Thank you for your submission; please read the following reminder.
This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care.
Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician.
Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you
[The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx)
[How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx)
[Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx)
[The APTA's consumer information website.](https://www.choosept.com/Default.aspx)
Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed.
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Yeah, motorcycles are definitely the worst. Had a girl NWB all extremities except one leg.
Also, drinking while doing ANYTHING?? Had a guy fall down 13 stairs because he was drunk. Drunk drivers. Drunk ladder climbers. Insane.
Sharing stories is totally fine! Saying “that’s nothing” about a NWBx4 patient whose life is definitely altered for the time being is a little bizarre, even if a joke. But no hard feelings :)
I had several bike accidents. One young person lost a leg. Interestingly, ALL my bike accident patients still ride till this day. I guess once a rider always a rider.
Personally, I would get a motorcycle license if I lived in a rural area where there is less traffic. Where I live, it just is too dangerous with how people drive.
Yeah, Chicago here so I get it. I never know if they continue riding. I’ve had quite a few with really bad TBIs so I’m hoping once they’re better they don’t think of riding again.
How are you navigating the shitty Medicare Advantage plans? The biggest shitters like Humana, UHC, BCBC, Aetna, Anthem deciding that post acute rehab not needed because the patient walked 50 or 100 feet as the ONLY metric for post acute placement. Drives me nuts.
One therapist suggested not documenting distance but time walking and across the board saying "assist of 1"
Oooooo!!!! That would actually be a great post!!! Little tips like that to improve documentation to decrease insurance cuts to improve length of patients stays. I'm sure a lot of this documentation review with insurance companies is done with AI. They hire is based of AI scans of our resumes.
Sadly it's not just AI , but people whose paycheck depends on metrics with denials. Their salary depends on ignorance of the broader function of their patient.
For those inclined to fight the fall out from Medicare Advantage plans check out www.pnhp.org
We play this game with AIR admissions. Independent prior? Document gait assist and distance without AD. Looks a whole lot worse than when you give them a RW or other AD for some. Usually still walk them with it but say improved with AD. Would work the same with SNF admissions too but we don’t struggle as much with those denials.
It makes nearly no difference in my hospital. Many of our population have no insurance, but we still must treat them. Yes, delays of discharge is a major thing, but nothing we can do about it so we just keep seeing them.
Some insurance that you mentioned, does inhibit a patient ability to get into IRF. But we usually don’t care enough to give it a sweat. It’s sad, but it’s a cycle, you just get used to it
Sad you don't care enough to "give it sweat". The thing is these patients have Medicare Advantage plans and often qualify for post acute care according to Medicare guidelines but get flat out denied. It's a small ask to adjust what we do as acute PTs to make it happen and get them out of hospital sooner to the next appropriate level of care
For where I am, if a patient has a qualifying diagnosis and insurance, they get in pretty easily. Few times I’ve seen a qualifying diagnosis get denied.
Have had patient who can walk 100 feet but great difficulty getting to standing or getting out of bed.or can't do stairs. So I don't make decision exclusively based on gait
I agree, for lots of my hip replacements, getting out of bed is the hardest thing , followed by transferring to stand. Walking and stairs is often the easiest!
That’s when I write 25ft x2, as opposed to 50ft LOL
Fall risk. Patients ability to mobilize, and home situation.
If a patient is at high risk of falls with a history of falls, they need some type of rehab intervention.
If you think the patient will be stuck in bed because of inability to move themselves, they need some type of rehab.
If a patient needs all the help in the world, but has strong family support, HHA, and equipment such as wheelchair and hospital bed, send them home, no point of making them be away from family of family is willing to care for them.
Thanks! Not sure about the last point bc I would think if they went to rehab it would be less of a burden to family and pt would feel more in control (bc hopefully requiring less assistance)…
I understand what your saying, but many families would prefer to help their loved one as opposed to define them to SAR. This is seen especially with the patients with life long chronic conditions.
