Impacts of a Rehab Aide Mobility Program on Employee/Patient Satisfaction and Hospital Patient LOS

Background

As I worked my way through my physical therapy studies here at UNC, I grew interests in areas of administration and management. I think exploring new ways of improving job satisfaction for Physical Therapists and other healthcare workers is interesting in the hospital and outpatient clinics. In my brief time spent in the Healthcare world so far, I have picked up on several different stressors that have been imposed on workers including: productivity standards, pandemic-related problems, burnout, employee shortages, and many more. On my clinical rotation at the hospital, I found myself walking into patient rooms and discovering quickly that skilled physical therapy interventions were not warranted, due to their high level of function. By the time I saw these patients, documented, and signed off on them, I felt as though there was time that I used during my day that was spent away from patients that were appropriate for physical therapy. Productivity also can experience negative impacts. I also observed nursing staff that was understaffed and, as a result, found it difficult to deliver the best care to all of their patients. When I saw an email related to a “capstone opportunity for people interested in management,” I knew I had to explore that further. This email opportunity developed into a collaboration with UNC hospital management to assess the effectiveness of a novel rehab aide mobility program that had been recently rolled out on certain units.

Statement of Need

In 2020, hospital expenditure contributed $1.2 trillion to the total healthcare expenditure.¹ The average LOS costs $11,700, with patients averaging 4.6 days in the hospital.² There is great incentive to reduce overall patient length of stay (LOS) because this is used to determine effectiveness and quality of care provided. Patients with shorter LOS and pleasant experiences will also be more likely to refer others to that hospital, adding to the incentive for short stay and optimal care.³ High LOS and acquired hospital disability are both associated with low physical activity while admitted.⁴ Other complications include poor quality of care, adverse events, nursing shortages, high levels of burnout, and low levels of physical activity while admitted.^4,5,6,7 UNC Hospitals rehab department recently rolled out a new program that involved the implementation of PT Techs, or Rehab Aides as they are called at UNC, on certain floors. The Rehab Aides are assigned to certain patients on specific floors, that have been cleared for activity either through walking or other “non-skilled” activities. The program’s goal is to reduce the ratio of patients’ expected length of stay versus their observed length of stay. Specific units have been targeted by this pilot program, including the GI unit.

Purpose

This project explores patient, caregiver, nurse, therapist, and rehab aide perceptions of the program. This effort was to capture any secondary benefits that this program might be having an effect on, such as if it is impacting staff “burnout” through improved job satisfaction or positively impacting workload. The approach for this project is to see if the Rehab Mobility Aides are causing a positive impact on: patient LOS ratio, patient satisfaction while admitted, and Hospital staff job satisfaction. My role with this project was to create surveys for various staff employees and patients to take, in an attempt to capture their perception of how this program is going, and more broadly their perception of the Rehab Aides role in patient care. The groups of people that were surveyed included the Rehab Aides, PT, OT, nursing staff on the units, and the patients/ caregivers receiving these services.

Products

A few items have been created throughout the capstone process. All of these items were created with the intent of being used at the Acute Care section of the 2023-2024 APTA Combined Sections meeting. The abstract will be submitted for review. The poster board has been created with the intentions of becoming a poster presentation, while the PowerPoint presentation will be intended for use in a 10 – 15 minute platform presentation at the event.

Abstract:

Abstract Submission for CSM 23-24

Poster Presentation:

Rehab Mob. Program Poster CSM 23-24

Platform Presentation:

Rehab Mob. Program Platform Presentation CSM 23-24

Evaluation

The evaluation of my capstone materials has been a continuous process throughout this experience. All members of my capstone committee were helpful by providing me feedback as the surveys were developed. Lisa Johnston, my Capstone Advisor, provided me with useful feedback on all of my capstone deliverables throughout their creation.

I asked for my classmates to provide their feedback on my poster board presentation via an anonymous google forms survey. The survey is 4 questions designed to help me determine if the information presented on the poster board is both easy to understand, and if it is helpful for the survey participant in their future practice as PT’s. All 7 respondents either strongly agree, or agree, that all information on the poster board is clear and easy to understand. All respondents also either strongly agree, or agree, that the information presented is helpful to them moving forward with their practice as PT’s. Classmate feedback for suggestions on how the poster can be improved includes: including more data on questions that had “negative” answers and reducing the amount of words.

If you wish to share your comments about the poster board portion of my capstone project, I would appreciate your feedback for improving the quality of this deliverable. The link is provided below, responses are kept anonymous.

