In With the New

A new, lean physical therapy machine is the result of our first Rapid Improvement Event

Out with the old

Physical therapists Mary Loose (left) and Sheri Melady are trading in their old-school methods for new streamlined processes to provide better patient care.

The Physical Therapy Efficiency Team

• Mikki Butler, case manager
• Daryl Gordon, R.N. Kim Jordan, R.N., administrator, patient care services
• Karen Kutner, administrator, surgery
• Mary Loose, physical therapist
• Chris Marucci, director, LVH–Muhlenberg pharmacy
• Sheri Melady, physical therapy coordinator
• Megan Snyder, R.N.
• Megan Trigiani, C.R.N.P.
• Ryan Vetter, occupational therapist

Help Bring in the New
Learn the results of upcoming Rapid Improvement Events at 8:30 a.m. in the LVH–Cedar Crest auditorium.

• Sept. 12 – Collaborative rounding
• Oct. 10 – Discharge process

Imagine you’re a physical therapist. You head to a unit to care for a patient, but he’s out for tests. You track down a computer, review the patient’s records and discover the activity order (required to start therapy) is missing. So you call his doctor.

Meanwhile, the patient returns. You search for a walker to assist him with therapy, but there are none in the unit’s equipment closet. So you begin your hunt, and after walking more than 1/2-mile, you snag a walker from another floor. By then, two hours have passed and the patient is too tired for therapy. You sigh and say out loud, “There has to be a better way.”

Unfortunately, this was the old-school reality for colleagues on LVH–Cedar Crest’s 6K. To help become new-school (more efficient), they tackled our health network’s first Rapid Improvement Event—the key component of our System for Partners in Performance Improvement (SPPI). The goal: to eliminate gaps in the process and allow patients to return home sooner.

“Therapists worked so hard, but the patient was benefiting from only a small percentage of it,” says Sheri Melady, physical and occupational therapy coordinator. “We needed to work more efficiently.”

To make it happen, a team of 10 staff members joined with SPPI coaches and our sensei, Mark Mahoney of Simpler (a company specializing in health care efficiency). They spent four full days mapping out their current process, brainstorming new ideas and cutting out unnecessary steps. On the fifth day, they presented their findings inside a standing-room only LVH–Cedar Crest auditorium.

Here’s how they improved:

Old-School Ways

• Equipment (including computers that properly documented patient information) was often hard to find.
• 50 percent of patients admitted to 6K didn’t have physician-prescribed activity orders.
• Caregivers were unsure of their role in keeping patients mobile (something that can optimize the patient’s hospital stay and prevent medical complications).
• Patients’ therapy often conflicted with tests, visitors or meals.

New-School Ways

• Equipment is easier to find. The team evaluated how much equipment the unit needed, then cleaned, stocked and labeled the unit’s closet accordingly (right). They also reserved a computer on a mobile cart with appropriate programs for physical therapists’ use.
• Activity orders are top-of-mind. The team consulted with information services colleagues and is developing changes in CAPOE (computer-assisted physician order entry) to ensure all patients have activity orders.
• Colleagues are more certain of their roles. The team re-educated staff on protocols that outline the right way to keep patients mobile. They also rearranged patient rooms to better suit therapy. One example: moving the chair between the bed and window.
• Therapy is scheduled with patients. The team implemented a process where physical therapists work with nurses to establish set therapy times and ensure patients are available.

Thanks to these new-school changes, physical therapists will now have more time for direct patient care (shifting to 80 percent productive work). To measure their success, 6K leaders will evaluate daily that patients have activity orders and are appropriately mobilized, and that patient rooms and the equipment room meet the new standards. The unit also will monitor patients’ length of stay as well as outcomes like fall rates. Eventually these new processes will be rolled out network-wide.

“We’ve gone back to the basics,” says Daryl Gordon, R.N. “What seemed overwhelming is now a well-oiled machine, and all caregivers—therapists, nurses, doctors and technical partners—know how to make it work.”

—Sally Gilotti

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