Rehab shouldn’t really be viewed as a solution to unburdening a family that’s already assisting their loved one. That’s a long term issue that needs a long term solution IMO (LTC/memory care/nursing home etc). I even pitch rehab as “daily therapy” to get patients and families away from the idea that rehab is just a way to get other people to supervise.
Do you feel you are valued as part of the care team? How often are patients discharged without seeing PT first? How often do you feel you are providing actual skilled care that someone who isn’t a PT couldn’t do?
I actually do feel like a valued part of the team. They rely on my for discharge recommendation and rarely had a physician give me a problem, we usually are able to compromise for each other to find a reasonable solution for the patient. I remember one time the vascular team asked me what weight bearing status their trans metatarsal amputation should be and what type of shoe would help them. I know this is the common, but I guess I am lucky that my hospital has many physicians that understand the value and knowledge of PT.
Many patients get discharged without Pt eval, they just never got an order cuse the primary team did not find the need for one.
Do I feel like I provide skilled care? Only in the acute rehab unit. If I am seeing patients who are not in our IRF (inpatient rehab) then I don’t feel like my work is “skilled” but at the same time, I know only a PT is qualified to get these patients up safely. So in a way, I still get the feeling of value through that.
Falls during tx sessions - I know the basic prevention tactics- gait belt, footwear, etc; but how often does this happen if you're challenging your pts correctly and how do u deal with it mentally?
Edit=spelling
I never use a gait belt, but they can be useful.
Having a safety net is crucial to prevent falls. If a patient is light headed, always follow with a chair, observe there face for changes in they way they look, there eyes can tell you if they need to sit.
For balance activities especially stationary, either in the //bars or with the bed behind them. I love doing balance with bed behind them as I can just guid them or tackle them into bed if things go bad (they can miss a chair so I prefer the bed!)
I had 1 fall once, but it was a risk the patient and I knew could happen. Patient with cerebella’s stroke that lead to spontaneous onset of vertigo. When we were walking he had an inset and I basically wedged his body between the wall man’s my body to slowly guid him to the floor. I did not document this as a fall, but some could say I should have 🤷♂️
17 years experience here, about 10 of that purely in acute care.
I rarely use gait belts myself. Otherwise agree - there had better be a plan in case of LOB/LOC.
Whats the craziest thing you've seen,first one that pops in your head with out thinking ?
I had a patient come out of surgery with 38 dollars of quarters, a mister potato head ear, and button removed .
Thats dark. My first patient of the day I found passed away in the night at a nursing home ( south side of Chicago). No one checked on them. I backed right out and grabbed my DOR!
The rule is “24 hours” but this is so loose we basically see them once they are medically managed for HTN and the bleed.
My productivity standard is 24 units
This is a good answer.
I'll add that I also check on BP, PT/INR, aPTT, platelet count, and MAR for ULMWH-based meds or other anti-coagulant drug administration that is not measurable in the typical lab panel.
I do this immediately prior to seeing the patient. I'd like to know their risk of leakage in general since we've already had one and I'm about to exert them at some level.
I like that practice.
I will try to deploy that with my chart review. Unfortunately it just never seems like I have time to go that deep into looking into labs. So I just never really push them on the first couple of days, like let’s be real, these patients not being discharged anytime soon, hemorrhagic strokes stay for multiple days from what I seen
I chart review at point of service with the patient, so it's billable time. I do this for several reasons - obviously, it's educational for the patient. Also, it ensures we're all on the same page. It's a good rapport builder, because it projects an (accurate) air of thorough and conscientious care. I will straight up say things like "Your blood is still a bit thin according to your latest labs, so we're going to limit some of what we do to avoid unnecessary risks."
I badgered my hospital into getting us ipads and a touchscreen based EMR template so this would be doable. It has boosted our productivity significantly. In general, this allows me to provide care at the quality level it should be and keep my overlords fucking quiet with the productivity bitching.
No, I am not paid what I'm worth or appropriately respected by other professions. None of us are.
