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The pit bull territorial philosophy of rehab facilities in the old millennium is not the best strategy for success and survival in the new one. Rehab providers who are part of larger health systems are finding new ways to improve patient satisfaction, clinical quality, and cost-savings efficiencies. One of the more successful strategies appears to be to change operations in order to integrate rehab services, documentation, and staff training across the continuum of care.
"Let’s imagine that I’m a daughter and my mom has come into the acute hospital after a stroke," says Cyndia Schreiner, BS, CRRN, LNHA, director of rehab services and administrator of long-term care at Alliance (OH) Community Hospital’s Center for Rehabilitation. The hospital has 100-plus beds, including 15 rehab beds.
"When my mom is on the acute care side she learns to do transfers one way, and then in rehab she learns to do it another way," Schreiner says. "Then she receives home care services, and she learns yet another way."
How likely is it the patient and her caregiver are going to be confused, dissatisfied, and inadequately trained to become independent? That is the question that fuels the move to greater rehab care integration across provider settings. The choppy, departmentalized approach to rehab services also may confuse and annoy physicians.
Before Appleton, WI-based St. Elizabeth Hospital, a facility that is part of Affinity Health System, integrated all rehab services across the care continuum, physicians found that their rehab referrals were handled differently according to which rehab clinic received the referral. There was no standardization, even among departments with identical levels of care, says Maija West, OTR, MPA, manager of rehab services for St. Elizabeth, which has 17 rehab beds, 20 subacute beds, and about 190 beds total.
"Documentation was different; even the duration or frequency of many of our programs were handled differently," West says. "We received some feedback from physicians and our health plan that they wanted to know rehab would be handled the same way, wherever their patients went."
Whether a rehab provider plans to integrate across a continuum of care or across various sites on one level of the continuum, it’s important to approach the process systematically and with sensitivity to its impact on staff. The goal is to improve patient care, with the additional benefit of saving money, West says.
"We now have much more efficiency with our management time and staff time," West says. "One manager can focus on one global task and facilitate all sites to complete it."
The rehab facilities associated with Affinity Health System now can benefit from improvements and products developed by their counterparts. For example, if one site develops a comprehensive training tool for therapists, then the other sites can download and use that same tool, West explains.
"One site does a lot of work investigating something, coming up with an idea, and another site will customize that process improvement to meet that site’s needs," she adds. "Standardization has allowed us to share staff, including nurses who work on both inpatient rehab units and speech pathologists who work at any site."
Even occupational therapists (OTs) and physical therapists (PTs) will travel back and forth between sites if a therapist is on maternity leave or one site is particularly busy, West says. While the health system might have attempted to pool staff this way before the integration, it wouldn’t have worked as well because the documentation and procedures might have been different between sites, making it difficult for therapists to quickly adjust to the new environment.
Alliance Community Hospital’s operational change gives the facility greater flexibility in staffing rehab therapists to the department that has the greatest need. If the outpatient department needs some additional help, then a therapist from inpatient or from subacute or long-term care can step in to provide coverage, and vice versa, Schreiner says.
"We had everyone cross-trained," she explains. "So we have been able to provide a seamless service, and it improves hands-on patient care, outcomes, and communication."
Customer satisfaction among both patients and physicians has risen in the three years since the hospital began cross-training rehab staff and providing a greater continuum of care, Schreiner says. Patients often see more of the therapists who began their treatment, and they definitely receive more consistent education, all of which improves outcomes, she adds.
"Any person we serve could have contact with the same therapist throughout the service period," Schreiner says. "Everybody is talking the same language, and as a result of cross-training we see consistency and continuity."
• Cyndia Schreiner, BS, CRRN, LNHA, Director of Rehab Services and Administrator of Long-Term Care, Alliance Community Hospital’s Center for Rehabilitation, 264 East Rice St., Alliance, OH 44601. Telephone: (330) 829-4067.
• Maija West, OTR, MPA, Manager of Rehab Services, St. Elizabeth Hospital, 1506 South Oneida St., Appleton, WI 54915. Telephone: (920) 738-2593.