The Dreaded “P” Word

Yep, this is a blog about that dreaded “P” word that we all hate… Productivity.

I recently saw a post asking about how people manage to do their documentation all on the clock instead of staying after hours to complete it. There were many different comments and such, obviously each facility is different, but I know many places it is actually illegal to do any documentation OFF the clock. The problem with this is that many therapists then feel pressured because they can’t reach the productivity standard set at their facility (this also varies tremendously and I’m still not sure why…) because they are taking their time with documentation (like the good therapist they were trained to be) as well as actually caring for the patient (say whaaaaatttt?!)…

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While I have many thoughts myself about productivity, especially working in acute care (ha), it is still something we all have to work with. Yes, physical therapy does have to be treated like a business in this aspect. We all need to get paid somehow, right? Again, there are many issues with productivity standards across the board.. I’ll leave it until the end of the post to discuss my feelings and opinions (which may differ from yours, but hey, that’s life). In the meantime, I want to discuss a few ways that help me to stay productive. I mainly work in acute care, so I understand some of these things may not fully apply to every setting… but here goes:

1. Wear a watch. And I’m not talking about your fancy Michael Kohrs watch (I mean, that’s fine if you want to… but honestly who wants C. Diff on their watch anyways?). I use a digital watch that I bought from Wal-mart. Sure, I use it for time, but I mainly use the stopwatch. Just before I step into the patient’s room, I hit start. I do my thang with the patient and kind of monitor my watch as I go.
– Is this a quick in and out that probably never needed a PT consult anyways because they’re totally independent? Okay – 8 minutes might be my goal.
– Or are we hitting 35 minutes and it’s about to be 3 units (38 minutes). What else can I work into this session? Is there something I’m forgetting to educate them on?

Please do not take this as “oh I have 10 more minutes until the next unit.. let me talk about dogs.” That is not the case. If you are done with your session, you are done with your session. You need to remain ethical in all circumstances.

BUT, one physical therapist once told me to treat each session as if the patient were going to discharge right after. Did you tell them everything you think they needed to know? Did you go over those 2 steps – whether physically or verbally talk through them? Did you provide caregiver education? A HEP? Likely, there is always something else that can be discussed that will be beneficial to your patient. But again, if not, then you are done your session. Don’t be ridiculous. Yes, it’s your license, but it’s also your patient’s money, your time, their time…you get my point. Be ethical.

2. Be brief. Do you need to talk to a nurse or a physician? Get bedrest orders removed? You need to advocate for your patient? Recommend imaging?

Gather your thoughts, summarize it in 1-2 sentences, and get your point across.

Because like, um, nobody is like trying to spend a bunch of time um figuring out what you’re trying to like tell them. If ya catch my drift..

Be confident in your knowledge and what you are asking. YOU KNOW SO MUCH MORE THAN YOU THINK, I PROMISE. (I mean, unless you already think you’re awesome – keep being awesome, but don’t stop learning and stay humble).

The physician who has gotten paged 5 times in the last 2 minutes and the nurse whose patient just coded.. Yeah, they do not have time to listen to your paragraph long reason as to why Billy Bob needs an X-ray. Be thorough, but be concise. Not only will this save everyone time, but it shows that you know a little something something about what you’re talking about… Which then turns into respect from co-workers in other disciplines… Which then turns into good relationships… Which then likely helps you when dealing with their patients down the road.. Which then helps the overall look of the profession… Sound good?

3. Don’t spend time chatting. If you feel like you are distracted because your favorite nurse is working nearby and you can’t help wanting to chat about your weekend plans. Do yourself and all of the patients a favor and giddy up on out of there. Find another spot to document, move on to your next patient, go do something that will better the people you are there to help.

…Now, if you are there to talk about a patient – that’s another story. Go on wit ya bad self and discuss! ๐Ÿ˜‰

4. Know what to look for in your chart review.ย Yes, this will take time and practice. What floor is this patient on? Are they ortho or neuro? What are the key lab values and how will they affect the patient during your session? What are the key takeaway points in the chart.

Try to understand how much time you will need to chart review, everybody is different and likely it will change over time. Do you retain information better right when you get to work and do a mass chart review? Is it better for you to chart review as you go through the day? Figure out what works best for YOU and free yourself from distractions while you do it. Be thorough yet be able to summarize that patient quickly if someone asks you about them.

Another thing here – make sure you’re not constantly re-chart reviewing. Sometimes I know I won’t get to a patient until the afternoon. I may do a brief view of the chart when I arrive to work, but I don’t do my day’s chart review until later, because I know I probably won’t remember what I reviewed.. which kind of defeats the purpose.

5. Have a potential schedule in your head. And a back up. And another back up… because let’s be real, things never actually go as planned in the hospital. When do certain floors generally have lunch? I used to plan my patients sometimes based on this. Because I would know I could walk Jim right before lunch and then run over to the next floor where they still hadn’t received their lunch…etc.

Is Mary more tired in the morning? Are there family visits that day, pending MRIs, does someone have a colonoscopy planned (cuz ya probably want to wait until after it’s done…am I right..)?

Have a tentative plan in your head of which patients you will try to see first, whether because they are a BID ortho patient or just based on the fact that nobody else seems like they’ll be ready to participate with you until after lunch… It’s helpful to know where to go first, and second, and then back to the first. You know what I mean.

Manduka

6. Understand your facility protocols.ย This is where things will differ based on your hospital, facility, the administration, the therapy department, etc.