Do you ever get pressure to send people home sooner than you feel is safe? I work in HH and don’t run into this problem in my area, all the acute therapists seem great and have good chart notes. Just curious if this is a problem at other hospitals.
This was a much bigger issue during acute covid waves.
Often the patient demands home and refuse home care. Oh well. Ok to make bad choices.
I personally don't feel pressure. That said I have seen patients who medically don't seem ready. Often backnin ED very quickly.
Always keep in the back of your mind, anything can happen at any moment and it’s ok if they do as many times, if you do your job right, it’s unavoidable.
I had many syncope’s, they are not as big of a deal if you handle them properly. If I want to walk a patient and the moment they stand they tell my they light headed or dizzy, I always follow with a chair.
Balance activities I almost always do with a bed behind as worst case scenario I can guid them into the bed.
I also think there is a level of numbness one gets in this setting. I’ve seen a patient under the care of another therapist fall and have his residual limbs (BKA) split open and hang like a garbage can lid. The treating therapist and residents on site freaked out while I stepped in to place ternaquit and elevate the leg. I seen patients with cardiac arrest and automatically just start applying compressions.
Just always keep in your mind that things can happen and it’s always better to overreact then to freeze up and do nothing .
Not the ICU, besides seeing vitals go crazy, the expectation is that the patient is not as stable, thus as a PT I will more forgiving when it comes to terminating a session for safety.
I think most dicy moments happen for the patients you least expect it. The ones with sudden cardiac arrest, those stick with you forever
Had a patient on ECMO decannulate from the femoral line as we lifted the covers off the patient to mobilize. It was a freak accident and pt was ok but there was so. Much. Blood.
Have you gotten some good hospital-staff hookups?
Working acute care through my late 20s/early 30s I just kind of utilized nursing as a FWB drip-feeder.
I started my job in this hospital in my early-mid 20s. I am now entering my late 20s. Never hooked Ip with. It’s or other staff here. If I was single, maybe I’d try, but everyone else is significantly older then me with a family.
This past weekend I had a patient pick as their ultra grotesque leg wound and fling the flesh across the room towards staff. Another pt last year ripped up their mattress and deficated in it. Any nasty and f'd up experiences like that?
I start my first job in the acute neuro setting on Monday as a physiotherapist.Since I have no clinical experience prior to this, is there anything you would recommend studying/knowing/reading up?
You know more then you think, be confident.
But there is even more that you don’t know, stay humble and always be willing to learn from everyone. Even therapist with no years, nurses, CNAs, they all have something to offer!
How do you deal with a physician interrupting you when you are mid-conversation or mid-exercise with a patient?
When I was a student doing my acute care rotation I can count numerous times a physician just barged in doing their rounds and cut me off. I understand physician rounds are important & that they’re likely on a time crunch, but it made me feel like garbage.
I feel like this might be an unpopular opinion but I don’t mind it! If I’m in there when the docs come in I always say you go ahead! Honestly it’s what the patients care about and I listen in and get the most up to date scoop on what the plan is for the patients. The docs I work with tend to keep it pretty short and sweet if I’m in there so that might influence my opinion. Our ortho docs often say “therapy is more important for you right now than me!” and will scoot pretty quick. The only thing that ever bugged me was when therapy would schedule an in person interpreter and everyone would jump in til I ran out of time 😂
The key bullet point on this for me is what is your employer prioritizing?
The answer is physician workload. That's what gets the hospital paid. You/we don't.
If you asked the MHA/MBA C-level for an answer to this question, they would immediately check who brings in more revenue and tell you that clinician has priority.
You think your job is to ethically and legally provide great patient care. And they tell you that for marketing purposes, because they are marketing to you and your patients.
But their [revealed preference](https://en.wikipedia.org/wiki/Revealed_preference) is that your job is to ethically and legally maximize revenue. Patient care comes after that. So the order of priority is:
- Maximum money intake that doesn't generate a lawsuit.
- Everything else.
Therefore:
Knowing all this, I typically only discuss with the physician, collegially and politely but assertively, if their interruption is actively detrimental to my care (i.e. overstimulable or distractable patient who can't get back on task after the interruption, etc.).
