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Raising the Bar in Rehab


Published July 30, 2009 10:17 AM by
So, the hospital I work at has a habit of doing a lot of co-evaluations and co-treatments between OTs and PTs, especially with patients who requires total or max assist.  

While I think it is good to work with other disciplines and have another set of hands, this co-treatment business has been hard for me to adjust to.  First, the treatment styles of the OT and PT must be compatible.  Second, there seems to be more wasted time with this method... OT obviously needs to assess things that aren't necessarily important from a PT perspective. I guess I haven't gotten into a real rhythm yet. 

Even more than co-treating with OT, I also have a plethora of nurses, doctors and social workers in this hospital setting, which is very different from an OP PT clinic or a privately owned clinic; where mainly PTs rule the road. 

What do you think?  What's the best way to handle co-treatments, or working with other disciplines?


Jason is absolutely right.  There are definite situations that benefit from co-treatment and there is a learning curve to get comfortable.  

An inpatient setting is very different from an outpatient facility.  I can remember days when I felt like all I did was wait on other rehab disciplines to finish or wait on nurses or radiology to get done with my patient.  Many times by the time the patient was finished with that activity, they were too tired for PT.  I'd let them rest, only to go back and find another department had shown up and usurped my position in line.

Everyone thinks their role is just as important as PT...that is why they are good at what they do; they believe in their profession and see how it benefits the patient.  Keeping that in mind helped me keep perspective.  

I wish I could say I got better at this as the years rolled on, but that frustration never went completely away.  What helped was to try to learn from every professional with whom I had the opportunity to interact.  In co-treatments, I'd look for something the other therapist did that I could take away and make my treatments more successful.  It might be a therapy technique or more a personality issue...something they did that made the patient respond positively.  Getting along with the other therapist isn't the focus.  A professional should be able to put differences aside, personal and treatment style differences, and work for the benefit of the client.  Instead of focusing on how their style doesn't mesh with yours, look at what you can learn from them.  Watch how the patient reacts to what they are doing.  If the patient is making progress, there may be something you can glean from the othe therapist's style and incorporate into your sessions to make your treatments even more effective than they already are.    

From OT's and ST's I learned techniques that weren't technically "PT" but that I could implement during PT treatments, along with PT techniques, that improved outcomes...even on days when I wasn't co-treating.

That said, there are therapists who choose to co-treat because it is "easy".  It isn't for the patient's benefit, but for the therapist's.  Those situations you have to discuss with your supervisor.  It may be there is value you are unable to recognize.  A seasoned manager will help you discern when this is the case.  But sometimes, you just have to call a spade a spade and refuse to co-treat.  If another therapist is using you like an aide and there is no skilled PT going on during the co-treatment sessions, you need to let that therapist know that the patient isn't receiving a PT benefit from these treatments so you will be scheduling separate treatments moving forward.  Make sure your supervisor is aware of the situation and knows your reasoning in case the other discipline manager gets involved.  Always good to cover your bases.

For the co-treatments, one thing to keep in mind is that the co-treating therapists need to have co-treatment goals.  You should both know what you are working toward and what you plan to accomplish each session.  Usually co-treatments aren't the only treatment the patient receives.  We might do 2 or 3 co-treatments a week and 2 or 3 individual treatments...or some other combination.  Maybe co-treat one time a day and individual for the other BID Rx.  

As far as the non-rehab disciplines, communication is key.  If you can approach it from a perspective of helping them, they will be far more agreeable.  If you are working on transfers with a bedside patient, you can ask nursing when they want the patient in the chair.  Schedule your therapy for before then and let them know you'll need the patient bathed and ready to be worked with, but emphasize you'll get the patient in the chair when you are done.  If they are getting something out of the deal, they will much more likely to help you and may even protect your time from would-be poachers!

Good luck navigating new waters!

Janey Goude August 2, 2009 2:08 AM

You are right on when you say the styles of the disciplines must match.  I like to co-treat and learn what they know and adjust as much as possible and within reason to their style of therapy.  

It is a learning curve and usually either the PT or OT will dominate the treatment but it doesn't mean the other will sit out of the session.  

There are benefits to co-treats, such as, when the patient is unable to tolerate two seperate sessions of therapy (cancer patients, CVA's, etc.).  If there is a specific activity you want to work on co-treat for 1/2 the time then go back.  

Jason July 31, 2009 10:41 AM

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