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Raising the Bar in Rehab

Common Themes

Published September 6, 2012 4:30 PM by Lisa Mueller

I picked up a few hours of work at the acute-care hospital I previously worked at this weekend. I'm still a "pool" staff therapist and I have worked a few shifts since I left in February. It's nice to see my old coworkers and practice my acute-care skills. As I walked around the hospital, I started remembering the things I missed about working in acute care, and saw many similarities with my outpatient orthopedic work. So, of course, I made a list -- common practices for therapists among most settings, and differences specific to either the acute-care or outpatient settings I've worked in since my graduation three years ago.

1. Patients- similar in all settings. Some are motivated, others are not. Some have stories I'll always remember. Some make a lot of progress quickly, others need more time. Some patients look forward to their physical therapy sessions, some dread it.

2. Schedule- probably one of the more noticeable differences between acute care and outpatient. In acute care I don't have patients scheduled at specific times, I see patients when they are available. If one of my patients is at an X-ray or other procedure, I proceed to the next name on my list and work with that person instead. If it takes me a little time to locate a patient who is ready to work with me, I can adjust my schedule to accommodate him. Compare this to outpatient where my patients are scheduled at 45-minute intervals. If one of them comes late to his appointment, I either have to cut his session short by the time the next patient comes, or a domino effect ensues and I will start the rest of my schedule late. The flexibility of acute care is nice in those circumstances, but I also like the structure of an established schedule.

3. Physical demands- different, and similar. At the end of my outpatient days, my hands are usually pretty tired from performing a lot of manual techniques, depending on my schedule. At the end of my acute-care days, I'm tired from helping my patients complete transfers and balance training, as well as from walking to each patient's room. Therapists need to use their own bodies to some extent while working with patients in any setting

4. Interruptions- different. In acute care my sessions are constantly interrupted by nurses, doctors, respiratory therapists, or any other provider or even family who also need to work with the patient. Patients in the hospital rarely have time during the day to rest because people come into their rooms frequently to provide care, and they have countless tests and procedures to go to. In outpatient practice, my sessions are rarely interrupted.

5. Cancellations- different. If a patient cancels in outpatient, I can attempt to fill the slot with another patient but many times a cancellation results in non-billable time. I then tend to work on more administrative tasks. In the acute-care hospital I work at, there is always more work to do -- evaluations waiting to be completed, patients who need equipment prior to discharging or family-teaching sessions to finish.

I think this list is a good reminder to me that my career and profession offers a lot of variety but common trends as well. The things I like about my job -- the patients, seeing improvements, helping people -- are the same in every setting. The unique things specific to a particular setting may explain why some physical therapists shift their practice to different settings throughout the span of their career -- we need a change from time to time.

What do you think? Are there parts of your job that are specific to your setting?


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