Acute Care Direct Access
There have been a few posts this week from some of the other ADVANCE writers about the progress being made toward direct access for physical therapists. Dean wrote about a London-based hospital staffed by nurses and PTs with very high initial satisfaction results from patients. Brian wrote about new research supporting fewer costs and fewer visits for patients who saw a physical therapist first instead of a referring physician. Obviously, the transition to a DPT degree was in part to promote a physical therapist's ability to practice without the direction of a physician.
The physical therapy profession is moving in the direction of direct access, slowly but surely. Most therapists welcome this change and want the autonomy and responsibility of being first-line providers. The APTA has made a lot of progress for both private practice facilities and other outpatient clinics, but acute-care practitioners still rely on referrals from physicians or nurse practitioners.
Hospitals are big facilities. There are hospitals in Wisconsin with over 700 beds. The New York Presbyterian Hospital has 2,200 beds. It's not possible with numbers that big for a physical therapist to walk from room to room determining if her services are needed. The same reasoning applies for other consulted physicians. For nephrologists, palliative care, neurologists or any other specialized physician who needs to be involved with a patient's care, they receive a consulting order from the primary physician; the same process used for consulting physical therapists. For patients to ensure they are getting the care they need, a primary caregiver needs to direct and organize each involved professional. I mean this in terms of logistics, not in terms of hierarchy or control.
As direct access continues to develop and become the standard of practice for outpatient physical therapists, it will be interesting to see how that missed opportunity for acute-care therapists will impact their professional growth. I don't think acute-care therapists will fall behind outpatient therapists, but the culture of practice will be different between those two types of practitioners.
So, what does direct access mean for physical therapists practicing in acute care? How will the changes in direct access affect them, or won't they? What about other types of facilities, such as a subacute nursing home or long-term acute care? Can physical therapists in those settings expect direct access, and if so, how would it work?