Patients Deserve Rehab Services

Sign Our Petition For Excellent Patient Care

For the last two months we have been describing how the staffing model regarding use of part-time FTE and the productivity system in use by OHSU’s Rehabilitation Services Department affect the rehabilitation therapists.

We believe this model and system has resulted in the loss of wages and benefits to rehab employees as well as producing possible wage and hour law violations by creating conditions which lead to employees working off the clock. Other impacts include the inability of employees to avail themselves of continuing professional education and increased staff turnover rates due to low morale and provider burnout.

Now let’s talk about patient care

Rehab members tell us that OHSU chronically and systematically understaffs the department. Simply, there are not enough therapists to provide services to the patients.  When members raise concerns and ask for more staff, they are told the budget does not support it because the department does not meet the productivity numbers. Previous articles (Timekeeping and Patient Care) have shared the errors in OHSU’s productivity system. Here are some examples from members about the lack of patient services:

  • The NICU (babies in intensive care) is staffed with one therapist per, on average, about 40 patients.
  • Acute Pediatrics has no Occupational Therapy coverage in the hospital on Sundays or holidays. There is often no Physical Therapy coverage in the hospital for Sundays.
  • Adult Acute Occupational Therapy is not available on Sundays, holidays or in the medical, trauma/surgical or cardiovascular ICUs.
  • Adult Acute Physical and Occupational Therapists are so understaffed that most therapists are routinely assigned 2-3 times the number of patients they can see in a day.
  • Adult Acute Speech Language Pathology had chronic and severe staffing shortages the past year and only recently achieved staffing at a level appropriate for patient care needs.
  • Often patients in Inpatient and Outpatient care are able to receive an evaluation, but have delay in follow-up treatment services. In some cases in acute care, a patient may go several days without services because there is not enough staff.
  • Adult Acute Rehab has only one rehab aide to provide assistance to the entire department, a position essential to providing assistance to therapists for patient care.

The ultimate result of OHSU management’s staffing plan is the daily certainty that many patients who need to be seen by rehab therapists will not receive rehab services. No amount of efficiency, productivity or working off the clock will change that. Patients not getting seen is directly related to OHSU management’s staffing and budget plan. Members would like to share more specific data in support of these claims, but are fearful of retaliation by the organization.

What happens when patients who need rehab therapy services don’t receive them, or receive them late or at sub optimal frequency?

Our members raise concerns that several undesirable outcomes are possible:

  • Patients may suffer loss of function or sub-optimal functional recovery
  • Patients may suffer longer length of stay
  • Sub-optimal discharge planning
  • Lower patient satisfaction
  • Moral distress/burnout for rehab providers

All of this can combine to result in increased costs to OHSU related to longer patient length of stay, less available beds for new admissions due to delayed and sub-optimal discharge, return of patients to the hospital due inability to succeed at discharge, and poor recruitment and retention of rehab staff.

Members have and continue to raise staffing concerns directly with their manager(s) and director. Members have and continue to raise staffing concerns through the employee engagement survey process. Our union has repeatedly raised these concerns to OHSU leadership.  The staffing issues continue. The patient care concerns continue. The stress on therapists trying to accomplish what is literally impossible, continues. Fear of retaliation for speaking up about these issues continues.

OHSU leadership needs to address these concerns, with our members and our union, in an atmosphere that can be guaranteed to be free of retaliation.

13 thoughts on “Patients Deserve Rehab Services”

  1. The professionals in rehab services are positive, compassionate, dedicated, courageous advocates for the patients. I stand with them in support of patient care.

  2. I stand with my colleagues and second many of the concerns raised in this post. I would add that staff/employees are not often heard or acknowledged when trying to have foresight and anticipate future staffing needs (e.g coverage for maternity leaves), resulting in chronic, repeated issues with staffing during times of pre-planned leave. Again, this impacts our patients, patient care, length of stay, and employee morale/mental wellness.

  3. Failure to fill positions, staff sufficiently for patient care needs and the gradual elimination of therapy positions over time are all cost saving measures taken at the expense of our patients and the mental health of the rehab team. This is not sustainable. This is not right.

  4. The outcomes listed above should not be associated with an institution that advertises itself as the “best” in the state. By withholding therapy services in order to improve the profit margin, OHSU is contributing to poor health outcomes and increased healthcare costs associated with poor health outcomes. By being active perpetrators of moral distress and burnout of their staff, they are showing rather clearly just how much they value the health of the community as well as the expertise and commitment of their rehab staff. Words of placation are easy for people who have no intention of keeping their word and do not feel badly about those false promises. The leadership has lost organizational trust over the past several years. And now its losing the trust of the community it has committed itself to serve. No amount of billboards splattered all over the state will change that. Consistent and transparent actions will. Changing practices so that rehab is fully and appropriately staffed will. Only then will OHSU rehab leadership be able to start to dig itself out of the mud of their own making. I stand beside the rehab staff. I know how dedicated they are. I know how skilled they are. I know how compassionate they are. Do what is right, OHSU. It’s long overdue.

