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Weekend acute care coverage
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Weekend acute care coverage - June 12, 2007 7:54:00 AM
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blromig
Posts: 3
Joined: June 11, 2007
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We are a 225-bed acute care hospital (also has a 30 bed short term rehab/skilled nursing unit) and interested in how other facilities staff their department on the weekends (this has become a very sore issue which has led to many good clinicians leaving the organization). It is understood that weekend coverage is necessary but how much staff is needed, how to structure the staffing, and how to determine whom really needs treatment on the weekend are questions that continually surface.
Currently, services are provided on Saturday and Sunday by clinicians (PT and PTA) from the acute care department, home health services, and outpatient facilities. Typically, there are 5 clinicians (e.g. 3 PTs, 2 PTs, and 3 or 4 technicians) working. Caseload is orthopedic, some neuro, and a large population of general medicine. Patients are seen BID, QD, or 6x/week.
We are interested in determining how other facilities (who are of similar size) determine their weekend staffing and whether they utilize a “priority” system (following JCAHO regulations) or some type of hierarchy of care to determine coverage needs.
The dilemma we are facing is that the staff of the outpatient facilities will be given comp time the week before and after they work the weekend. This definitely disrupts patient care at the facilities in terms of scheduling and continuity of care. Also, it has contributed to dissatisfaction in the work place (good clinicians have left the organization secondary to weekend coverage issues).
Any input, suggestions, or experiences (e.g. creative staffing solutions) would be greatly appreciated.
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Re: Weekend acute care coverage - June 12, 2007 9:06:00 AM
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orthotherapist
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I thought you were describing my former employer until you said they got comp time the week before and after(we got one day of comp time but put in 15-16 hours on the weekend - one of the reasons I left)
Anyway to answer your question it is my belief that if a patient needs therapy Monday - Friday then why don't they get it on Saturday and Sunday? To a sick/recovering individual all days are the same and should be treated as such - they should not expect a lower level of care just because it is a weekend.
I did a clinical rotation at a facility that worked 10 hour days seven days a week. Excellet outcomes and patient satisfaction. They were covered by inpatient staff only and worked a 5on/4off/3on/2off rotation (basically worked every other weekend and always had the same two weekdays off.
My question to inpatient staff (based on my clinical rotation) is that if you feel the patient does not need therapy BID or QD on weekends why do they need it that often during the week?
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Re: Weekend acute care coverage - June 12, 2007 11:24:00 AM
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blromig
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Joined: June 11, 2007
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Do you recall how many staff were involved in this type of work schedule? Also, how did they feel about working every other weekend?
Thanks for your reply.
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Re: Weekend acute care coverage - June 13, 2007 3:30:00 AM
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orthotherapist
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I do not recall specifically but the staffing was the same seven days a week.
Basically take what you have now and apply to seven day a week coverage. Since many patients are DRG based this may be an issue as costs will go up but reimbursement will remaini the same. My challenge to your staff would be to ask "does this person need skilled intervention" - in my inpatient experience many that were on the caseload did not.
I would always look forward to my Monday morning phone call questioning why I had discharged Mr. Smith and my reply would be he did not warrant skilled intervention.
As far as working every other weekend they knew that when they were hired so it was not an issue for those that choose to work there (just as a nurse knows they must work weekends). These therapists were indoctrined into the belief that inpatient care needed to be provided seven days a week.
Other alternatives that i have seen are to hire just weekend staff - many new grads are willing to do this in addition to their regular full time outpatient job.
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Re: Weekend acute care coverage - June 19, 2007 4:03:00 AM
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buckeye
Posts: 181
Joined: May 24, 2007
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I have worked at various sized hospitals - 35 beds to over 225-beds. I generally agree with orthotherapist - the patients' needs do not change just because it is Saturday, Sunday, or a holiday. However, too often, there is not sufficient staff to provide the coverage for weekend care. This may be a reflection on tradition in the therapy field, lack of available candidates to fill positions, budget concerns, etc. The facilities where I have worked never adjusted regular hours with comp time - the weekend just became overtime pay.
I recall a study in the past that looked at discharge status and length of stay for orthopedic inpatients who received PT over the weekend versus those who were seen just Mon - Fri. I am not sure if this was a well-designed study, but the length of stay and outcome at discharge did not change significantly between the groups. With DRGs, it was easy for hospitals to look at minimizing weekend PT coverage as a cost savings. And some PTs likely saw this study as a means to say - weekend coverage does not make a difference.
"...how to determine who really needs treatment on the weekend..."
As you develop the plans of care for the inpatients, you do not have to think in terms of traditional PT. The frequency of PT visits is based on the examination and evaluation and 'should be determined by the physicial therapist to maximize effectiveness of care and efficiency of service delivery.' (Quote is from APTA Guide to Physical Therapist Practice.) If you elect to follow through with the professional judgement on delivery of care, be prepared to justify your actions because it may change the bottom line in your budget. I have talked to other therapist providing inpatient coverage and the frequency and duration can be vague - one to three times per day four to seven days per week. This allows for easy changes in the delivery of physical therapy based on how the patient is doing. At any time, you can then determine - Does this patient need skilled PT?
If your staff is truly not sufficient to cover the weekends at the same level as weekdays, then it is fair to adjust the delivery of care. Then you can ask questions - "Is discharge on Sun or Mon and are there specific needs for PT delivery prior to discharge?" "Will it do harm if they do not have therapy one or both days on the weekend or for a holiday?" "Are the skills of PT necessary for this patient to get out of bed or to walk?" "Does the patient need rest from daily PT?" These are only sample questions to ask yourself - you can think of others.
Staff structure for weekend - I am not aware of a proven formula being available. My experience has varied from combined PTs and PTAs, PTs only, and PTAs only (with PT on call). Orthotherapist mentioned one method to make the work schedule a seven-day week with 10-hour days. There are others available - it just takes some looking. The weekend inpatient work is not attractive to PTs since they can work an outpatient clinic without weekend coverage - you may need to structure some incentive (usually dollars).
Comp time at outpatient facilities will definitely disrupt the efficiency and continuity of care. Your outpatient satisfaction will likely spiral downward.
blromig - I do not think you will ever find the ideal answer since there are gaps that exist. Traditional delivery of therapy care versus the PT determining based on need for skilled care. Facilities that are looking too hard at the budget versus appropriate care. Therapists who want the easy life of no weekend work versus those who are willing to work weekends and holidays. A physician writing an order for specific frequency of PT versus the PT determing the frequency based on examination and evaluation.
Good luck.
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Re: Weekend acute care coverage - June 20, 2007 2:55:00 AM
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blromig
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Joined: June 11, 2007
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Thank you for your very insightful thoughts- I could not agree with you more. We have to think beyond the technical role that we have assumed in the past and act like a professional. Our examination and evaluation should dictate the "skilled" needs of the patient.
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Re: Weekend acute care coverage - June 20, 2007 3:29:00 AM
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orthotherapist
Posts: 219
Joined: February 6, 2007
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It all comes done to determining what the patient needs. If it is skilled therapy then provide what is appropriate based on a thorough evaluation. If this requires weekend (which like I stated earlier should not be thought of as any different from Monday-Friday) then provide the patient with it. If it is not skilled then speak with the nurse/MD and discharge the patient.
Blindly treating a patient due to an MD order and because it "has always been this way" is an inappropriate use of resources.
If a patient does not need therapy on a weekend then for sure they do not require it BID monday-friday or even daily.
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