The objective of the project was to change the delivery of services for total joint arthroplasty patients in a cost-effective manner while maintaining aggressive discharge criteria and high levels of functional status. The question was: Can you change the delivery of services from a total professional staff to a multiskilled workforce and maintain the quality standards? As managed care penetrates the New York City market, the Hospital for Special Surgery, an institution dealing exclusively with orthopedics and rheumatic diseases, has had to develop unique staffing solutions to provide the appropriate level of continuous care at a cost-effective rate. Managed care has impacted the delivery of acute care services by decreasing length of stay, increasing financial risk, and decreasing reimbursement. The departments of rehabilitation and nursing at the Hospital for Special Surgery have worked together to adapt service delivery in today's marketplace. This collaboration has resulted in the development of a new staff position, the "mobility technician," that changed the staffing skill mix to 50:50 (professional:paraprofessional/support staff) and allowed for maintenance of quality standards while lowering overhead. The rehabilitation department moved from a centralized administration consisting solely of the licensed mobility technician. This model was adapted from our clinical nursing model that utilizes the concept of the "unit assistant." Mobility technicians are on-the-job staff-trained personnel hired to work under the direction of a licensed physical therapist or registered nurse in order to augment treatment. The training program lasts for 6 weeks and combines didactic and practical labs with both rehabilitation and nursing professionals with an inhouse textbook and appropriate supervision. The mobility technician allows patients to practice what they learn in their physical therapy session (similar to a nursing home ambulation program) as outlined in the clinical pathway. Tasks include patient mobilization, assisting with patient transfers, and escorting patients to and from therapy treatments. This support staff position allows patients to receive increased care from the rehabilitation department.
Principal Outcomes:
Total savings in salary and benefits of $203,750
* Implementation of 7-day coverage
* Patient care was optimized: patients are seen twice daily by a member of the rehabilitation staff
* Length of stay for total joint arthroplasty patients has decreased from 6.5 to 5.0 days, while quality measures have remained constant
* Functional milestone achievement for these patients has remained at the level of independent mobilization with a cane on level surfaces and stairs
* Patients experience a continuum of care within the department under the care of several different care providers, with a single therapist "manager" overseeing their care
The decentralized team model when combined with the creation of the mobility technician program allowed the hospital to increase coverage while decreasing costs and maintaining desired patient outcomes. Quality patient care can be provided on a cost-effective basis by a multiskilled workforce composed of licensed professionals and staff-trained support personnel.