overlap

RehabLink/Marianjoy has changed the scheduled work hours of many clinical staff to overlap with the different nursing schedules. Instead of all occupational therapists (OTs) coming in at 7 or 7:30 a.m., some OTs come in earlier and work side by side with the night nursing staff getting patients through the morning activities of daily living.

Some speech-language pathologists start earlier so they will be on hand for breakfast and can assist with swallowing problems. Others work a later shift and are on duty at dinner.

The case managers, who are social workers or nurses, periodically change their shifts so they sit in on the evening shift report to find out about family interaction issues that occur in the evening. The case managers typically work evenings about once a week and take the opportunity to update the nursing staff on what is going on during the day shift, Peterson says.

The staff who are on duty from 3 p.m. to 11 p.m. receive the most questions from families about how the patients are doing in therapy and about discharge planning, Peterson says. "This gives the case manager an opportunity to find out what the family concerns are and to answer them," she says.

Program managers and therapy leaders visit different shifts to conduct staff meetings and brainstorming sessions. Representatives of all shifts serve on the process improvement teams.

The RehabLink staff has developed several forms to allow the off shifts to provide feedback and input. For instance, a rounds form allows staff who can't participate in team rounds to communicate questions and concerns to the treatment team.

The forms are kept on the unit and routed to the case manager, who functions as reporter during the team rounds. There is a place for a reply to the staff member who expresses the concern.

For instance, if a night nurse expresses a concern to the attending physician, the physician may change a medication order or issue an order for a new piece of equipment. He or she will make a note on the form, which is routed back to the team member who raised the issue.

The evening and night shift frequently use the forms to call an issue to the attention of the day team, Peterson says.

The care plan, which identifies the patient's functional level and need for assistance, is a key communications tool for staff on all shifts.

In the past, the patient's need for assistance was posted on a white board over the bed. Because of confidentially issues, the information now is kept in a pocket on the wall or in a folder at the nursing station. As shifts change, staff members are expected to check to see what assistance the patient requires.

Weekend feedback

When a patient goes on a weekend pass, all members of the treatment team must sign off on a pass form before the physician will approve the pass. This step ensures that the patient can safely function in the home and that the family member who checks out the patient has completed educational sessions to help care for the patient.

When the patient returns from the pass on Sunday night, the nursing staff complete an interview with families, note any problems or concerns, and put the form into the medical record to provide the weekday staff with feedback on issues that might have surfaced while the patient was at home.

"Getting their feedback is an important part of the discharge process, because we find out what things they encountered that hadn't been anticipated and make dealing with them a final part of the treatment plan," Peterson says.

[Editor's note: For more information, contact Linda Peterson at (630) 462-4082.]