Inpatient Settings Acute, Inpt Rehab, SNF

Inpatient SettingsAcute, Inpt Rehab, SNF PTP 641 Med Surgical PT Exam and POC Spring/Summer 2012

The Hospital System

Welcome To best Hospital • The System: • Best Hospital is a small 400 bed hospital just built in the thumb area of Michigan. • The hospital would like to expand to include an inpatient rehab unit and SNF. • Need to have orientation of approximately 60 New Graduate Physical Therapists to the hospital setting along with the inpatient and SNF settings.

Introduction • Accommodate a wide variety of routine, urgent, or emergent patient care needs • Settings to provide therapy services along with provide 24 hour care • Physical, psychosocial, emotional sequalea of illness and hospitalization • Change in daily routine • Lack of privacy or independence • Change in lifestyle • Medial crisis • Critical illness • Long-term effects • End of life

The System • Mission • Strategic Plan • Community Involvement • Partnerships

MISSION STATEMENT FOR best Hospital • BEST HOSPITAL • MISSION STATEMENT: • To promote healthy and happy lifestyles with the BEST care, based on research, experience, and compassion. • PHYSICAL THERAPY DEPARTMENT • MISSION STATEMENT: • To restore and promote healthy and happy lifestyles of both patients and employees by addressing the health needs of society with research, experience, and compassion.

Organization • Administration • CEO COO CFO • VP of Ancillary Services • PT, OT, SLP, Rec Therapy, • Resp Therapy, Dieticians, Tissue Trauma, Dialysis, • Case Managers, Social Workers, Departments • Physical Medicine and Rehabilitation – Acute, Inpt Rehab, SNF • PT, OT, SLP, Ther Rec Therapists

Expenses • Revenue • Acute: 10 PTs x 7 days 10 pt/day 24 units 24x$60 • Rehab: 10 PTs x 7 days 4 pt/day 24 units 24x$60 • SNF: 10 PTs x 7 days 6 pt/day 36 units 36x$60 • Expenses • 60 PTs 60 x $32.00 x 2080 • Benefits 30% of each salary • Training 4.5 hrs x 9 weeks x $32.00 • APTA dues 60 x $500 • Cont Ed 60 x $1000

Financial/Reimbursement

Reimbursement • Acute Care – DRG • DRG = Diagnosis Related Group • Inpt Rehab – PPS and FIM • PPS = Prospective Payment System • FIM=Functional Independence Measure • Acute Hospitals reduced payment if d/c early to SNF or Rehab • SNF – RUGs • RUGs = Resource Utilization Group

Reimbursement • ICD-9 Code = Medical diagnosis code • Guide Pattern = PT diagnosis code • CPT Code = Treatment code • Third Party Payers • BCBS – Master Medical • Complete Insurance Plan – HMO • Medicare, Medicaid • Private Pay • Charity Pay • Combination • Insurance and Private Pay • Coordination of Benefits

Policies and Procedures

Policies and Procedures • Primary Focus: Patient Safety • Facility Policy and Procedures • JCAHO • State • Medical

Policy & Procedure - Facility • Community Injury • Fire • Bomb • Child Abduction • Violent Situation • Weather • Hazardous Material

Safe Environment • Universal Precautions • Special Room Warnings • Nosocomial Infections • Wash hands • Linen • Equipment • Jewelry and Fingernails • Trash • Equipment

Safe Body Mechanics • Equipment working properly • Equipment adjustable heights • Safe lifting

Policy & Procedure - Patient • Patient Rights • Advanced Directives • Living Wills • Medical Power of Attorney • Order of Hierarchy for Decisions • Medical Power of Attorney • Spouse • Majority of Adult Children • Parents • Nearest Relative • If conflict, Ethics Committee or State

Policy & Procedure - Patient • Identity of Correct Patient • Consent for Treatment • Refusal of Treatment • Informed of Risks and Benefits • Alternative Resources

Policy & Procedure - Patient • Respect – Privacy - Confidentiality • Safe Environment • Call light system • Clean • Abuse • Restraints

Policy & Procedure - PT • Customer Service • Dimensions of Patient Care • Respect Me As A Person • Relieve My Fears • Provide Me Comfort and Pain Relief • Involve My Family and Friends • Coordinate My Care • Treat Me As A Person, Not As An Episode • Give Me Predictive Information • Provide Me Access

Discharge From Acute • Home • Inpatient Rehab • Sub acute inpatient rehab • Adult foster care • Assistive living • Skilled nursing facility • Extended care facility

Policy & Procedure - PT • Michigan Right to Know • MSDS - Label chemicals • Electronics • PPE – Blood and Airborne Pathogens • Reaction to emergencies • Standards of Conduct • Quality Care • Law and Regulations • HR Policy and Procedures • Business and Ethical Practices • Confidentiality • Conflict of Interest

PT Responsibilities • Provide and maintain a safe environment • Equipment you use , responses to codes, infection • Informed of legal responsibilities and limitations • Good Samaritan, no code vs adv directives • Acuity of patient • Dx, vitals stable • Recognize situation and be ready to respond • CPR, Heimlich, call for assist • Know patient’s rights and wishes • Adv directives, confidentiality, no code

Inpatient Settings Acute, Inpt Rehab, SNF