How Not to Prioritize
Over the past weeks, I've been blogging my concerns about staffing levels and quality of care. More and more it looks like staffing will continue to be diminished in cost-cutting efforts. In one blog, I posed the question of how to prioritize patients when caseload isn't manageable with the goal of seeing as many patients as possible and still providing adequate therapy.
Last week I got my answer. On Monday we were short-staffed, with each of us having 17 patients on caseload including evaluations. I decided to limit therapy to the most important thing for each patient. Therapy sessions would be shortened but something could still be accomplished. In some cases, that meant getting out of bed without performing bed exercises. I saw all but two people on my list and thought I had done pretty well considering.
Thus we come to my patient in the ICU. My plan was to sit him edge of bed for balance, then attempt a functional transfer to a high-back wheelchair. Initially he refused to allow me to transfer him. He made no effort to balance when edge of bed. Once he was in the chair he requested the tech lift him back to bed.
On Tuesday the lead therapist, an ST, summoned me to his room because he had a complaint about his therapy. He complained that he hadn't done anything but get out of bed, via the tech, leaving out that he refused to allow me to do it. I suspect there was more to it but he toned it down when she pulled me into the room. I tried to explain to him that instead of exercises I attempted to do something more functional. That the lead therapist wasn't backing me up didn't help.
In fact, after the conversation she commented she was tired of having her behind used as a chew toy. Yes, pulling me in was politically savvy but it didn't help. I went from being proud of myself for thinking I had accomplished something to having handled the situation completely wrong. No one wants to hear the therapist is too busy, but the man was offered an opportunity for more and he declined. I wasn't going back.
I'm not sure what else I could have done. I could have spent more time with him and skipped several other patients. I've since learned his normal therapist skimps on patients who don't do much. She believes this gentleman benefits more from her time so she does little with them and spends extra time with him. Had it been her with 17 on caseload, I suspect she would have skipped the lower-level people and given him his full treatment. That doesn't work for me.