« This Week's Health-Related DVDs - August 3rd, 2010 | Fingertips Home | Inexpensive Massage Music »

August 5, 2010

A Day In The Life Of A Physical Therapy Student

At the rehabilitation hospital where I am currently doing my clinical internship, patients must be well enough to withstand 3 or more full hours of therapy a day. The goal for the patients is to be seen by physical therapy for an hour and a half, and an occupational therapy for an hour and a half. Also, patients may go to speech therapy for a half hour to an hour and music therapy for a half hour, if they qualify for it. To qualify for these therapies, the patient usually has experienced a stroke or a brain injury. If a patient does not qualify for speech and music therapy, they are assigned to group therapy. During the patient's first week at the hospital, if they assigned to group therapy, they will rotate, learning about energy conservation techniques, wheelchair mobility, and upper and lower body strengthening. During their subsequent time at the hospital patients may be assigned to exercise to music, upper extremity strengthening, lower extremity strengthening, or pulmonary group depending upon which is most appropriate for them.

For physical therapists, our day starts at 8:00 am, and we generally are expected to see six patients a day. We treat two patients at a time. Therapy sessions start at 8:30 am, 10:00 am, and the two afternoon patients are staggered, starting at 1:00 and 1:30 pm. We treat for 1-1/2 hours or 6 15 minute increments or "units." Holes in the schedule are 8-8:30, 11:30-12, and 3-3:30 (unless it's our day to lead a group therapy). These "holes" are opportunities for documentation, making up missed units, or tying up loose ends from the previous day or planning the upcoming day. 3:30-4:30 is set aside for evaluations and the obligatory documentation that goes with them.

As part of our daily treatment plan, we choose an activity based upon a functional goal such as walking. These activities take more time for some patients than others, for example, exercise therapy for a high functioning patient may only take 1 unit whereas it may take 2 units for a more debilitated patient. Sounds straight forward enough.

But when treating two patients, their differing level of function dictates how much one-on-one time the therapist needs to spend with them doing skilled therapy. A low-functioning patient may take 15 minutes to transfer from their wheelchair to a mat in order to perform exercise therapy. What do you do with your high-functioning patient when that is happening? A patient needs gait training; what do you do with a low-functioning patient needs to practice sit to stand? The services of an aide or tech is warranted here, but in order for services to be billable, the therapist must be careful what they ask the tech to do. A Hoyer lift transfer performed by a tech is not billable, but keeping the patient on track for their exercise program is billable, because the therapist created the exercise plan.

Twelve weeks is plenty of time to get this juggling act down. However, there are other tasks we are expected to perform and these responsibilities alter our treatment plan. A list of these other of these include new patient evaluations, patient discharges, equipment ordering, family education, functional status updates, weekly staffing meetings for each patient, group assignments, and, on Fridays, preparing weekend treatment assignments. For each of these responsibilities documentation is required which can number anywhere from 1 to 9 different forms that must be filled out or updated. None of this paperwork is computerized.

Remember those "holes" in our schedule that I mentioned earlier -- this list gives you an idea of they types of things we may do to fill those times. To throw a monkey wrench into the works, family education takes 45 minutes or 3 units during a patient's treatment time to discuss the patients functional abilities, safety and equipment issues, and discharge setting. During this time, we must figure out how to treat our other patient and meet their goals during the time we spend with family education. Four days per week staffing meetings with an interdisciplinary team interrupt our treatment flow. These meetings take anywhere from 3 to 10 minutes and are usually an opportunity for a patient to take a rest break. Problems arise when you have cognitively impaired patients on wander guard who need constant attendance if they are left alone, impulsive, and do not want to cooperate with application of a pelvic restraint belt in their wheelchair.

Amid the noise and chaos, the phone rings, faxes need to be sent. Patients may leave their gait belt, their glasses, their grippy socks, orthosis (or you name it) up in their room and you cannot work without it. Vendors cannot locate the needed equipment, or insurance does not cover products from a particular company and the hunt is on to find a compatible source. Communication is essential between professionals and must occur with patient privacy and HIPAA laws observed. Patients miss units because they come down from their room late, they feel sick, or they need to be changed due to an incontinence episode. Some are confused or belligerent, most are sweet. Nearly all have issues surrounding cognition and those that don't have serious co-morbidities to account for. Safety is paramount and the most amazing things that we take for granted can become a serious hazard to a patient who at risk for falling or is cognitively impaired.

It's easy to feel overwhelmed. I have 2-1/2 weeks left. I will make it through this clinic. Maybe, after many years of experience, I will feel compelled to challenge myself with a neuro-rehabilitation setting. However, after this experience, I believe that this is probably not the area for me.

Posted by linda at August 5, 2010 2:04 PM