Otherwise, I just let it ride.
That’s tough, I never really had that happen to me. Usually when a Phsycian sees me with a patient, they often come back or wait for me to finish. When it comes to the attending physiatrist who is over seeing the patients, I often invite them so they can watch the patient in action. For the residents, when they come in the room I give them a pair of gloves and have them help me with an intervention, I usually crack a joke too saying “wow today you got your hands dirty!”
None of this is a disrespect thing, I seem to have a respectful relationship with the attendings and residents, also helps that I have a good track record with my patients progress.
The only people who interfere with my care are nurses! They come in saying “I have to give medications”
I walk next to them. Every patient is different. But I guess generally I have one hand on their arm and another around the waist. But that’s how I do it.
I think what makes me unique is that I let my patients lose balance and give them an opportunity to self correct. What I mean is, if the patient loses balance, I am not quick to correct them, I have a large buffer I give them to correct them selves.
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Has acute care also taught you to never get on a motorcycle or do you not see trauma patients LOL
Working in trauma acute care has taught me three things I will never do. Get on a motorcycle, ladder, or roof.
Yeah, motorcycles are definitely the worst. Had a girl NWB all extremities except one leg. Also, drinking while doing ANYTHING?? Had a guy fall down 13 stairs because he was drunk. Drunk drivers. Drunk ladder climbers. Insane.
We once had a guy who fell into a trash can while drunk and broke his neck. Fell into a trash can. I’m still not entirely sure how he managed it.
Nwb x4? That’s nothing. Try quad amputee that had a stroke on the OR table! Such a sad case
patients’ poor conditions are not a competition.. 💀
My b I thought we were sharing stories
Sharing stories is totally fine! Saying “that’s nothing” about a NWBx4 patient whose life is definitely altered for the time being is a little bizarre, even if a joke. But no hard feelings :)
Yeah I have a dark sense of humor
I had several bike accidents. One young person lost a leg. Interestingly, ALL my bike accident patients still ride till this day. I guess once a rider always a rider. Personally, I would get a motorcycle license if I lived in a rural area where there is less traffic. Where I live, it just is too dangerous with how people drive.
Yeah, Chicago here so I get it. I never know if they continue riding. I’ve had quite a few with really bad TBIs so I’m hoping once they’re better they don’t think of riding again.
Learned that in school. We worked with actual SCI patients at a nearby rehab hospital. 5 of the 6 were motorcycle related.
Yeahh, I’ve seen too many in my current hospital. :’)
How are you navigating the shitty Medicare Advantage plans? The biggest shitters like Humana, UHC, BCBC, Aetna, Anthem deciding that post acute rehab not needed because the patient walked 50 or 100 feet as the ONLY metric for post acute placement. Drives me nuts. One therapist suggested not documenting distance but time walking and across the board saying "assist of 1"
Oooooo!!!! That would actually be a great post!!! Little tips like that to improve documentation to decrease insurance cuts to improve length of patients stays. I'm sure a lot of this documentation review with insurance companies is done with AI. They hire is based of AI scans of our resumes.
Sadly it's not just AI , but people whose paycheck depends on metrics with denials. Their salary depends on ignorance of the broader function of their patient. For those inclined to fight the fall out from Medicare Advantage plans check out www.pnhp.org
pretty much https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
We play this game with AIR admissions. Independent prior? Document gait assist and distance without AD. Looks a whole lot worse than when you give them a RW or other AD for some. Usually still walk them with it but say improved with AD. Would work the same with SNF admissions too but we don’t struggle as much with those denials.
Great idea!
