'Because I Said So'
A PTA came up to me and asked why a patient was on caseload. The patient recently had a THA, was independent with transfers, able to follow an HEP independently and walking more than 150 feet with an SPC. Vital signs were within normal limits with activity and the patient was weaning off pain medication in preparation for going home. A home assessment had not been done on this patient and there was some question if one was even needed. I suggested the PTA talk it over with the PT and from there they could formulate a plan of care or discharge the patient.
I'm a fan of allowing the PTAs to suggest POCs and encourage them to be actively involved when discussing the patient's progress and discharge planning. Of course, the final decision is up to the PT, but a phrase like "Because I said so," is not an appropriate reason to keep a patient on caseload. There should be a functional deficit or an objective measurement we can work toward improving to show progress. When there's a question if a patient should be discharged, I look at the goals (both short-term and long-term) and assess whether the patient has met them or not. If the goals are met, the PT needs to reassess the patient and determine, with the PTA's professional input, if the patient is clinically appropriate to continue with therapy.
I've worked with PTs who will keep a patient on caseload because they know the patient's family or they both go to the same church. I've seen goals change from 300 feet of gait to 500 feet, Tinetti goals from 25/28 to 28/28 and Berg scores updated from 45/56 to 50/56. Yes, these are measureable goals but is there good clinical reasoning behind the updated goals or are they being changed just to keep the patient on therapy? And should I be questioning the clinical judgment of the PT when he updates the goals like this?