1. 180 minutes of core rehabilitation therapy Providers Processes / procedures Patients Place / equipment Policies Why are we not achieving the 180 minutes of rehab intensity? Dealing with family or patient complaints, comforting, counseling them repeatedly Families do not want to help with therapy or lack of family support Patient not ready in time for scheduled treatment Language barriers (ESL) Unrealistic expectation of pt./family or they don’t know what is expected of them in rehab Complex patients with co-morbities, fatigue, unable to tolerate therapy Patient has falls/injury or too ill to participate Patient refusal for various reasons ++visitors causing fatigue or taking away from therapy time Patient leaves the floor for leisure or tests Complexity of ALL patients on the floor pull away therapist from time to be spent with stroke clients only Not enough time for SW, psychology or MRP to talk with patients so therapists doing education and counseling Nursing has difficulty getting patient ready on time (various reasons) Unable to recruit casual therapists Lack of flexibility in therapist schedule No charge nurse or unit clerk on weekend No CDA to assist SLP 6:1 pt. to nurse ratio, 2 nurses on after 7 pm – need to put pts. to bed at 6:00 pm. Pts. miss evening programs 13:1 therapist to pt. ratio, even higher for SLP Time is spent attending family meetings Only ½ day PT on weekends, not OT or SLP FTE’s split between two programs for SLP Large scope of practice for OT Call bells ringing for non nursing issues Lack of education or time to update skills Lack of education of nursing staff in proper therapeutic transfer methods Therapists doing am care/toileting fo client for whom this is not a therapeutic goal Volunteers not allowed to do transport MRP not available when needed Not enough ipads Blocked access to websites that can be used for treatment or education Waste time due to lack of standardized education and equipment Not enough rehab beds Worn out equipment, equipment not available for use of assessment Not enough cognitive ax and tx activities available Not enough treatment rooms/space esp. quite rooms for 1:1 treatment OT and SLP Wheelchair insufficient or inappropriate Not enough computers for documenting Kitchen too small to complete treatment tasks No appropr. VFSS equipment Not enough plinths, tx space lack of community resources to discharge to or program with long wait times Waiting for MRP to write orders, assess issue and follow up so therapy can resume Hospitalist changes every 2 week, no continuity Neuro consult takes too long MRP’s not rounding daily, no consistent MRP, no physiatrist input Difficulty with scheduling multiple therapies Not using whiteboard, pt. and family unaware Having to copy and organize own supplies for each client Not enough time for rounds to discuss each pt., set goals and update weekly with team Electronic charting takes too much time, requirements for documentation to be detailed and specific Difficult to treat patients under precautions in their room All staff not aware of therapy approach, client goals Flow pressure “ fill bed with anyone” if bed is empty, pressure to take outliers Slow referrals from acute care- can’t flag pt. soon enough to ensure transfer day 5-7 Rehab philosophy not shared or recognized by all team members Too many other meetings – not enough time with patients and family Pt. not ready in time for therapy Alpha FIM no always done correctly, validity and accuracy of Alpha FIM Best practise not supported by Ministry and LHIN FIM scores done accurately describe client need for/ability to benefit from therapy or LOS Groups/rec therapy don’t count for rehab intensity Time spent doing status for MIS No blanket referral for SLP Do not use FEE’s (ENT) for swallow AX No PPC/PPL for allied Competing QBP priorities (joint vs stroke) Pts. Come day 5-7 – too early not ready for rehab No dedicated time for education/evidence based practise Pressure for earlier/faster discharges Difficulty booking VFSS Time spent filling out applications to other services/finding the support services Transporting pts. to and from therapy No evening and weekend therapy when family would be able to attend and learn Therapy hours M-F 8_4, no evening or W/E therapy