Re: Hand-off of patients from PT to PTA

[Guest guest]

We frequently have this debate in my setting. My take on it is, how can a PT

write a goal for something that they did not assess? How would you know if the

goal is appropriate? How would you determine how long it would take to meet it?

When I pose these questions to my staff it usually helps them to understand a

little better.

It is a difficult situation though, especially in acute care when our volume of

evaluations is so high and the PT needs to keep extra treatments on their

caseload if they were unable to complete the full evaluation on the first visit.

Jill Piazza, PT, MSPT

Florida Hospital DeLand

---- " patricia.bergman " wrote:

=============

I am an OT/PT Coodinator for my facility's inpatient and acute

rehabilitation units. One of the recent topics of discussion was

regarding when a PT can realistically turn patient treatment over to a

PTA in NY. The question was, if a patient has been evaluated by the

physical therapist for bed mobility or a sit-to-stand transfer only, is

it reasonable or appropriate to write a goal for stair climbing which

would then be addressed by a PTA on Day Two?

The current NYS Practice Acts read that a PTA cannot perform evaluation

of any kind. The concern that is raised is whether or not having a PTA

be the first to actually see the patient perform on the stairs is

outside their scope of practice. The PTs are cureently divided on

this, and any input you can provide will be much appreciated.

Thank you.

Bergman, OTR/L

--

Jill

[Guest guest]

Jill,

My answer to the question " how can a PT write a goal on something they

have not assessed " is relatively simple - especially as it relates to

the Inpatient Rehabilitation Facility setting ...

We as PTs constantly assess patient's " strength " , balance, coordination,

perception, " motivation " etc. and, we read and interpret reports, test

results and other inputs from the patient's Acute stay and " pre-injury "

status and, hopefully have enough experience with the current/relevant

diagnosis to have a good idea of how a patient will perform a number of

activities that are not necessarily assessed upon admission. Indeed,

isn't that one of the reasons we do all of our other " assessing " ?

I think ascending/descending stairs may be one of the more difficult

functional activities to write a goal for without actually assessing,

but I believe that by the time a therapist has a patient at the stairs,

he/she has already made a determination of how well that patient is

going to do the very first time.

To be clear, this is my take only, and the practice on our Acute Rehab

Unit is such that there is always a therapist available to discuss a

case with a PTA or other staff. PTAs do not write goals in our

facility, but they are strongly encouraged to make recommendations to

PTs who follow-up with the patient in person. I welcome other thoughts

and opinions.

Trumbull

Bloomington-Normal, IL

[Guest guest]

I fully agree with you! I have worked in a hospital setting for

12 years and have seen many therapist write goals without ever

assessing the skill. Why bother ever seeing the patient then! I

have never understood what the rationale is of practicing therapy

this way.

Anyway, other facilities I have worked at never let a PTA write

goals, but the new rehab facility I'm at say that PTA's and COTA's

can write an updated goal when a goal from the eval has been

achieved. I'm trying to discourage this as the PTA's and COTA's

really have no background in regards to writing complete and

functional goals. Do you know what the APTA's stand is on this

issue?

Egbert PT, WCC, CKTP

Director of Rehab

Draper Rehab

Draper, UT

>

> Jill,

>

> My answer to the question " how can a PT write a goal on something

they

> have not assessed " is relatively simple - especially as it relates

to

> the Inpatient Rehabilitation Facility setting ...

>

> We as PTs constantly assess patient's " strength " , balance,

coordination,

> perception, " motivation " etc. and, we read and interpret reports,

test

> results and other inputs from the patient's Acute stay and " pre-

injury "

> status and, hopefully have enough experience with the

current/relevant

> diagnosis to have a good idea of how a patient will perform a

number of

> activities that are not necessarily assessed upon admission.

Indeed,

> isn't that one of the reasons we do all of our other " assessing " ?

>

> I think ascending/descending stairs may be one of the more

difficult

> functional activities to write a goal for without actually

assessing,

> but I believe that by the time a therapist has a patient at the

stairs,

> he/she has already made a determination of how well that patient is

> going to do the very first time.

>

> To be clear, this is my take only, and the practice on our Acute

Rehab

> Unit is such that there is always a therapist available to discuss

a

> case with a PTA or other staff. PTAs do not write goals in our

> facility, but they are strongly encouraged to make recommendations

to

> PTs who follow-up with the patient in person. I welcome other

thoughts

> and opinions.

>

> Trumbull

> Bloomington-Normal, IL

>

>

>