  5. This problem in Rehabilitation Services has been going on for YEARS. It has caused MULTIPLE OT’s, PT’s and SLP’s to quit OHSU. This is a HUGE loss for our patient populations who need their experience, expertise and specialty care. The leaders in Rehab are only concerned with profit, at a HUGE loss of integrity of patient care. It is such a shame that this continues without OHSU leadership stepping in to right these wrongs. All we have to do is look over the years, *2009-2010 especially and see the litany of staff that left the department. OHSU is a LEVEL 1 Trauma Center, has state of the art Ortho/Surgical care, top Neurologists in the nation, and a rehab department that is a failure. How embarrassing.

  6. I fill in here sometimes to support the front desk, and I’m telling you two people doing check in and scheduling is far from sufficient. Especially during check out and the patient says “I need to come back 4 times every 2 weeks” (or whatever it may be), there are never any openings, or nothing the provider has works with the patient’s schedule. So checking a patient out can take a good 15-20 minutes, while a line of people checking in forms. I don’t know what inpatient rehab services looks like, but if it’s anything like outpatient, it really needs to be fixed. All of the staff is so wonderful, but there are crucial check in steps that are consistently skipped simply because they are being rushed. I can’t attest to the provider turnover rate, but I know the front desk staff definitely has a high turn over rate. It’s very overwhelming and I can definitely see how patients are falling through the cracks due to the high demand for services and high patient volume. I certainly hope for the sake of patient care and for the well being of the essential employees, appropriate changes can be made. I honestly think that as with nearly all OHSU clinics, the rapid growth in patient volume has simply become overwhelming.

  7. Case in point: This past Monday I had a list of 20 patients for an 8 hour day, I received 5 pages from case managers and physicians to see patients who we couldn’t get to for the past few days due to insufficient staffing. As an example, 2 of them were stroke patients who we only had time to see once 5 days ago, and 2 others were inpatient rehab candidates who we recommend high frequency intensive therapy for but failed to see in house for an entire week. We try our best but when we are set up for failure by management consistently cutting our staffing despite us voicing our concerns, our team gets burnt out and patients lose out of a vital service during their critical recovery period. We are a comprehensive stroke center and a level 1 trauma center and these stats are really unacceptable. This is a disgrace and such a disservice to our patients.

    1. It should be added that it is not only the Therapists that run short staffed routinely but there has not been enough support staff. There is only 1 rehab aide that helps the entire team of therapists M-F who is only available for for less than 6 hours per day. Saturdays and Sundays there is only 1 aide for 4 hours to help the therapists who work on those days. When the aides are not working the therapists have to add those duties to their already busy schedule. Thus they are spending less time with the patients providing care. Aides are a vital part of the team and are necessary in order for the therapists to provide care to many of the patients that are so ill. There is only 1 support staff other than the part time aide in the acute care department but she is filled with jobs to assist management. Wouldn’t it be nice if when you called the Rehab department someone actually answered the phone.

  8. We are also a Knight Cancer Center, a certified Bariatric Surgery Center and a Knight Cardiovascular Center but these service lines are always the ones short staffed. The knowledge of all* for the care of one**. *Except rehab services and **except cancer, cardiac, surgical or general medicine patients

  9. As an OT who is not employed by OHSU, I can wholeheartedly attest to staffing issues among rehabilitation professionals across the continuum of care. It is up to the employer to not only support it’s employees but to also allow its employees to prove the best care possible. This standard of care is clearly not being met at this facility. For the sake of your employees and patients, please do better.

  10. I am honored to work with a group of PT, OT and SLP Therapists that are so dedicated to their patients! It saddens me that OHSU management has lost site of why we are here. All Patients Deserve Rehab!

  11. For an institution that has over 11 billion dollars in unrestricted funds, it is a disgrace they would not put forth the small amount of money needed to provide better care for their patients. When at least 30% of patients do not get an opportunity for therapy everyday (on a full staffed day), how are we meeting the mission of the hospital?

  12. As a resident physician who has worked in a poorly staffed, low-efficiency facility and a well-staffed, high-speed facility I know how essential it is to have appropriate rehabilitation and mobility services 7 days a week. Cutting hours and staff only serves to lengthen inpatient admissions (raising the cost of care) and is likely associated with poorer patient outcomes.

    If you can’t staff to the needs and volume of your patients, you should be diverting patients.

Leave a Reply to Acute Care Rehab SLP Cancel reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>