outpatient-success

Top 10 Ways to Achieve Successful Outpatient Outcomes

How do PTs define successful outpatient outcomes? As outpatient therapists, we play a key role in our patients’ recovery processes. We are often the people who spend the most time with them along the continuum of care, especially as acute hospital and rehabilitation admissions continue to become shorter.

Regardless of the diagnosis, it is crucial that we take a proactive approach to help engage our patients in their care. While there are various objective markers of improvement and guidelines that we must follow to achieve them, it is the quality of our care that drives outcomes in a positive direction.

Here’s a top 10 list of “must do’s” to set the tone for successful outpatient outcomes:

1. Establish a foundation for building rapport

The key is to utilize an active listening approach. By listening intently and acknowledging that we hear what the patient is telling us, it demonstrates that we are invested in the process.

When information is unclear, we may use the strategy of repeating back to the patient what we heard to assure that we are correctly interpreting what the patient is trying to convey. This reinforces the active listening process.

There are some instances when we may not have the opportunity to evaluate the patient – in these cases, it is helpful to recap the information that was obtained and discussed during the initial visit to bridge the gap in creating good rapport. It is also important to consider the impact on outcomes when the patient is not assigned to a consistent therapist.

2. Gather key information

As we gain more experience, we learn how to expertly conduct a comprehensive evaluation. It is helpful to have a list of routine questions to ask, regardless of diagnosis, in addition to specific questions that will be determined based on the patient’s presentation or condition.

This should involve screening the patient for certain conditions to gain information about past and present medical history us (i.e. diabetes, cardiac arrhythmia, presence of a pacemaker, latex allergy, cancer history, etc.) prior to conducting the various tests, measures and functional assessments.

The details of our questioning may vary based on our setting (hospital vs. private practice) and the amount of time that is allotted, however it is critical to spend adequate time obtaining a clear picture of the patient’s overall health in order to design the most beneficial treatment plan.

3. Identify each patient’s goals

Asking a patient about individual goals is a crucial element of engagement and is often overlooked by many clinicians. Patients are generally more invested in the rehabilitation process when they know that the therapist is fully aware of what they would like to accomplish during the course of treatment.

While patients’ goals are not always realistic (given the expected duration and frequency of therapy or due to the nature of their condition and the anticipated prognosis), it is important for patients to know that the therapist will incorporate their goals into the treatment plan at some level.

It is a crucial part of our job to develop realistic therapeutic goals as they relate to short and long term outcomes.

4. Assess the patient’s communication style and needs – and be aware of your own

Just as we appreciate our unique personalities and communication style, we must do the same with our patients. It is important to identify communication barriers and solutions to minimize frustration both for the patient and ourselves. In doing so, we learn to communicate more effectively and empathetically. We may face various challenges as we interact with so many different individuals who present with varied ways of communicating.

Some patients may be more visual than verbal and find diagrams or demonstrations helpful; some may prefer instructions in written form. Some may prefer detailed explanations while others require a more simplified approach.

We may encounter language barriers due to cognitive deficits or due to the patient speaking a different native language than our own. It is expected that we constantly adapt and find ways to address these issues in order to create a channel of effective communication. We must employ various tools to accomplish this and also be willing to acknowledge the areas in which we need to improve our own communication.

There are many resources, including online courses, to improve communication skills. It may also be worthwhile to check with your organization to inquire about seminars on this topic. In regards to language barriers, there may be available technology or resources to provide translation services. Developing our ability to communicate effectively will serve us well in all venues, both personally and professionally.

5. Optimize the treatment environment

Have you ever witnessed a patient becoming disengaged, overstimulated or overwhelmed due to the surroundings? Consider a patient who comes in for treatment of an orthopedic issue who suffers from chronic migraines or a patient who has a neurological injury and becomes agitated in a noisy or crowded area. Do you work in a clinic that has private treatment areas or private rooms or in a gym that is completely open?

While we are not always able to control the variables of the physical environment in which we work, we need to be mindful of the surroundings in which we provide treatment.

It may be helpful to plan ahead by talking to your co-workers or supervisors to reserve a more secluded or quiet space to implement treatment or to make suggestions for potential changes to the physical space in the long run to improve patient care.

All patients are not appropriate for all settings – we do our very best to optimize the treatment area to match our patients’ needs; however, it may be necessary to consider referring a patient to another location within the facility or even another practice to facilitate the highest quality care for that individual. While these are difficult decisions, it is imperative to discuss options with the patient and family to optimize services.

6. Avoid the pitfalls of passive interventions

All too often, both novice and experienced therapists fall into the trap of delivering mainly passive interventions. Some clinicians don’t believe in modalities and tend to omit them altogether from the treatment plan, while others focus on passive treatments and fail to include more active interventions.