Link: https://forms.gle/2d4w1M4somJo7mpaA

Blank Survey:

Capstone Feedback Survey Copy

Preliminary Data Results:

Capstone Feedback Survey Results

Self-Reflection

I set various personal learning objectives at the beginning of this capstone project including: describing the various factors that impact patient LOS ration, determining factors that impact overall working environments in inpatient settings, analyzing and synthesizing survey data into presentable forms, verbalizing an understanding of effective presentation methods, and understanding how this translates and impacts inpatient physical therapy practice. I can confidently say that, after completing my capstone project, I was able to meet all of the personal goals I set. This project also helped me grow as a professional by improving my communication skills, my ability to self-pace and set reasonable timelines, and learn the best methods for receiving feedback.

I was drawn to this project because it attempts to bridge the gap between the common knowledge we have that mobility and exercise is beneficial to patient outcomes, to the question of if mobility can simultaneously shorten patient LOS and improve workplace satisfaction. This project revealed to me several things related to care within a hospital setting. I witnessed first-hand the positive impacts that a mobility program has on the patients and staff. Patients were very excited to have a somewhat normal schedule when they knew they were going to get up and move around throughout their unit. Patients also realized how much better they felt once they took the opportunity to walk several times per day. I believe skilled physical therapy and “non-skilled” mobility both play crucial roles for improving patient outcomes and LOS in the hospital. I learned so much throughout this capstone project that I am thankful for, and I believe that this helps reaffirm my curiosity to continue exploring new ways to improve healthcare experiences for both the clinician and the patient in the future.

Acknowledgements

To Lisa Johnston PT, MS, DPT for serving as my Capstone Advisor and the person who facilitated the creation of this capstone by connecting me with the necessary individuals. Thank you for your guidance and expert advice throughout my research experience in the Fall and into my capstone project in the Spring. I learned a great deal about the process of creating research and submitting it to the APTA CSM thanks to your mentorship.

To Sean Lowers PT, DPT for being a key person in keeping me connected throughout the capstone project with the rehab staff at UNC main hospital. Thank you for your efforts in posting the survey information throughout the hospital so I could gather the relevant data needed for this project. Also, thank you for your expert input into the creation of this capstone project and your help in submission to APTA CSM 2023-2024.

To Emily Hoke MHA, PTA, IASSC-CBB and Jeremy Barner PT, DPT for collaborating with Lisa, Sean, and I on this project. You both were extremely helpful and welcoming to me and our goals of reaching out to your co-workers, other hospital staff, and the patients that you serve. Thank you for relaying information and allowing me the opportunity to join in your efforts on analyzing the effectiveness of the new rehab aide mobility program. Emily, thank you for the opportunity to pitch my survey to the rehab department during a team meeting. Jeremy, thank you for guiding me through the hospital and making sure that patient survey collection was a seamless process.

To my classmates for reviewing my poster board presentation and providing me with valuable feedback I plan to use in the future if the product is accepted to APTA CSM 2023-2024. Thank you, and best of luck to everyone in your future endeavors as new Physical Therapists!

References

1. National Health Expenditure Fact Sheet. Centers for Medicare and Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet. Published August 12, 2022. Accessed September 13, 2022.
2. Freeman WJ, Weiss AJ, Heslin KC. Overview of U.S. Hospital Stays in 2016: Variation by Geographic Region. Healthcare Cost and Utilization Project – User Support. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb246-Geographic-Variation-Hospital-Stays.jsp. Published December 2018. Accessed September 13, 2022.
3. Rashidifard CH, Bush CM, Muccino PP, DiPasquale TG. Implications of Admission and Surgical Timing on Hospital Length of Stay in Patients with Hip Fractures. J Am Acad Orthop Surg. 2021;29(2):e79-e84. doi:10.5435/JAAOS-D-19-00129
4. Pavon JM, Sloane RJ, Pieper CF, et al. Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults. J Am Geriatr Soc. 2020;68(2):261-265. doi:10.1111/jgs.16231
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6. Frith KH, Anderson EF, Caspers B, et al. Effects of nurse staffing on hospital-acquired conditions and length of stay in community hospitals. Qual Manag Health Care. 2010;19(2):147-155. doi:10.1097/QMH.0b013e3181dafe3f
7. Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care. 2004;42(2 Suppl):II57-II66. doi:10.1097/01.mlr.0000109126.50398.5a