Toni Talks about PT Today : PT News

October is PT Month

Toni Patt — Wed, 21 Oct 2009 12:30:00 GMT

Tomorrow morning my department is going to have a breakfast for all the PTs to celebrate PT month. The food will be provided by the OTs, STs and supervisors. Sometime next week the rehab unit is supposed to do something similar. I'll be surprised if that...(read more)

Do We Really Want Direct Access?

Toni Patt — Wed, 06 May 2009 19:21:00 GMT

Last month at the SED (southeast district) of the TPTA meeting, the topic of discussion was the status of direct access in Texas. Both speakers encouraged the membership to get involved by contacting state representatives in support of the measure. They...(read more)

Hurricane Preparedness

Toni Patt — Wed, 17 Sep 2008 17:49:00 GMT

On September 13th Hurricane Ike slammed into the Texas gulf coast. Ike moved through the center of Houston resulting in millions of dollars of damage power outages to 90 percent of the population. Fortunately the loss of life has been minimal. Because we had advance warning, many Houstonians were able to "shelter in place" while riding the storm out.

For me, this meant filling ice chests, buying batteries, bottled water and non-perishable foods. The area health care facilities faced a much larger challenge. Not only did they have to prepare buildings for the hurricane, arrangements had to be made to maintain patient care during and after the storm. What follows are the preparations and immediate aftermath of the facility where I'm working.

Pre-Ike

1. Facilities on the east side of the city were closed. Patients were transferred further inland to facilities less likely to suffer significant damage. NICU patients were transferred as far as Austin and San Antonio.

2. Any patient who could safely be discharged was sent home to open up beds for the incoming transfer patients.

3. Full operations were continued until noon on Friday. At that time all employees except those who would be staying through the weekend were sent home. Visitors were given the choice of staying or leaving. Those leaving had to leave by noon. Those staying had to provide their own food and bottled water.

4. Those employees who were staying the weekend were given Thursday off to make their preparations. When they returned Friday, they brought clothes to work through the weekend and provided their own food and bottled water. The cafeteria closed Friday at noon.

5. Flashlights were issued to each department and nursing station. Conference rooms were designated sleeping rooms. Bottled water was delivered to each nursing station.

Post-Ike

1. Electricity was lost. The hospital ran on generator power until during the day Monday. The most noticeable effect was inadequate air circulation and warm temperatures.

2. Water pressure was lost. All the toilets and faucets in the building stopped working. Tap water was considered "dirty" and not for consumption. Large jugs of the dirty water were provided to flush toilets. The toilets began working Sunday afternoon. Water was cleared for consumption Monday evening. During meals patients received only water, coffee or tea.

3. Because of lack of water pressure, patients could not be dialyzed until Monday.

4. Patient meals were limited to sandwiches and easily prepared foods. Because of the generators the food was warm.

5. Houston was filled with downed trees which blocked roads and intersections. Some employees were unable to make it to work to relieve those already there. Others couldn't leave because they couldn't get home. This improved by Monday.

6. Throughout Houston cell phone service took a dive. Getting a call through was next to impossible and took multiple attempts. Those in the hospital were unable to contact families and friends outside the facility.

7. Discharging patients became difficult. Facilities that normally would accept them are unable due to the lack of power. Others can't be sent home because their homes have no electricity for medical equipment or have begun unlivable. As of Wednesday this remains a problem.

8. There was one bright spot. Physical therapy was up and functioning Sunday. We had a full staff and saw every patient. It took each of nine hours but no one missed therapy.

LET ME USE MY JUDGMENT

Toni Patt — Tue, 29 Jan 2008 16:04:00 GMT

I'm a big fan of talk radio. So when the topic is healthcare related my ears perk up. On a recent show the topics was a discussion about why Medicare is going broke. One of those reasons was the belief that everyone is entitled to any and all available medical care no matter what cost at all times. The show went on to explore the costs associated with that. The host took the position that just because a treatment is available, that doesn't mean the treatment should be used. Rather, he favored a system of limiting treatment to those that were feasible and cost effective.

I see this to a lesser extent in the world of therapy. In this case the issue isn't so much cost as utilization of services. There is a finite amount of therapy a department can provide. When demand for services exceeds that care suffers. The first line of defense is usually shortening treatments so that everyone gets a little something. The positive side is that more patients on case load receive therapy. The down is twofold. First, some therapy isn't necessarily the best therapy. Doing exercises with someone just so that someone can be said to have therapy isn't enough. Same for edge of bed exercises when the patient really needs to get into a chair but can't because of time restraints.

The second downside is more insidious. There are therapists who can't think outside the box. Its almost like they memorized for this diagnosis you do that treatment. I don't' think this is the best approach but it can be effective. The problem is when you take those therapists and tell them to do something different, for example see more patients by spending less time with each. I worked with someone like this. He couldn't do it. If anything fewer patients were actually seen because he wasted so much time explaining why he couldn't make those changes.

These aren't the problem. They are symptoms. The problem is therapy is being ordered for patients who aren't appropriate. The do everything available mentality has trickled down. Just because therapy is offered doesn't mean it is appropriate. I'm saying we should deny therapy. In theory everyone deserves that chance. If an order is written, a therapist responds. An evaluation is completed. Most facilities will follow patients on a trial basis. The problem is the stress these trial patients put on an already over worked staff. There is an assumption that if an order is written the patient will receive therapy when in reality all the order does is initiate an evaluation. We go to school to learn how to be therapists. We learn how to use clinical reasoning. If my clinical reasoning is good enough to develop treatment plans based on an evaluation it is also good enough to recognize someone won't benefit from therapy.

It's a shame we're not allowed to do that. I've tried. First of all let me say dependent isn't a bad word. It's a description of functional status. The same is true of being at baseline. If a person's status is the same after admission as before admission they are at baseline. The goal of therapy is to recover function. Baseline implies maximum functional level. That does not indicate therapy. A decline in functional status indicates therapy. This may seem obvious to you and I. It isn't to everyone else. Admission to a hospital isn't an automatic referral to therapy. If a patient doesn't want therapy I'm not accomplishing anything going back the next three or four days to be sure.

In case it isn't obvious, this is one of my pet peeves. Anyone that needs therapy should receive it. Anyone referred to therapy should be given a chance. The radio talk show host I mentioned earlier summed up the situation by saying over utilization is draining healthcare. The same is true of therapy. By relying on our clinical judgment all those who will benefit from therapy will receive it. Those who won't will come off case load. Controlling case load will result in better treatment because no one will be as rushed.