The physicians and therapists of Hand and Plastic Surgery Associates, Ltd. (HPSA) continue to advocate the importance of timely and effective occupational therapy as a requirement to maximize the injured workers functional outcome. While in subsequent articles I will focus on specific modalities which we utilize in occupational therapy I’d like to begin with a topic which gets little recognition and is often overlooked as an essential component of occupational therapy. This deals with the role of communication in the patient’s care.
The following scenario is one that is commonly seen in our occupational hand therapy clinics due to the reconstructive nature of our physicians hand surgery practice:
I’m going through the charts and organizing myself for the upcoming day’s patients. Today I will again be treating my current most challenging workers’ compensation patient.
The individual sustained a severe crush injury to their hand. Initial intra-operative findings included several metacarpal and phalangeal shaft fractures, a digital nerve injury, multiple flexor and extensor tendon lacerations as well as, an injured blood vessel. The fractures required pin fixation and due to the multiplicity of injuries it took approximately 10 weeks for the fractures to heal adequately so that the pins could be removed and occupational therapy started.
The patient has undergone a total of three surgeries with subsequent procedures including split thickness skin grafts to reconstruct open wounds and finally extensor and flexor tenolysis, as well as, joint capsulectomies to allow for improved motion.
The patient has made substantial progress since their last surgery, but still has not been able to return to full duty at this time. It is clear that the patient will require additional occupational therapy for range of motion and strengthening despite nearly six months of treatment. The physicians and therapists are anticipating an additional 2-3 months of occupational therapy for this individual. You know from the severity of the initial injury that this is not an uncommon scenario. Your goal is to have the patient make a full recovery and to return to full active duty but you also want to ensure that the care provided is targeted, effective, reasonable and medically necessary throughout the course of treatment.
How do I achieve this? What else can I do as an occupational therapist to ensure that the needs of my patient are being met in an efficient, timely, and cost effective manner to maximize my patient’s progress and ultimate functional result? What should the patient, case manager or adjustor expect from the occupational/hand therapy clinic and its practitioners?
The answer can be summed up in one word: COMMUNICATION
An experienced and well designed hand therapy clinic will not only provide the highest quality of hand care but will also have a functional, systematized internal communication system in place that can easily be accessed by the patient’s case manager or adjustor. The process begins with a phone call to a designated communicator that can relay/fax/email any patient information requested within 8-48 hours of the request. Documentation should be specific to the patient with clearly delineated goals. Therapeutic modalities being utilized should coordinate with the plan of care. Ongoing documentation should include a section detailing which goals have been met, as well as, new goals to be achieved based on the level of progress.
There should be evidence of communication between the physician and therapist and between the therapist and the patient. Speaking directly with the treating therapist should be as easy as picking up the phone or dropping into the clinic. A case manager, adjustor or other professional should feel comfortable asking any specific questions of the therapist and should expect informed and accurate information in return. This allows for the best coordination of care and minimizes any chances of interruption of treatment. Therapists should also be accustomed to communicating with other professionals in order to coordinate the earliest possible return to work for the patient whether that includes a light duty restriction or full unrestricted activity.
My colleagues and I at HPSA recognize the benefits achieved in ultimate functional outcome when an aggressive return to work program is instituted by the practice. We believe that the benefits extend to not only the patients functional outcome, since even light duty restrictions are viewed as therapeutic, but it also reinforces to the individual that they are expected to return to the workplace environment and continue as a productive and valued member of the company.
At Hand and Plastic Surgery Associates, Ltd. we feel that it is vitally important that our three occupational therapy clinics operate as a single and unified department which are linked by a set of common values, standards and goals. This allows us ensure the same level of quality and professionalism regardless of where our patients are treated.
Because our clinics are located on the same site as our physician offices frequent and timely communication with the treating physicians ensures that any change in the patient’s condition is dealt with immediately, whether this is to address an unforeseen complication or more commonly to increase the pace of therapeutic rehabilitation. We are therefore able to design more individualized treatment plans for our patients as opposed to just following established protocols. This also permits case managers and other individuals involved with the patient’s care to speak with the physician and the therapist at the same visit so that everyone is on the same page and all aspects of treatment are coordinated.
We believe that communication and coordination is an extension of the physician’s evaluation and surgical or non-operative treatment as the situation dictates.
What is the best way to manage your complicated patient? Communicate!!
Talk it over with the treating therapist. They should be happy to partner with you in an effort to maximize the patient’s recovery and functional outcome.
Should you have a difficult case which you are managing please contact our offices and one of our physicians will be happy to speak with you.
Angela Sarno, MS., OTR/L
Head, Department of Occupational Therapy
Hand and Plastic Surgery Associates, Ltd.
Information provided by: Hand & Plastic Surgery Associates, Ltd. – The physicians of HPSA treat the most challenging and complicated hand and wrist problems as well as minor conditions and injuries. They believe that seeing a physician who specializes in surgery of the hand yields the best results. When caring for injured workers, HPSA takes a proactive role to insure that these individuals are returned to work as soon as medically possible. They assist employers and case managers in determining appropriate job placement. Their physicians are also available for independent medical evaluations and second opinions. Visit their website at www.handplastic.com to learn more about HPSA.
