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Life of a PTA

Keeping Continuity

Published February 21, 2014 4:14 PM by Allison Young

When a patient first arrives at a SNF from the hospital, typically he's in pain, ill and many times confused. Once the primary therapist completes the initial evaluation, that patient is quickly scheduled for PT seven days a week. The ideal situation would be to have the primary PT and a PTA treat the patient throughout the week, progressing treatments and meeting the goals of the established plan of care.

Unfortunately, this isn't a perfect world and skilled nursing PT can quickly "run off track" when it comes to providing an important component to a patient's recovery; continuity of care. As a full-time therapist, I'm lucky enough to be able to treat the same patients Monday through Friday with the exception of the primary PT's fifth visit, of course. However, there are weeks when my schedule of patients shifts daily due to a colleague calling in sick, PRN staffing, or the full-time weekend therapist's arrival (working Friday through Monday).

There are many times a patient, who I have treated for weeks, inexplicably "disappears" from my schedule only to resurface on another PTA's patient list. In such cases, my PTA colleague and I will make a "player trade" with someone off my schedule who that PTA has worked with before.

I've actually seen patients work with four or five different therapists in one week. This lack of continuity with just one main therapist is the least ideal for the patient. Despite the fact that every therapist who treats this patient is working toward the plan of care goals as set by the primary PT, it's difficult to progress when each therapist has a different there ex plan. The phrase "too many cooks in the kitchen" comes to mind during such a scenario.

Our rehab team has addressed this issue in the past and has made efforts to schedule patients with the same PT/PTA daily, but some patients do fall through the cracks when census is high and additional PRN staffing is necessary. When this is recognized, we advocate for the patient and keep the "player" on our roster.

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Hopefully,  most of the therapy team is in tune with what the patients need.  Having a PT/PTA team is ideal in most situations.  There have been some issues with continuity of care though.  Some patients do not like the therapist and want to switch after several treatments.  Some patients prefer a female therapist to a male and we may not find out until a week or two into the patients treatment.  We may need a break from certain patients too.

There are times when we will switch on purpose to find out if another therapist has a better idea about progression.  Having several therapists treat the patient is not such a bad idea because the patient gets exposed to several different ideas and treatments all working towards the same goals.  

Jason Marketti February 24, 2014 4:13 PM

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