How do you bill for co-treats? If you feel like this hinders you at times, ask yourself – is a co-treat really warranted? By all means, I understand it DEFINITELY is sometimes. But maybe not as often as you think. Can you use a tech? Can you do an overlap (where the OT starts and does things for 10 minutes or so, then you come in to do things together, then the OT leaves..). Can you use the bed or some propped up pillows to help support instead of another person? Get creative. But make sure it is the optimal treatment that you are providing!

In regards to your facility and hunting down a physician vs calling them (also considering the physician’s views on this)… What is preferred? If you see the physician on one floor – why not ask him a question then about a patient even if it’s for later in the day? If you’re calling a physician and he doesn’t return the call for 10 minutes – do you move on and write a note in the chart that you tried (and it’s your attempt) or do you keep waiting? I’ve been at facilities that do both. The biggest thing is to try to find something to do during those minutes of waiting – documenting, talking to the nurse.. do something productive!

7. Document however much you can, whenever you can.ย Depending on your documentation system, if you can document parts of notes and then save the rest for later – why not do that? Especially if you’re waiting 10 minutes for someone to call back, or waiting a few minutes until your patient is clean. Don’t just stand there – get some of your notes done! If you can’t do partial notes and pend them away, maybe at least organize your thoughts and key points from a session on a piece of paper so you can easily transfer it later without straining your brain to remember.

Do you need to bulk your patients and then sit and type after you see 3 or 4? Or do you need to document right after each one? Know yourself. This will take time to figure out and of course it’s not always going to happen YOUR way, but you can definitely adjust the best you can.

8. Utilize your PT techs (if you have them). I understand this may not always be an option. And even if you have PT techs, likely there aren’t enough for every therapist to use one to help all at the same time. I will say this is something I didn’t utilize as much as I could have at times. Need to check if the ortho patients got their pain meds? Send the tech to ask the nurse while you document. Need a hemi-walker? Send the tech. Need a new gown, sheet, etc? Send the tech. Not sure if someone is back yet from MRI and nobody is answering the phone? Send the tech to check. You can even just have the tech do this for everyone on the floor for multiple therapists just to prep everyone and minimize all that walking and waiting time so that you can focus on the treatment.

Their job is to help out – but be careful if you feel like they begin to do something that is an over qualification for their job. Remember, they are working under your license.

9. Don’t waste time on the people who don’t want therapy. Mr. Jones is a frequent flyer and has been here 5 times in the last 3 months. He always yells when you walk in, he hates physical therapy, he says he doesn’t ever want to walk again. Welp, okay then. Definitely give it a try. But if you have seen him every single time before and he is not budging again, why spend 10 minutes trying to convince him? That’s 10 minutes of time you could spend with another patient. Certain people are worth talking to for that long, don’t get me wrong.. But really, the guy who spits at you when you’re not even fully in the door.. Probably not. Sometimes you have to remember that you can only help those who want to help themselves.

10. Understand you’re going to have good days and bad days. That’s life, especially in acute care. Whereas in outpatient, they actually have to make the effort and *generally* want to show up… Acute care is like a constant walking into a half-clothed person’s room who just had brain surgery and being like “Hey, want to get out of bed?” I mean, heck, even I sometimes would probably just want to lay in bed and sleep. Can ya blame them? Be human, understand they are human and you might not be able to talk them into it today (or they may be medically unstable), find an employer who understands this as well.

11. Move with a purpose. Yeah, and I mean fast. If you were planning on taking casual strolls through the hospital when you decided to become an acute care therapist.. I’m not saying you can’t.. I’m just saying if ya put a little pep in your step, you might actually have time to eat lunch. Don’t run, and be safe (duh), but in my opinion, when I am trying to treat the most people that I can the BEST that I can… I need to minimize the time spent walking in the hallways. Some larger facilities already group therapists to one hall or floor, but if that’s not the case, maybe try to plan to stay on one floor for the morning and then head to the next when you’re done. Even just walking up the stairs and taking the elevator multiple times takes up precious minutes in your day (one time I even timed it at a facility just to see..TMI ha)

mandala-tapestry1
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All in all, being productive just takes time and practice. If you are determined to focus and are able to minimize distractions, you definitely can be productive and not have to stay extra hours to finish typing! Just keep in mind that there are always good days and bad days. Patients vary, workers vary, everything varies – especially in acute care.

One rant I have personally; however, is — why is there not a standard productivity rate for each setting?! I’ve been to multiple different facilities who count different amounts of minutes as different amounts of units.. some weigh evals to be heavier while others don’t. All of this is referring to acute care. But then obviously SNFs are different since they go by RUGs – I can’t even explain that, ha. And I know outpatient facilities range greatly (from the mills to the one on one practices)…

I’m not sure how we can fix this or make a better joint productivity system, idea, thought process.. But I’m hopeful that someday we will! I see too many varying answers (which, I get it, it does vary based on patient population, hospital size, etc). But certainly we can figure out some sort of standard, right?

LennyLarry

Anywho, rant over. I hope this helps some of you! I’m sure there are many more tips and tricks out there – so feel free to comment and add on to help each other out ๐Ÿ™‚

PS if you are interested in acute care, be sure to check out my blog on being an acute care therapist. And if you’re small (like me), I have one for that too ๐Ÿ˜‰

And be sure to check out my recent post on being a PT without any specialty (The Generalist PT)… The “Jen of all trades” if you will.. For now at least ๐Ÿ˜‰

Until next time,

Jen

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