IRB Rehab Efficiency Study 4A Rehab UPMC St Margaret Judith Tinelli MSN, RN, ONC, CNL, CRRN
Overview Significance Purpose Hypothesis Results 1. 3 hour rule 2. Patient satisfaction 3. Staff satisfaction Community discharge Timely rehab arrivals Statistics Clinical relevance
Three Hour Rule- CMS A patient may be discharged from the acute inpatient rehab unit due to noncompliance with the Three Hour Rule per day of therapy The Three Hour Rule compliance is not only the preferred time spent in therapy for advancing the patients functional status but is a requirement for acute inpatient rehab and a Center for Medicare Services 2010 rule Significance Late arrivals may exclude the patient from therapy sessions Noncompliance 3 hour rule may d/c a patient from rehab Non adherence to schedule may decrease patient satisfaction and decrease functional progress Non adherence to efficiency may decrease therapist satisfaction
Purpose Evaluate the effectiveness of a medication nurse 4 days per week until 9:30am for 2 months. No FTEs added-budget neutral Hypothesis-adding a med nurse for the morning medication pass would positively impact the on time arrival to therapy appointments by decreasing the reasons for lateness such as med administration. Background-currently 19-30% of the patients arrive late each month Bathroom and medications have always headed the list averaging 15-35 times/month
Results Medications and bathroom disappeared of the reasons for lateness list No medications errors Increased Patient & Staff satisfaction Increased dispositions to home
3 hour rule compliance Rehab rule compliance soared to 88% during the Rehab Efficiency Study from the previous quarter which was 80-84%. Percent compliance 3 hour rule 88% 86% 84% 82% 80% 78% 76% 74% 72%
Press Ganey Patient satisfaction scores Availability of nurses Quality of night shift nurse Quality of day shift nurse Patient satisfaction overall Chart1.crtx 0 50 100 Post study(n12) Study(n33) Pre study(n89)
Staff Satisfaction Multi-disciplinary Survey Monkey (n16) 60 50 40 30 20 10 6am aid morning med nurse delay therapy 30 minutes 0 strongly agree agree neutral disagree
Community Discharge (n94) Community Discharge 90 85 80 75 70 Community Discharge
Late Arrivals to Therapy 30% 25% 20% 15% 10% 5% 0% aug sept oct nov
Results Summary Positive for Nurse Satisfaction Positive for Therapist Satisfaction Positive for Patient Satisfaction Positive for 3 hour rule compliance Mixed for patient return to community setting Positive for efficiency to therapy overall FIM (Functional Independence Measurement) change mean for the study was 19.25 as opposed to 21.9 the previous calendar year.
Clinical Relevance Observation of 94 patients over a period of 60 days Earlier start on med pass patients not as rushed Diary kept by med nurse interruptions by physicians, OT, social work, home health, missing meds, tests (dopplers, stat tests, etc) which are arranged around therapy times impeded med pass.
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