A unique aspect of physical therapy is that we can treat people at all stages of their health. Physical therapy in acute care settings is not often sought by patients, but they are happy to have it once they realize how much better they feel when they move. It is more difficult to be creative with treatment plans and interventions in the hospital setting, but it is another area to promote our services and market our profession. Remember that these people will eventually leave the hospital, and would likely benefit from ongoing services. It is our job to educate them on how physical therapy can help them continue their road to health, and hopefully decrease the risk of any readmission.
In acute care, we tend to discharge people who are independently ambulatory from services because there is “no skilled need.” We make jokes about the referrals to evaluate these mobile individuals. I get it - with staffing limitations, it is difficult to justify spending time with someone who is not going to show a change in a standard outcome measure… But are there other outcome measures to explore? There is a reason this person was admitted to the hospital; is there a lifestyle factor that we can address while we have them in our care?
According to the APTA, “physical therapists are educated to provide insight and interventions to increase physical activity among appropriate patients to reduce excess body mass, improve health status, and reduce associated chronic disease risk. For example, for patients who are obese, physical therapists develop programs that can balance the progression of exercise with the need for joint protection and safety.” So, again I ask, is there a goal that can be addressed with this independently mobile patient?
Hospital management may not be fully on board with this approach, but it is our job to promote our profession. Present the idea that providing more physical therapy in the hospital may lead to a boost in the hospital’s outpatient services – this could be persuasive because that is a source of revenue. Also arguing that more physical therapy can contribute to a lower readmission rate may get their attention. I see the challenge – today’s health care model looks at upfront spending rather than long term costs (and savings.) But if we don’t start advocating for our profession now, what incentive will the hospital management have to keep as many physical therapy staff if reimbursement rates continue to decrease?