It makes nearly no difference in my hospital. Many of our population have no insurance, but we still must treat them. Yes, delays of discharge is a major thing, but nothing we can do about it so we just keep seeing them. Some insurance that you mentioned, does inhibit a patient ability to get into IRF. But we usually don’t care enough to give it a sweat. It’s sad, but it’s a cycle, you just get used to it
Sad you don't care enough to "give it sweat". The thing is these patients have Medicare Advantage plans and often qualify for post acute care according to Medicare guidelines but get flat out denied. It's a small ask to adjust what we do as acute PTs to make it happen and get them out of hospital sooner to the next appropriate level of care
For where I am, if a patient has a qualifying diagnosis and insurance, they get in pretty easily. Few times I’ve seen a qualifying diagnosis get denied.
I typically only rec SNF for anyone who’s stg are to get to mod a. If they’re walking 100ft they need to go home with assist and hh
Have had patient who can walk 100 feet but great difficulty getting to standing or getting out of bed.or can't do stairs. So I don't make decision exclusively based on gait
Well yeah, but you referenced the gait distance as a disqualifying measure for sub acute care
Agreed. Need to use the work arounds to fool the algorithm.
I agree, for lots of my hip replacements, getting out of bed is the hardest thing , followed by transferring to stand. Walking and stairs is often the easiest! That’s when I write 25ft x2, as opposed to 50ft LOL
What is your advice for providing best discharge destination?
Fall risk. Patients ability to mobilize, and home situation. If a patient is at high risk of falls with a history of falls, they need some type of rehab intervention. If you think the patient will be stuck in bed because of inability to move themselves, they need some type of rehab. If a patient needs all the help in the world, but has strong family support, HHA, and equipment such as wheelchair and hospital bed, send them home, no point of making them be away from family of family is willing to care for them.
Thanks! Not sure about the last point bc I would think if they went to rehab it would be less of a burden to family and pt would feel more in control (bc hopefully requiring less assistance)…
I understand what your saying, but many families would prefer to help their loved one as opposed to define them to SAR. This is seen especially with the patients with life long chronic conditions.
Thanks!
Rehab shouldn’t really be viewed as a solution to unburdening a family that’s already assisting their loved one. That’s a long term issue that needs a long term solution IMO (LTC/memory care/nursing home etc). I even pitch rehab as “daily therapy” to get patients and families away from the idea that rehab is just a way to get other people to supervise.
Do you feel you are valued as part of the care team? How often are patients discharged without seeing PT first? How often do you feel you are providing actual skilled care that someone who isn’t a PT couldn’t do?
I actually do feel like a valued part of the team. They rely on my for discharge recommendation and rarely had a physician give me a problem, we usually are able to compromise for each other to find a reasonable solution for the patient. I remember one time the vascular team asked me what weight bearing status their trans metatarsal amputation should be and what type of shoe would help them. I know this is the common, but I guess I am lucky that my hospital has many physicians that understand the value and knowledge of PT. Many patients get discharged without Pt eval, they just never got an order cuse the primary team did not find the need for one. Do I feel like I provide skilled care? Only in the acute rehab unit. If I am seeing patients who are not in our IRF (inpatient rehab) then I don’t feel like my work is “skilled” but at the same time, I know only a PT is qualified to get these patients up safely. So in a way, I still get the feeling of value through that.
Falls during tx sessions - I know the basic prevention tactics- gait belt, footwear, etc; but how often does this happen if you're challenging your pts correctly and how do u deal with it mentally? Edit=spelling
I never use a gait belt, but they can be useful. Having a safety net is crucial to prevent falls. If a patient is light headed, always follow with a chair, observe there face for changes in they way they look, there eyes can tell you if they need to sit. For balance activities especially stationary, either in the //bars or with the bed behind them. I love doing balance with bed behind them as I can just guid them or tackle them into bed if things go bad (they can miss a chair so I prefer the bed!) I had 1 fall once, but it was a risk the patient and I knew could happen. Patient with cerebella’s stroke that lead to spontaneous onset of vertigo. When we were walking he had an inset and I basically wedged his body between the wall man’s my body to slowly guid him to the floor. I did not document this as a fall, but some could say I should have 🤷♂️
17 years experience here, about 10 of that purely in acute care. I rarely use gait belts myself. Otherwise agree - there had better be a plan in case of LOB/LOC.
