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Thoughts on acute care

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AngelaNHPT View Drop Down
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Joined: Aug 11 2011
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    Posted: Aug 11 2011 at 6:52pm
I recently shadowed a PT at an acute care site and was surprised to learn that they expect you to see 10 to 12 patients/day most of which if not all are evaluations. I was also told you only see the patient once normally if you give the patient to the PTA which is the case most of the time. Patients tend to get very little PT and it seemed like the evals were borderline skilled. The eval mainly consisted of just getting the pt out of bed perhaps going to the bathroom or walking a few feet and the evaluation basically just stated the patient's level of assist with mobility i.e. transfers, gait. It seemed like something a nurse's aid could do. I saw many missed opportunities for helping the patient have better outcomes including initiating a few simple exercises, having an anxious person start off with some simple seated exercises before initiating walking or even just let them get used to standing. I would think it would serve the patient better to have increased duration/minutes of therapy since hospital stays are so short now a days. But the focus seems to be more centered on seeing as many patients as possible and spending less time with each patient. My exposure was very limited but it left me sort of concerned about the limited PT offered for acute care patients effecting patient's safety and success to return home. What are your thoughts for those of you who are therapists in the acute care setting? Is there something I am missing or not understanding?
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PT Guy View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote PT Guy Quote  Post ReplyReply Direct Link To This Post Posted: Aug 17 2011 at 3:19pm
Hi Angela - That is too bad that was the kind of care that you observed. I would hope the PT would not only assess transfers, gait and bed mobility but range of motion, strength, posture, balance and other variables as well. I know in many hospitals PTA's are utilized and are expected to follow the plan of care developed by the physical therapist. This is in their scope of expertise and as a PT that has worked in an acute setting in the past, I have no problem with them working with patients as long as they follow my plan of care. You are right that with the costs of healthcare and the ever changing dyanmics of healthcare reform, stays are shorter. Does that mean that patient care should be compromised? Definitely not. The goal you mentioned is to ensure that the patient is safe and can attain the highest level of function prior to discharge. Strength, ROM, balance, etc. are all factors whic can contribute to achieving the functional tasks you had mentioned the therapists you observed were having their patients work on and should be incorporated into treatment as well. At the facility which you shadowed at, how many PT's were working in the acute care department?  I know at times case loads can fluctuate in the acute setting, but the PT department should have a game plan for this so that patient care should not be compromised. I guess the question the PT's should be asking there is, would I be happy if that was the kind of therapy my family member is receiving? If not, than they definitely need to reexamine the way things are done in their department.
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