P4R5W3: Tertiary Physiotherapy

Last week I failed to talk about the role of the physiotherapy in the acute care setting... obviously, we don't have a set client list so we print a handover sheet like we did on the AT&R ward. Patients are then prioritised based on their health status and rehabilitation goals, the risk for chest infections/falls/pressure sores/ability to self-manage, and with consideration of their planned date of discharge. We liaise with other healthcare professionals and services about their physiotherapy management, often getting information that makes our input more effective or safe. 

The typical day on the wards starts with printing off the handover sheet and annotating it with notes from the previous day's handover sheet (otherwise I might forget what I've done or going to do with the patient). We then scope out likely candidates for physiotherapy services from the list, check their notes and cross-reference the ward patient board (which is a large whiteboard with patient names, their room/bed number, nurse + Dr, planned discharge date and a list of services (OT, PT, SLT, Nutrition, Social work etc) that may have had input requested for a given patient. There's a triangle system: one side of the triangle symbolises a referral/input needed. Once the healthcare professional sees the patient, they can add another side of the triangle. When the healthcare professional has discharged the client from their service, they can add the final piece to complete the triangle... they can also put a red or green dot in the triangle to indicate that the patient is safe and ready to discharge or not. Of course, communication extends beyond the whiteboard and we discuss patients status / our findings with the healthcare team as well as reading their notes/making note entries into their medical documents. Depending on the ward, there will likely be some form of ward rounds... the ortho ward has a round at 8am every day, the surgical ward has two rounds during the week and a grand round on Friday, the medical ward will likely have daily rounds too (I haven't really observed this yet).

So we've got a list of patients to see, time to get on with the job! We start by visiting the HDU (high dependency unit) to see whether we can offer physio input there (at other times people at the HDU will page/ring for us). We take a couple of flights of stairs up for a fleeting flyby through the ortho ward to see how that's looking, and up another set of stairs to surgical.  At morning tea time the acute physiotherapy team regroups in the acute services office to ensure there is adequate cover across all wards (if one ward is particularly busy, then another physio will take on a couple of patients from another ward for the day). At lunch, the PTs regroup again to discuss how the morning has gone. By the end of the day, we are likely to somewhat regroup and tie up loose ends of paperwork etc.

Our role ranges, but generally we aim to have patients stay physically conditioned and mobilising safely (walking) and effectively for returning to their home environment (ie. do they have stairs with a rail that we need to see them complete before discharge) and performing chest/respiratory physio (assisting patients to clear lung secretions, breathe easier or otherwise maintain good lung health for their stay in hospital). There is, of course, a lot of patient education and information collecting (i.e. patient's previous level of function & home situation).

These are the common wards that are covered by the physiotherapy acute care team.

• General Surgical ward
• HDU/ICU
• Medical ward
• Orthopaedic ward
• Paediatric ward
• Emergency department

This week was very quiet on the Surgical and Orthopaedic wards, so I got to hang out on the medical ward and revamp patient information sheets for Bubble PEP and Incentive Spirometry. I also took to Snapchat whilst the draft copy was being sent to the printer! 

By all accounts, it was a very enjoyable week.