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Toni Talks about PT Today

My Caseload is Getting Sicker

Published May 20, 2009 3:57 PM by Toni Patt
I've noticed something about my caseload recently.  The patients have become sicker and heavier.  Right now I'm treating four patients. All of them require two people to mobilize.  Sicker patients I understand.  More people are surviving worse injuries. As our population ages, co-morbidities and premorbid immobility have become more common. Any one of those is a predictor for therapy to be involved. When combined the result is a patient who needs therapy but will be able to do very little at the start.  For someone who enjoys working in the ICUs, sicker patients aren't really a problem.

Heavier patients, on the other hand, are a problem. The more a patient weighs, the harder it is to mobilize that patient.  The truly obese ones require bariatric equipment to safely mobilize. That equipment isn't always available. My hospital rents the equipment when it's needed. It can be as many as two days before it arrives.   When patients are immobile any extra weigh usually becomes dead weight. Dragging the extra weight during transfers increases the risk of skin damage. A small skin tear can easily lead to a decubitis if the patient isn't able to shift weight.

Heavy patients require extra man power which is always at a premium. Treatments must be scheduled when assist is available. Missed treatment time is difficult to make up.  The risk of care giver injury is also increased.  Mechanical devices can significantly decrease the risk but don't eliminate it.  The unit I work on doesn't have such a device because the goal is for the patient to move himself. A max assist X 2 transfer is an injury waiting to happen if the patient slips or loses his balance. Getting hurt is something I worry about more and more. I'm getting old and probably weaker. It's not as easy as it was to move those bigger patients around.  I'm very careful but I can't keep from thinking what if.  Where is the line between patient benefit and therapist safety?

These aren't easy patients to work with.  Gone are the days when a medically complex patient was a 90 pound little old lady.  It's been awhile since I've seen one of those.  This is a trend that needs to be monitored. More acute patients don't automatically translate into more staff. More staff might be required but won't be available because of cost cutting measures. I've worked in units where nursing wouldn't get anyone up so it fell to therapy.  The evidence suggests early mobilization and OOB is related to better outcomes and shorted lengths of stay. The evidence doesn't indicate who should be responsible for doing it.

If this trend continues the future isn't pretty. There is a finite amount of work you can get from any one group of people. It doesn't matter how much work is assigned.  One therapist can only do so much. If every patient requires two people to mobilize that therapist will be doing more bed level treatments and getting fewer people up. If the patient has a trach the problems multiply. PTs are capable of treating these patients no matter what situation.    The limiting factor isn't knowledge or skill. If these are the patients of the future I hope the present day planners are looking ahead.


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