Scenario 1: "OK, I'm almost done; just two more patients to see today. Wait, Jessie has Mr. Johnson in physical therapy and Karissa is working with Mrs. Jones for occupational therapy. It'll be at least 45 minutes until either of them is finished with treatment and ready for speech. Let me see, Mrs. Jones is scheduled for three times a week so I can see her tomorrow instead of this afternoon, but Mr. Johnson is five times this week and his payer source is Medicare Part A. If I don't see him today, his weekly treatment frequency will be out of compliance, I'll have to document a missed visit, and he won't meet his reimbursement group level. On the other hand, if I wait 45 minutes to see him, the idle time will keep me from meeting my productivity requirement for the day."
Scenario 2: "Mrs. Harris has experienced worsening of her dysphagia secondary to progression of her multiple sclerosis. I want to complete oral feeding trials during our session this morning, but she's high risk for aspiration and her posture in her high-back wheelchair is less than ideal right now. The nursing assistants have helped but she's still not at 90 degrees and they say she keeps sliding down in her chair. I know she would be safer if we could maintain upright positioning while working together. Too bad she's not working with OT until the afternoon today."
When I first started work as the lone speech-language pathologist in a small sub-acute and long-term care facility, I often found myself in scenarios like these. Not only did such situations add stress to my day, but they were frustrating because, clearly, patient care suffers when our schedules conflict. I knew such scenarios could be avoided with better collaboration with the occupational and physical therapists at our facility.
To avert such scheduling mishaps, improve patient outcomes and boost our ability to meet company productivity and treatment-frequency requirements, I set out to improve our collaboration. My first step was to better understand PTs' and OTs' roles in my patients' daily treatment and discharge planning—and to pinpoint where increased coordination could help us provide better care.
My second step was to make that collaboration actually happen. To get there, I put into practice some simple logistical strategies that you can try as well:
- Hang a master schedule board in the gym or office on which all clinicians estimate when they will see each patient on a given day. In smaller rehab gyms, simply checking in with the other clinicians in the morning may be enough to avoid scheduling conflicts. Make sure any publicly displayed information is consistent with your facility's HIPAA compliance policy.
- Keep a small dry-erase board in each patient's room where clinicians note daily treatment hours. This strategy requires a little extra planning in the morning, but allows patients to anticipate therapy and to practice planning, organization and memory skills.
- Check in with other clinicians in the gym after a treatment session to see if they need to see the same patient and if it's a convenient time for them to begin. I find patients don't mind waiting in the gym for 10 to 15 minutes for the PT or OT to be ready. It keeps them from going back and forth from the gym to their room multiple times in a day. And they often enjoy watching others receive treatment, listening to music and socializing while they wait.
- Coordinate with PTs and OTs to end one therapy session where the next session can begin. For example, a PT can walk a patient to the dining room after a session, or an SLP can bring the patient to the therapy gym after a session. If you're working with a dysphagia or voice patient, ask the PT or OT to complete a transfer at their session's end, so the patient is upright in a chair and ready for speech.
- Set up a small treatment area in or close to the rehab gym or office. This strategy keeps speech from being isolated from physical and occupational therapy activity in the gym. If you're able to conduct cognitive treatment in the office, post a "Treatment in Progress" sign on the door to minimize disruption and noise.
- Plan to see patients for swallowing, breathing or voice treatments after physical or occupational therapy, so that the patient is upright in a wheelchair. Ask for PTs' and OTs' help to achieve ideal positioning in future sessions.
- Schedule patients working on sequencing, planning and executive function skills before the OT goes through an activities-of-daily-living routine or completes a complex task, such as cooking, with the patient. Ask the OT ahead of time for a written outline of the patient's ADL routine or the recipe to be used for cooking so that you can review it with the patient beforehand. Offer suggestions that will help the clinician to use an appropriate number of steps for each task and effective cueing strategies that help the patient follow directions and achieve success.
- Schedule patients who need support for memory and problem-solving related to safety awareness and mobility before physical therapy. Ask the PT for a list of safety precautions specific to the patient's physical and weight-bearing status so that you can use common terminology and apply memory strategies to maximize carryover. Give the PT input on how to simplify or adjust terminology and incorporate repetition according to the patient's level of comprehension and recall ability.
Of course, despite all our best efforts, scheduling conflicts are bound to happen once in a while—in which case courtesy, flexibility and cooperation always work best. A culture of mutual respect and a coordinated approach to care are key to interprofessional collaboration and to helping our patients achieve the best possible outcomes.