Therapy Workloads in Pediatric Health: Preliminary Findings and Relevance for Defining Practice.

PURPOSE: To measure time spent by pediatric physical and occupational therapists in performing daily work activities. METHODS: Physical and occupational therapists at an urban pediatric academic hospital were observed during a standard workday. Time studies recorded total time spent performing patient care and other workplace-specific tasks. Data were analyzed to identify trends. RESULTS: Broad similarities existed in average amounts of time spent in direct patient care, indirect patient care, and nonpatient care tasks. Indirect patient care tasks demonstrated the lowest variability in time spent. CONCLUSIONS: This is the first report of pediatric physical and occupational therapists' time in performing daily tasks. The metric and tools derived from these findings support managerial decision-making, provide a comparison of actual versus targeted workload, assist with determining appropriate and safe staffing caseloads, and contribute to measurements of a patient's therapy acuity level.Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A280.

The effect of suit wear during an intensive therapy program in children with cerebral palsy.

PURPOSE: To examine the effects of suit wear during an intensive therapy program on motor function among children with cerebral palsy. METHOD: Twenty children were randomized to an experimental (TheraSuit) or a control (control suit) group and participated in an intensive therapy program. The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Measure (GMFM)-66 were administered before and after (4 and 9 weeks). Parent satisfaction was also assessed. RESULTS: No significant differences were found between groups. Significant within-group differences were found for the control group on the GMFM-66 and for the experimental group on the GMFM-66, PEDI Functional Skills Self-care, PEDI Caregiver Assistance Self-care, and PEDI Functional Skills Mobility. No adverse events were reported. CONCLUSIONS: Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function compared with those wearing a control suit during the same program.

A Model for Cultivating a Culture of Continuous Learning and Improvement: An Ethnographic Report.

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available. The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement. An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation. A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified. Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture. Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

Development of guidelines for determining frequency of therapy services in a pediatric medical setting.

PURPOSE: The purpose of this article is to describe guidelines for frequency of therapy services that were developed to help physical therapists and occupational therapists determine appropriate utilization of therapy services in a pediatric medical setting. DESCRIPTION: The guidelines were developed for use by physical and occupational therapists when treating inpatients and outpatients at a large urban Midwest pediatric teaching hospital. Factors for consideration when determining frequency of therapy were adapted from the existing literature. Four modes of service delivery were developed; intensive (3 to 11 times a week), weekly or bimonthly (1 to 2 times a week to every other week), periodic (monthly or less often but at regularly scheduled intervals), and consultative (episodic or as needed). Descriptions are provided in a table format with factors to consider when making treatment frequency decisions. IMPORTANCE: These guidelines have been helpful to therapists in this medical setting when communicating therapy needs and goals to families and other professionals.