While modalities and treatments such as ultrasound, electrical stimulation and massage may be necessary and beneficial for certain conditions or at specific phases of care, the vast majority of patients also require an exercise component and/or functional training in order to reach the desired goals.

Utilizing an evidence-based model will help to guide our treatment planning; however, we must also draw our own conclusions from our clinical practice regarding what works best. It is always advisable to differentiate passive and active treatments as they pertain to the condition or injury and explain how these treatments are expected to affect the overall outcome.

In addition, it is important to educate patients that there may be a need for some passive treatments (i.e. use of ultrasound or edema massage during the early treatment phase of an ankle sprain or the use of electrical stimulation and heat during the treatment of an acute episode of lower back pain). However, improvement in function is dependent upon inclusion of exercise and movement re-education.

While our time with patients is indeed limited, it is critical that we teach exercises properly, observe performance repeatedly and scrutinize its quality.

There will be patients who are resistant to participating in the active phase of rehab due to poor comprehension of their condition, lack of motivation or medical co-morbidities that contribute to pain and fatigue. In these cases, we must continue to find creative ways to progress treatment and encourage these individuals to be active participants in their care.

7. Provide the HEP early and progress in stages

One of the most challenging aspects of preparing a patient for discharge is designing and implementing the HEP. It is generally helpful to provide the HEP and progress in stages so that the patient does not become overwhelmed with too many different exercises.

Specifying the nature of each exercise and selecting an appropriate number to prescribe may vary greatly based on a patient’s personality and commitment to therapy. Keep it simple and provide frequent opportunities for the patient to practice with your supervision and hands on guidance to assure proper form and execution of the movements.

In order for appropriate movement patterns to become ingrained, we must instruct the patient correctly when the exercise is first taught and continue to assess quality of performance in order to identify the appropriate time frame for and degree of progression.

Practice should be ongoing throughout the course of treatment to promote proficiency and compliance.

8. Involve family members/caregivers in the treatment process sooner than later

For patients who present with complex issues pertaining to physical, emotional and/or mental status, it is critical that we involve the family members and/or caregivers as early as possible. Often times, therapists wait until discharge approaches to begin training caregivers to reinforce or implement the HEP – this is not always successful as the caregiver, patient and therapist may become overwhelmed.

Providing early caregiver training often promotes increased patient participation and compliance. It also demonstrates our commitment to the patient’s well-being after discharge.

9. Collaborate and seek support

When possible, we need to seek support from one another in order to develop the necessary skills to provide the best care and especially to manage difficult cases. Consult with clinicians who specialize in the treatment of certain patient populations and inquire within your organization to identify practitioners who possess advanced skills or certifications.

Establish a system to communicate with these individuals and don’t hesitate to reach out for advice. By remaining open to the ideas and feedback of others, we may learn different approaches to care. Realizing that every clinician offers a unique body of knowledge encourages us to work collaboratively to guide our decision making process.

10) Maintain a commitment to learning

No one knows it all – there will always be a patient with an unfamiliar diagnosis or a situation which presents an unexpected challenge. While we acquire the foundations of our professional skills in school, we continue to learn every day on the job.

We are all highly educated and we all have valuable knowledge to share. A therapist with twenty years of experience may learn something new from a recent graduate just as a less experienced therapist may benefit from the expertise of a highly trained therapist.

I have learned many techniques by watching my colleagues. If you are fortunate to work in a teaching environment and with therapists who possess a wide range of skills and years of experience, do not take this for granted.

Learn from one another formally and informally. Take advantage of opportunities to learn through co-treatments, team meetings and in-services. If your clinic or facility doesn’t have a formal continuing education inservice program, consider developing a proposal for one so that staff can learn from one another as they complete coursework. We may better identify individual learning paths by choosing areas of study about which we feel passionate. We must then commit to imparting our knowledge in order to build highly skilled teams who are dedicated to service excellence.

Success is ultimately defined by patient satisfaction, regardless of whether or not all goals are achieved. A content patient who has trust in the clinician and also learns the skills for self-reliance is a true reflection of a successful outcome and a job well done!

About Katerina Liapis

Katerina Liapis
As a PT, I have dedicated my career to helping people achieve a higher state of wellness. After fifteen years in the field, I am currently exploring different options to utilize my skills in a new way. I am honored to share some clinical pearls of wisdom as a guest contributor to various sites. I have also contributed content to Covalent Careers and Web PT and I am currently working on a new project. Stay tuned! -Katerina (Tina) Liapis

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