Working within managed resources

Background

Nia is an occupational therapist working on a subacute general medicine floor.  On the subacute unit, OT referrals are automatically generated on admission.  There are 2 full-time OTs assigned to the unit and one OT is on extended leave.  Nia has spoken to the unit manager regarding the complexity of the patients and her difficulty managing the volume of referrals. Given the short stay, fast-paced nature of the subacute unit, there are instances when a patient is transferred to another unit or, discharged entirely from the hospital before Nia can assess or complete her involvement and documentation with the patient.  

Members of the interprofessional team have observed the challenges Nia is facing and are assisting with screening referrals for occupational therapy by identifying high priority patients. Nia wonders what solutions can be put in place to manage her large caseload.

Considerations

• Nia reviews the Standards for Record Keeping, and Working Within Managed Resources on the College website
• Nia reflects on the impact to patient care if the clinical record is not up to date and the client is discharged from the subacute floor
• Nia considers speaking with the unit nurse manager and the OT professional practice leader about her concerns of risks to patients and the impact of reduced OT resources on the OT’s ability to provide safe care
• Nia considers contacting other organizations with a similar patient population to explore their processes as an option to revise the expectations for OT service delivery

Outcome

• Nia reviews the Working Within Managed Resources document and finds the sections: Models of Care and Managing Caseloads useful in formulating her discussion with her manager and team
• Nia reviews the Standards for Record Keeping and understands that record keeping demonstrates professional accountability, records events, decisions, interventions, and plans made in the course of the delivery of occupational therapy services
• Nia consults with other OTs in the organization who provide strategies for her to implement; Nia decides to alter her record keeping processes and now documents immediately following seeing a patient and prior to seeing the next patient to prevent gaps in the patient chart
• Nia drafts a proposal to present to her manager and team as a solution to improve patient safety and program efficiencies. Some of Nia’s solutions include:


• Develop an occupational therapy priority matrix to support decision-making for effective prioritization and allocation of resources
• Work with the interprofessional team to clearly identify priority areas of the service 
• Develop a priority matrix to identify patients who are appropriate for OT services and to support prioritizing services on the subacute unit
• Develop a template and forms to support efficient documentation – tailoring documentation to aspects that apply to occupational therapy services on the sub acute unit
• Use evidence-informed practice to develop service models and provide rationale for service delivery recommendations when presenting options to management or payers
• Clarifying expectations with managers, interprofessional team members and patients about what to expect regarding OT service on the subacute unit.

Discussion

Within the healthcare environment, balancing service delivery demands and patient/client expectations with fiscal responsibility, health funding reform, and resource management can present challenges for health care professionals. The College encourages OTs to speak with management regarding any identified risks to patient/clients if the OT feels the provision of care is compromised or unsafe due to the allocation of resources. The OT is expected engage in a collaborative process to identify reasonable solutions and appropriate courses of action.

References

• Working Within Managed Resources
• Standards for Record Keeping

Contact

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