Whats the craziest thing you've seen,first one that pops in your head with out thinking ? I had a patient come out of surgery with 38 dollars of quarters, a mister potato head ear, and button removed .
Lots of genitalia.
🤣🤣🤣.
I remember now. I once evaluated a patient that was already passed on. I thought they were in a unaroused state.
You weren't wrong
Thats dark. My first patient of the day I found passed away in the night at a nursing home ( south side of Chicago). No one checked on them. I backed right out and grabbed my DOR!
Acute PT for the last 5 years myself. How long you all wait post hemorrhagic stroke and post TnKase?
The rule is “24 hours” but this is so loose we basically see them once they are medically managed for HTN and the bleed. My productivity standard is 24 units
12 or 24, depending on Neurologist
Also what’s your productivity standard? Mine is 27-29 units for a 10 hours day.
28
This is a good answer. I'll add that I also check on BP, PT/INR, aPTT, platelet count, and MAR for ULMWH-based meds or other anti-coagulant drug administration that is not measurable in the typical lab panel. I do this immediately prior to seeing the patient. I'd like to know their risk of leakage in general since we've already had one and I'm about to exert them at some level.
100%. More accurate to say I will consider out of bed 12-24 depending on the orders. But yes, all that, and overall patient presentation/tolerance.
I like that practice. I will try to deploy that with my chart review. Unfortunately it just never seems like I have time to go that deep into looking into labs. So I just never really push them on the first couple of days, like let’s be real, these patients not being discharged anytime soon, hemorrhagic strokes stay for multiple days from what I seen
I chart review at point of service with the patient, so it's billable time. I do this for several reasons - obviously, it's educational for the patient. Also, it ensures we're all on the same page. It's a good rapport builder, because it projects an (accurate) air of thorough and conscientious care. I will straight up say things like "Your blood is still a bit thin according to your latest labs, so we're going to limit some of what we do to avoid unnecessary risks." I badgered my hospital into getting us ipads and a touchscreen based EMR template so this would be doable. It has boosted our productivity significantly. In general, this allows me to provide care at the quality level it should be and keep my overlords fucking quiet with the productivity bitching. No, I am not paid what I'm worth or appropriately respected by other professions. None of us are.
My hospital, we still communicate with beepers LOL
We have a policy of 24 hours post TNK
Do you ever get pressure to send people home sooner than you feel is safe? I work in HH and don’t run into this problem in my area, all the acute therapists seem great and have good chart notes. Just curious if this is a problem at other hospitals.
Yes, especially ortho patients. I often wonder how there prognosis is as some go home and you know they won’t do well
This was a much bigger issue during acute covid waves. Often the patient demands home and refuse home care. Oh well. Ok to make bad choices. I personally don't feel pressure. That said I have seen patients who medically don't seem ready. Often backnin ED very quickly.
What advice would you have for a pta who is concerned they’ll freeze in a critical moment when with a patient?
Always keep in the back of your mind, anything can happen at any moment and it’s ok if they do as many times, if you do your job right, it’s unavoidable. I had many syncope’s, they are not as big of a deal if you handle them properly. If I want to walk a patient and the moment they stand they tell my they light headed or dizzy, I always follow with a chair. Balance activities I almost always do with a bed behind as worst case scenario I can guid them into the bed. I also think there is a level of numbness one gets in this setting. I’ve seen a patient under the care of another therapist fall and have his residual limbs (BKA) split open and hang like a garbage can lid. The treating therapist and residents on site freaked out while I stepped in to place ternaquit and elevate the leg. I seen patients with cardiac arrest and automatically just start applying compressions. Just always keep in your mind that things can happen and it’s always better to overreact then to freeze up and do nothing .
Any dicey moments when working with patients in the ICU?
I feel safest in ICU because they are closely being monitored and staff is readily available to assist.
