The Role of the Acute Care Physical Therapist

The Role of the Acute Care Physical Therapist

Caroline Ballard, SPT

Background

Before entering physical therapy school and while building my resume, I attempted to gain experience in acute care at the local hospital in my hometown of Wilmington, NC, but was unable to due to restrictions in place that limited students from shadowing.  Coincidentally, I was placed at New Hanover Regional Medical Center for my second clinical rotation in the program.  I quickly grew to appreciate my role as a student physical therapist in this setting and learned a significant amount about interdisciplinary care.  I was also able to complete an inservice on this rotation that introduced the rehabilitation team to Move in the Tube sternal precautions, as they were introduced to us in the Cardiopulmonary Physical Therapy course.  Since then, these less restrictive and evidence-based precautions have been adopted by the hospital at large for all patients who have undergone surgery via median sternotomy.  In our Evidence-Based Practice II course in the fall, I completed my critically appraised topic on the subject of mobilization after an acute deep vein thrombosis and was inspired to expand my literature search and project direction to include broader topics related to management of patients in the acute setting.  My research and positive experiences on my clinical rotation sparked my interest in pursuing employment in acute care after graduation and I felt drawn to help future classes of students prepare for this important clinical rotation and develop an appreciation for our role as physical therapists in this setting.

 

Statement of Need

It is well known that physical therapy services in acute care can result in improvements in functional status, gait speed, activity tolerance and quality of life.^1,2  There are also studies that report reduced readmission rates, length of stay and overall cost to the hospital system.^2–4  Additionally, The Bureau of Labor Statistics reports that 28% of working physical therapists are employed by hospitals.⁵  Due to the positive patient outcomes and the shear prevalence of physical therapists working in acute care, it is essential that new graduates feel prepared to enter this setting. Unfortunately, many student physical therapists and entry-level providers lack confidence when treating medically complex populations in the acute care setting.  It is important that physical therapy programs prepare and inspire students to work in this setting through quality education and clinical experiences and enable them to fulfill their role as generalist providers upon graduation. There have been few student Capstones in this content area in the last several years and I want to take this opportunity to give back to the program and other future therapists by increasing their confidence working and thriving in the acute care setting.

 

Purpose

In the current UNC DPT curriculum, content about physical therapy and patient management in acute care is split between different courses but is primarily located in PHYT 720 Intro to PT Intervention and PHTY 710 Cardiopulmonary and Other Organ Systems.  The purpose of this capstone project is to update and add to materials in the Acute Care Module of the PHYT 720 course.  It is important that as future evidence-based providers, our educational materials are regularly updated and presented in forms that are relevant to and representative of current practice models in each setting.  The products produced through this project will direct students in learning about their roles in acute care including maintaining safety for patient and self, conducting thorough chart reviews, new patient examinations, evaluation, assessment, developing a plan of care, choosing and implementing appropriate interventions, progressing patients appropriately based on response to treatment, communicating with an interdisciplinary team and discharge planning.  One of the most important products I produced are the materials associated with the Chart Review Activity.  It was essential that this material be updated for future students to simulate a real electronic medical record, as one of our main experiences with Chart Review when I took the course was to look through paper charts in binders, which is just not realistic, especially in the acute setting.

 

Products

Products for this capstone project include a PowerPoint presentation and VoiceThread narration, a printable Lab Values Booklet and a Chart Review Activity.  The activity includes an interactive patient case presented in the form of a medical chart created with OneNote, guiding questions for chart review and an associated answer key for reference after completion of the activity.  The PowerPoint presentation and VoiceThread narration outline the various roles of the acute care physical therapist and are organized in a logical manner beginning with chart review and continuing to include essential skills in examination, evaluation, assessment, intervention selection, documentation and discharge planning.  The Lab Values Booklet is designed to be a quick reference guide for students to use while on clinical rotations to look up pertinent values and their normal ranges and help to identify contraindications to mobility.  For those that may prefer the values organized in a different manner, a PDF of the slides in chronological order is included.  All products are linked below:

Capstone Presentation

VoiceThread narration

Lab Values Booklet Final

Lab Values PDF

Mock EMR 3_24_22

Chart Review Activity Guiding Questions

Chart Review Activity Answer Key

 

Evaluation

I created a Qualtrics survey to assess students’ responses to the capstone materials and gather data on their feedback.  Since PHYT 720 does not meet until the Fall, I did not have a built in class of students to present my materials to.  Capstone materials were distributed to students in all three classes and they were asked to consider reviewing and evaluating the project.  Students who reviewed my materials reported they were presented in a clear and logical manner, overall of good quality and relevant to clinical rotations and practice.

Qualtrics Survey

 

Self-Assessment

My personal learning objectives for this project included solidifying my own understanding of management of various acute populations and learning more about teaching and developing educational materials for professional students/peers.  I hoped to use this project and the process of its development to review topics that will be tested on the NPTE, as well as become more confident in my ability to step into the acute care setting after graduation.  While I did not produce a formal evidence table as a product for the project, I conducted an extensive literature review on all included topics in the presentation and educational materials.  It was a unique and rewarding experience to review and update material I had seen before in the curriculum.  I was able to utilize skills in literature review and appraisal that I did not have when I saw this material the first time and this allowed me to deepen my understanding of the topics.

I was also able to develop material at an appropriate level for entry-level students and practice my skills in presenting to a group of peers.  I feel I managed my time wisely and often found myself completing items ahead of my self-assigned timeline.  This meant I was able to reach out to my committee more frequently with updated materials to review and had more opportunities to incorporate their feedback along the way.  I feel I met my learning objectives and beyond over the course of the project.  I am very proud of the products I created and am excited for them to be used in the curriculum for future UNC DPT cohorts.

 

Acknowledgements

To Lisa Johnston, PT, DPT, thank you for your guidance and feedback throughout this capstone project as my primary advisor.  Your expertise in content and teaching were essential to the success of the project and development of quality products.

To Sean Lowers, PT, DPT, thank you for the fresh perspectives you provided as both a clinician and educator and serving as one of my committee members.  PHYT 710 will always be one of my favorite courses in the curriculum and it was great to work with you again.

To Ana Reyes Lewis, PT, DPT, thank you for facilitating an excellent clinical rotation at NHRMC and agreeing to serve on my capstone committee.  I valued your feedback on my products as a practicing therapist in this setting and am so grateful for everything you taught me on my rotation as well.

 

References

1. Braden HJ, Hilgenberg S, Bohannon RW, Ko M-S, Hasson S. Gait speed is limited but improves over the course of acute care physical therapy. J Geriatr Phys Ther. 2012;35(3):140-144. doi:10.1519/JPT.0b013e31824baa1e
2. Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Physical Therapy Services Reduce Length of Stay and Improve Health Outcomes in People With Acute and Subacute Conditions: An Updated Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2018;99(11):2299-2312. doi:10.1016/j.apmr.2018.03.005
3. Falvey JR, Burke RE, Malone D, Ridgeway KJ, McManus BM, Stevens-Lapsley JE. Role of physical therapists in reducing hospital readmissions: optimizing outcomes for older adults during care transitions from hospital to community. Phys Ther. 2016;96(8):1125-1134. doi:10.2522/ptj.20150526
4. Freburger JK, Chou A, Euloth T, Matcho B, Bilderback A. Association between use of rehabilitation in the acute care hospital and hospital readmission or mortality in patients with stroke. Arch Phys Med Rehabil. 2021;102(9):1700-1707.e4. doi:10.1016/j.apmr.2021.02.026
5. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook: Physical Therapists. September 8, 2021. Accessed April 13, 2022. https://www.bls.gov/ooh/healthcare/mobile/physical-therapists.htm