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Information, Please
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Meadowside nursing facility had a good referral relationship with the local hospital, so it was no surprise when Mrs. White, discharged from the hospital after her stroke, was referred there for therapy. She was admitted, but unfortunately, she arrived without orders for therapy. Nor did the Meadowside staff know that she required an assistive device. It was Friday afternoon. Mrs. White could not be evaluated or treated until Tuesday, when her doctor returned and sent therapy orders.
Sound familiar? Although Meadowside had an excellent therapy department, lack of information and paperwork compromised Mrs. White’s care before it even began. “To be most successful with an admission, the process has to start not when the patient gets there, but before she even arrives,” says Mark Besch, vice-president of clinical services for Aegis Therapies. “The facility needs an in-depth prescreening procedure with the referral source, so that when the decision is made to admit, staff has therapy orders and already knows her situation, her needs, and even what her desired discharge destination is going to be.”
Armed with such detailed information, the facility can anticipate the patient’s requirements not only for therapy, but for special equipment, supplies, assistive devices, pharmacy, diet, etc. “Focusing on the patient means being the most prepared you can be,” says Besch. “When she walks through the door, you want to begin her care immediately.”
Had Mrs. White arrived at Beverly Healthcare Columbus in Columbus, Nebraska, her needs would not have been a surprise. Admissions at Columbus collects detailed preadmission information from the discharge planner. Therapy team leader Lynn Teply, PT, notes that “a therapist sometimes visits the hospital therapy department, or therapists there will send notes on what they have been working on with a patient.”
The entire staff at Columbus is included in the information loop. “When we get a call on an admission, social services routes the paperwork to nursing,” says Khristy Long, director of nursing. “We look at diagnosis, risks; we make sure we have therapy orders.” At 8:30 a.m. and 1:00 p.m. every day, department heads meet for a five-minute stand-up to talk about admissions, discharges, and anything that’s going on in the facility. “Our therapy team leader is an integral member of the stand-up meetings,” says Staci Cardenas, executive director. “When a resident comes in, he or she has already been assigned a therapist and we have all the systems in place.” The unit director writes up the information for the nurses’ station. “The hands-on staff knows who is coming in, the diagnosis, the fall risk, therapy needs, etc.,” adds Long. “The practice has improved clinical outcomes and increased census.”
To solve the common problem of missing therapy orders, Vickie Cortner, senior community relations representative for Beverly Healthcare’s District 33 in Indiana, worked with hospital case managers to add check-off boxes for therapy to physician’s interfacility orders. “It saves time for the physician and helps in the transition of the patient from hospital to our facilities,” says Cortner. “It’s a huge step forward in providing quality care for the patient.”
For orthopedic patients, some facilities have proactively focused on the patient before the patient even goes to the hospital for surgery. The PA Peterson Center for Health in Rockford, Illinois, advertises its Pathway Orientation class for upcoming surgery candidates in the local newspaper.
Held every Thursday, the class provides an overview of what to expect in therapy after surgery. “We give a tour of the facility so people can see exactly where they will stay,” explains Terry Klein, PT assistant and rehab program coordinator. The nurse explains pain management. Then the therapist describes therapy goals and what further therapy is available as an outpatient and through the facility’s wellness program.
“Patients feel very relieved knowing what to expect and seeing exactly where they will be,” says Klein. “The program helps people understand the value of postsurgical therapy, and it gets them into the facility.”
That’s a win for the facility, but it’s also an example of how the partnership between therapy and the facility can creatively focus on meeting the patient’s needs.
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