IMPLICATIONS OF THE DURATION OF INPATIENT PHYSICAL THERAPY AT A TERTIARY TEACHING HOSPITAL PILOT STUDY

J.H. Ocden¹, M.A. Gelisanga¹, J.V. Angeles²

¹Philippine General Hospital, Department of Rehabilitation Medicine, Manila, Philippines, ²De La Salle Medical and Health Sciences Institute, College of Rehabilitation Sciences, Dasmarinas, Cavite, Philippines

Background: In-patient physical therapy (PT) care entails service provision for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during admission. Identifying adequate time allocation for safe patient service within an eight-hour working time frame remains a difficulty across settings. At a selected tertiary teaching government-run hospital, personnel-population ratio method of human resource allocation is used which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling and promote wellness, however, guidelines regarding PT care duration are lacking.

Purpose: To determine the duration of direct PT care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of PT care with the physical therapist’s months of experience.

Methods: A continuous observation time motion study of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer timed the tasks done by the physical therapist from receiving referrals, preparing for and conducting patient care, communicating with the rehabilitation team, documenting patient encounters, completing other tasks related to patient care, and attending to other institutional tasks. The external observer kept distance from the direct patient encounter to minimize interference of the session. Patients with conditions of different etiologies and functional levels were included.

Results: Nineteen physical therapists with clinical experience from 9-163 months (mean: 54.53) were observed. There were no reported adverse events and client complaints during implementation of this study. The total mean time in minutes of patient management of neurological conditions is 37.5, and musculoskeletal conditions is 28.5, respectively. Documentation time is 14 minutes, and communication with the care team is 1 minute. A low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471) was found. Based on the results, total treatment times allocated to patients (45-55 minutes) is sufficient time to perform safe PT activities.

Conclusions: Our study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. The durations of tasks were defined and may serve as basis on optimal patient decking on PTs for safe and evidence-based service delivery, while ensuring ample time to be allocated to tasks outside patient care that are also vital to achieve institutional and professional goals.

Implications: Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and professional development. Figures have been presented which could be the basis for future policy research for task times, reimbursements, management science, and resource allocation studies.

Funding acknowledgements: This study has been funded by the Expanded Health Research Office of the University of the Philippines Philippine General Hospital.

Keywords:
In-patient care
Duration
Tertiary hospital

Topics:
Globalisation: health systems, policies & strategies
Professional issues: business skills, leadership, advocacy & change management
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: University of the Philippines Manila - Philippine General Hospital

Committee: University of the Philippines Manila Research Ethics Board

Ethics number: 2019-0490-01