I feel compelled as a manager to expand on the notion of keeping patients longer just to extend length of stay.
I have seen it all; therapist don't want to continue the patient any longer because of many reasons: extra paperwork, lack of clinical judgment, lack of training in treatment of some conditions, i.e: recertify for one more week? oh no, let the nursing staff teach them about their meds at home...oh well, the caregiver can show her how to use the walker in her kitchen...well the cna's know how to do ROM...well, she will get use to her room eventually; we don't need to set it up... her family will help her how to get in/out of the car, her daughter will do all the shopping...no she doesn't have any hobbies, etc. These are all real responses from average , well intended clinicians. i would never consider them slackers in the general sense. Simply they loose sight of some issues than CAN be addressed in the context of a treatment session: TEACH/TRAIN patient, family, caregiver etc I have a pre-d/c checklist that I go thru with the team, As an outsider in the plan of treatment, I help my team offer all we can vs. what we have time for. I have a busy department with roughly 50 treatments provided daily...the therapist are VERY busy and it is only human to miss something. Just yesterday my OTR decided to d/c his patient initially evaluated to increase her level of assistance during bed-side toileting care given by nursing. Very obese lady in deep depression with her med discontinued by mistake upon d/c from hospital: the transcript was not carried over to the snf admissions orders. the patient refused therapy every time so due to refusals...he decided she ins not motivated...does not want to... Well...he missed her high risk of skin breakdown as an initial approach and after discussing with me his decision and going over our d/c checklist we decided to stay longer to address that component . Proper orthotics for the feet, staff edcation on schedule...etc A couple of sessions perhaps but necessary because nursing DID NOT provide the orthotics she really needed. The perception that ...well the manager just want to get more money from the ins can be there. We use a wide variety of objective assessment tools to help identify the impairments particularly Pt and occupational needs, and to help deter that impression. Lack of experience in the managerial scope, lack of understanding of the big picture usually feeds the miss-perception yet , I have learned: You will disagree with your staff in some of their decisions but you must explore opportunities for treatments that are the best interest of the patient . Education on the scope and possibilities of our professions come with experience in the settings we practice. Cultural differences facilitate certain approaches that can not be possible in others. That understanding helps tremendously in "discovering" opportunities totally within our scope/ethical responsibilities. Wow, sorry for the log post...like the energizer bunny: I just kept going! Carmen > Date: Fri, 27 Feb 2009 08:20:52 -0500 > From: [email protected] > To: [email protected] > Subject: Re: [OTlist] Misery loves Company and Collaboration > > Chris and Ron, > > I've been monitoring your responses on the list here and I appreciate > the discussion. Chris, your points on creating a culture, fostering > interdisciplinary relationships, and earning respect with hard work > and effective treatment are very much similar to my experience over the > years. > > I agree wholeheartedly and have had many many similar experiences. I the > departments that I have worked the OT/PT/SLPs have all shared common > treatment and office areas and we communicate, collaborate, and > socialize all the time. Like you Chris I've worked hard to earn respect > by being (hopefully) a good example. Giving good OT where warranted and > getting out when needed. Some of the PT/OTs with less experience are > into the separation and treatment turf issues but they soon warm up to > the value of creative collaboration. > > If you look at the PPS/SNF system from a strickly business perspective > (which I rarely do), you will see that the pt gets more opportunity for > beneficial therapy time on a greater variety of skills and the > Department gets more financial benefit from the involvement of more > services i.e. RUGS category $$$. > > So it's win(PATIENT)-win(OT)-win(PT)-win(Administration) when teamwork > is applied. You often can throw in a win(Nursing) when we > involve-educated-collaborate with them. I know I sound like a PollyAnna > but I know this concept to be true. > > The problem is often the situation when PT or OT continues to be > involved when a pt really no longer progresses or benefits from the > skilled service. Then...out comes the bad therapy practices we've all > complained about on this list. As Breanne stated in her post, there are > companies that want you to go "Create referrals through screening" or > "keep the pt for a longer length of stay". It's these bad clinical > decisions that create the treatment that causes such > misperceptions/misunderstanding/disrespect amongst the health care > community. > > Last time I looked there is a enough appropriate and meaningful work to > be done for all of us to work together in the Rehab industry. I have > had my moments of professional doubt base on the types of patients that > end up in SNF (see earlier post) but I've seen a lot of good overall > practice come from a well run Rehab department. > > Another point that often irks me in these discussions is this > preoccupation (pardon the pun) with being "unique" and "understood". To > me being "effective" and "relevant" is more important to the healthcare > market place. As Chris alluded to about community respect and > education ..a profession's impact is built one customer at a time, one > session at a time. > > Thanks for reading, and posting, > > Stir the pot! > > Brent > > > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] _________________________________________________________________ Windows Live™ Hotmail®…more than just e-mail. http://windowslive.com/howitworks?ocid=TXT_TAGLM_WL_t2_hm_justgotbetter_howitworks_022009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
