“If I am on service,” says Dr. Rajput, “my patients are assigned [perhaps as] one on the 10th floor, one on the ninth floor, [and] one on the eighth floor.”
His occupational therapists told him that if the hospitalists could be assigned to patients the way they are, it would certainly improve the communication between the two groups.
“It is much better to have a verbal communication with the hospitalist than [simply] reviewing the chart,” says Dr. Rajput.
Some hospitalist groups are looking at returning to this geographically based system. “To restructure the whole system would be very complex,” says Dr. Rajput, who is also the program director for the Internal Medicine Residency Program at UMNDNJ—Robert Wood Johnson Medical School in Camden, “but… it still makes sense [from a communication perspective], for instance, the way it does in the ICU.”
Given the difficulties and drawbacks of making that system a widespread reality, however, Plan B would be to increase and encourage contact between occupational therapists and hospitalists. At the UC Hospital, which employs 12 occupational therapists who work with the patient population that hospitalists are responsible for, “the volume of [patients in] the general medicine unit is too high for OTs to meet with hospitalists daily” explains Quinney, who has been with the UC hospitals for six years.
To breach what might be a communication gap, however, she says, “all OTs have pagers, and whenever they write their note in the chart they will leave their pager number. There is always a way for someone to get in touch with them.”
That, of course, can also be said of hospitalists. And because hospitalists respond quickly when occupational therapists page or call them, says Morales, it can help with patient satisfaction.
“The hospitalists round more quickly or at certain times; they have a routine down,” she says. “And that’s a big thing because when patients are ready to be discharged, they want it now. They don’t want to wait.” And when they can be discharged expediently, “we all look better.”
Throughput and quality care: At the UC Medical Center, as at most institutions, hospitalists are encouraged to move patients from admitting through discharge in the most timely and efficient way possible.
“Hospitalists know that [occupational] therapy is part of that important closure of getting them from one site to another,” says Quinney. But sometimes she hears a [hospitalist or resident] say, “I was just told I need to refer them to you in order to get my patient out of the hospital.”
That’s important, Quinney emphasizes, because occupational therapists want to be part of discharge planning. “But we want to be referred to appropriately so that the people who need us most can utilize us, versus going after patients that aren’t appropriate and are using our resources,” she says. “It’s not that we aren’t happy to see those patients, we truly are; it’s a matter of getting people in a timely manner so that we can really make a difference.”
Great Working Relationships
Morales thinks hospitalists have a good understanding of the services that are available from occupational therapists “because whenever we see them about a patient, if they’re not sure about something, they ask questions such as, ‘Is there anything else you can offer?’” she says. “I think they’re right on target [with us].”
Morales’ team thinks hospitalists are involved, friendly, and open. “It’s just a great work relationship,” she says, “because they’re actually seeing the patients in therapy and asking for our input; it’s very refreshing.” Most of all, she appreciates how they show respect for what the occupational therapists do. “They are listening to what we are saying and that makes a difference.”