Therapists Should Determine Frequency

Toni...

This is one of the very reasons I left IP care.  PT was being treated more like a techical position and not one that values our skilled assessment.

Truth is, very little evidence exists to support how much PT one should or should not get.  Things were all hunkey-dorey in the world of fee-for-service where many patients DID get BID, even TID therapy. No one argued because it was simply more revenue.  Then Medicare reform happened (which as much as I hate Medicare telling me how to do my job), they were right...too much overspending.  Research is now trying to catch up to understanding how much PT is actually needed to reduce stays and limit disability.  

Nurses and doctors have the luxury of not knowing (or caring) that for every "unecessary" treatment it is another chunk of money that comes out of the system...money that could be used to hire more PCTs, build new wings, etc.  So it's no skin off their back to order more PT...of course more PT should lead to a shorter stay, right? We've got the magic wand. Or do we?  Do we really just not know, so it's best to oil the squeaky wheel?

Which brings me to my next point. Patient satisfaction is such a goal  for hospitals. But has it made everyone a little short sighted?  Are we so eager to please and get a good survey out of that patient that we neglect evidence? Physicians are in the same position. Patients come into their office demanding MRIs for non-specfic low back pain.  Do they comply with the patient's wishes or send them to physical therapy? You and I have the luxury of knowing that MRIs are often uncessary...but it's a hard sell to a patient.

Finally, and this probably brings me to my best point is "are we being misused?"  Does it really require someone with a master's or doctorate degree to "walk" a patient or perform SLRs with them?  We've dealt with many of the same pitfalls you describe. Heck, we were down to 1x/day for our orthos and seeing most other patients only 3-5x a week.  Meanwhile, orders for BID and TID PT were largely ignored except by the "squeaky wheels."  Our solution. Deligate those who are at contact guard assist or supervison to an "activity aide". PCTs are required to learn how to ambulate patients safely for their certificate? Why do they stop doing this skill once they get on the floor?  We now have a program in place where a specialy trained PCTs sees patients for "activity" throughout the hospital. It's not being billed as physical therapy, so no harm...but even if it was, would it make a difference since we don't get paid for administering therapy anyway?

Do the physicians and patients care that they are not getting "physical therapy"...no...they just care that the person is up and active.  Meanwhile, we can administer therapy to those who really need it and at any time, we can step in and reassess those patients we've deligated to the mobility team.

Best of all, we've been able to reinstate BID therapy for orthos and daily therapy for those who need it...and finally, the mobility aid comes out of the nursing budget. No one is complaining.