Time Study: Acute Pediatric Therapy Amy Swenson, PT Heather Winters, OT

Investigation of time use is required to more fully understand workflow and efficiency, time use of documentation systems, and effect on average productivity in acute pediatric therapy CQI Question:

Anecdotal evidence suggests therapists spend more than the expected working hours per day to achieve current average productivity requirements

Annual employee satisfaction survey results suggest current productivity requirements and documentation issues may negatively impact quality of care, quality of documentation, efficiency, and employee satisfaction

Methods : Time study of daily activities of two pediatric therapists (PT & OT) Therapists completed daily data collection sheets for 3 months (11/08-1/09)

Sample Data Collection Sheet Double- click on sample form to open document for full review

Data Collection Time use was tracked by the minute by category throughout each workday Major categories: productive/billable vs nonproductive/nonbillable time

Productive Time Evaluation Treatment

Nonproductive Time Scheduling Chart review Communication with rehab team Travel time to patient room/building Nurse approval Discussion with nurse after session

Nonproductive Time Waiting for patient Failed attempts Ordering equipment Retrieving equipment/supplies Set-up for session Clean-up from session

Nonproductive Time Documentation Family education Nonbillable patient care Computer problems Meetings Work-related

Nonproductive Time CQI project Organizational time (I.e. making copies, filing) Student time Personal time (I.e. lunch, restroom, making personal calls, socialization)

Time Total time - personal time = work time Work time = productive(billable) + nonproductive(nonbillable)

Productivity Tracked: Total units of productivity # of evaluations & total evaluation units # of treatment sessions & total treatment units # of failed attempts

Documentation Tracked amount of nonproductive time spent on documentation Documentation time per unit of productivity Documentation time per working hour

Location/Day Tracked work location Inpatient Outpatient (DOT clinics, preschools, OHO) Some days we do it all…! Tracked day of the week

Results: Double-click on sample data tables to open document for full review

Assessment: Productivity requirements at the time of this study were higher than these therapists were achieving in an 8-hour workday Therapists start early, work through lunch, stay late, complete work from home, and/or complete work on off-days to improve productivity and attempt to meet scheduled patients needs

Inpatient Productivity is lower than in outpatient setting More time spent on documentation Other major nonproductive time is spent in scheduling, chart review, communication with team, and travel between patients # and time spent on failed attempts not the major factor, although more than outpatient

Outpatient Able to achieve current productivity requirements more often in outpatient setting Less time spent on documentation Fewer failed attempts

Both settings Documentation takes up majority of nonproductive worktime Increasing time on documentation as week progresses from Monday to Friday, possibly due to deferred documentation…?

Recommendations: Information collected in this study was submitted to pediatric therapy managers for use in developing new productivity requirements and to direct further investigation into time use

Productivity requirements should be lowered for days therapists cover the inpatient setting Known estimates of nonproductive time that is essential to support productive time should be accounted for when assessing productivity

Team should investigate methods of improving efficiency to increase productivity in major areas of nonproductive time in the inpatient setting: Documentation Scheduling Chart review Communication with team members Travel between patients

Additional time use studies by other therapists in inpatient/outpatient, by floor or unit, by therapist experience level, full-time vs part-time, or by time of year May assist with departmental planning, budgeting, and training

Pediatric Therapy Time Study For questions or comments, please contact Amy Swenson, PT (615)