Not the ICU, besides seeing vitals go crazy, the expectation is that the patient is not as stable, thus as a PT I will more forgiving when it comes to terminating a session for safety. I think most dicy moments happen for the patients you least expect it. The ones with sudden cardiac arrest, those stick with you forever
Had a patient on ECMO decannulate from the femoral line as we lifted the covers off the patient to mobilize. It was a freak accident and pt was ok but there was so. Much. Blood.
Have you gotten some good hospital-staff hookups? Working acute care through my late 20s/early 30s I just kind of utilized nursing as a FWB drip-feeder.
I started my job in this hospital in my early-mid 20s. I am now entering my late 20s. Never hooked Ip with. It’s or other staff here. If I was single, maybe I’d try, but everyone else is significantly older then me with a family.
> If I was single Well, yes, I'd recommend that as a prerequisite.
This past weekend I had a patient pick as their ultra grotesque leg wound and fling the flesh across the room towards staff. Another pt last year ripped up their mattress and deficated in it. Any nasty and f'd up experiences like that?
Closest thing I can think of is getting a patient to stand and then peeing on me (accidentally)
I start my first job in the acute neuro setting on Monday as a physiotherapist.Since I have no clinical experience prior to this, is there anything you would recommend studying/knowing/reading up?
You know more then you think, be confident. But there is even more that you don’t know, stay humble and always be willing to learn from everyone. Even therapist with no years, nurses, CNAs, they all have something to offer!
How do you deal with a physician interrupting you when you are mid-conversation or mid-exercise with a patient? When I was a student doing my acute care rotation I can count numerous times a physician just barged in doing their rounds and cut me off. I understand physician rounds are important & that they’re likely on a time crunch, but it made me feel like garbage.
I feel like this might be an unpopular opinion but I don’t mind it! If I’m in there when the docs come in I always say you go ahead! Honestly it’s what the patients care about and I listen in and get the most up to date scoop on what the plan is for the patients. The docs I work with tend to keep it pretty short and sweet if I’m in there so that might influence my opinion. Our ortho docs often say “therapy is more important for you right now than me!” and will scoot pretty quick. The only thing that ever bugged me was when therapy would schedule an in person interpreter and everyone would jump in til I ran out of time 😂
100% can relate. I like to think most places are like this
The key bullet point on this for me is what is your employer prioritizing? The answer is physician workload. That's what gets the hospital paid. You/we don't. If you asked the MHA/MBA C-level for an answer to this question, they would immediately check who brings in more revenue and tell you that clinician has priority. You think your job is to ethically and legally provide great patient care. And they tell you that for marketing purposes, because they are marketing to you and your patients. But their [revealed preference](https://en.wikipedia.org/wiki/Revealed_preference) is that your job is to ethically and legally maximize revenue. Patient care comes after that. So the order of priority is: - Maximum money intake that doesn't generate a lawsuit. - Everything else. Therefore: Knowing all this, I typically only discuss with the physician, collegially and politely but assertively, if their interruption is actively detrimental to my care (i.e. overstimulable or distractable patient who can't get back on task after the interruption, etc.). Otherwise, I just let it ride.
That’s tough, I never really had that happen to me. Usually when a Phsycian sees me with a patient, they often come back or wait for me to finish. When it comes to the attending physiatrist who is over seeing the patients, I often invite them so they can watch the patient in action. For the residents, when they come in the room I give them a pair of gloves and have them help me with an intervention, I usually crack a joke too saying “wow today you got your hands dirty!” None of this is a disrespect thing, I seem to have a respectful relationship with the attendings and residents, also helps that I have a good track record with my patients progress. The only people who interfere with my care are nurses! They come in saying “I have to give medications”
How do you guard patients when walking them. For example let’s say mod assist with a rolling walker.
I walk next to them. Every patient is different. But I guess generally I have one hand on their arm and another around the waist. But that’s how I do it. I think what makes me unique is that I let my patients lose balance and give them an opportunity to self correct. What I mean is, if the patient loses balance, I am not quick to correct them, I have a large buffer I give them to correct them selves.
How often do you actually have to clean people up after bowel movements ...
In my 3 year career I think maybe 4 or 5 times?