You guys…I have ONE semester left until I become Elizabeth Stanek, PT, DPT-how crazy is that?? Time sure does fly when you’re chasing your dreams. I finished my third clinical rotation a little over a week ago & it was bittersweet! In my last post I briefly explained what it was like, but that was only a few weeks in & 15 weeks later I have a ton more to share. These are the top things you may not have already known about acute care PT:
1. We don’t just “move people”. A lot of people (myself included until this rotation), think that it is just the PT’s job to help a patient get into a chair. Many of the acute care patients at this rotation are very disabled; in fact, many of these patients cannot even assist with a transfer from their bed to a chair. In this case, they are required to be dependently transferred by hospital staff into a special chair that converts from a stretcher using a slide board. Here’s a quick demo I found on YouTube to show what I’m talking about:
The truth is, we cannot ethically bill for this type of a transfer because it’s not technically skilled PT. That’s not to say that we can’t help a nurse or aide with this transfer if they need another set of hands, but this is not something that can only be performed by the PT. However, it is vital that a patient gets transferred into a chair at least once a day if possible. Sitting upright has been proven to increase blood flow & help with organ functioning. It helps patients to breathe better & decreases the chance of a blood clot forming. Additionally, upright posture helps to stimulate healing effects in the body.
2. We don’t just “walk patients”. While it might look like the PT’s in the hospital are just walking up & down the hallway with patients, we are doing so much more than that. During walking, we are talking to our patients, which trains dynamic balance & challenges endurance. Many times, we have to navigate around obstacles in the hallways such as linen bins, computers, & housekeeping carts. Again, this stresses more realistic walking because in real life you often have to navigate around obstacles to reach a destination. Walking challenges the patient’s balance, which is a common goal of many of our elderly patients. Additionally, we are continuously reassessing the patient during ambulation & creating new goals as the patient progresses. Once a patient reaches their ambulation goals, we often will add in cognitive tasks to challenge them further. This is especially true if the patient is very young & active prior to being admitted to the hospital.
3. We play a large role in helping the medical team choose a discharge disposition for patients. When doctors & case managers are determining where a patient gets discharged to, we are the experts in mobility that they rely on to determine what a patient needs from a mobility standpoint. We take into account where the patient lives, what they need to do daily, their support system, what they were doing prior to admission, & their endurance & motivation when deciding the best discharge location.
4. Not every patient in the hospital is seen by PT, & not all are seen daily. Part of our job as an acute care PT is to screen potential patients into & out of our caseload. This is done by rounding each morning with nursing, case management, & physicians. Nursing staff is able to tell us how they’ve seen their patients move & if they think PT is an appropriate intervention. Case management tells us if a patient has a specific discharge disposition they are working for, or if they need us to see the patient to determine discharge. Physicians sometimes have specific preferences about PT, so it is important to speak with them whenever possible regarding this. Once rounding is done, we will go check on specific patients that we think are independent & not requiring PT. Many times patients will be walking around by themselves & report that they feel safe & do not feel that they are getting around any differently than they were prior to being in the hospital. If not, we will perform a full evaluation & create goals for their treatment while they’re in the hospital. Depending on the severity of the patients’ deficits, we decide how frequently they are seen & the best setting to discharge to.
5. Discharge disposition is not necessarily a long-term solution. In the acute care setting, the main goal is to get the patient out of the hospital as quickly as possible. If a patient is medically stable & no longer requiring the intense care of a hospital but aren’t safe enough to go home, they can be discharged to a nursing home or inpatient rehab facility for a short period of time to continue to get stronger & healthier. Many people think that this is a long term disposition, but it isn’t always the truth. If a patient is discharged to a post-acute facility, once they are there it can be decided whether or not they want to transition to a long-term care facility or return home.
I’ve learned a wealth of information in these last 15 weeks & I wouldn’t trade this experience for the world. It was an intense rotation & I really enjoyed the hustle & bustle of a level one trauma center. I feel like I have improved my acute care skills immensely from before this rotation, but still have much to learn. Something that really can’t be simulated in labs is heavy transfers of patients suffering a newly diagnosed stroke. I could write a whole blog post on this subject alone (and maybe I will!); I have truly found a new passion with the stroke population through this internship. Additionally, I have made some great friends & mentors in the last 15 weeks; they have taught me so much & for that I am so grateful!
Team Bonding at Zombie Paintball
Christmas Pop-Up Bar for my Goodbye Celebration!
Now, I have a month off before starting my fourth and final rotation! This one is in a private school for children with special needs. I am so excited to pursue my other passion with a pediatric clinical! Right now, I’m currently sitting in the airport waiting for my flight to Chicago to see my Dad’s side of the family. I can’t wait to see my niece & nephews; it’s been about a year since I’ve seen them last!
What else would you be interested in hearing from my clinicals? I’ve learned so much that I don’t even know where to start!
Keep on dreaming,
Liz
Dreaming dpt 