3.1 Collaboration, Consultation and Referral to Others Flashcards
General approach
Situation 1: Case states that Pt is already working with another individual
- Verbalize how and why you would consult and collaborate with that individual
Situation 2: The case does not state that the patient is working with others but you feel that another individual should be involved in care to benefit the patient
- Verbalize who you would refer your patient to and why
- Explain how you would collaborate with the other healthcare provider moving forward
Overview of individuals
- Nurse (in-patient setting)
- Surgeon or Physician (in-patient setting)
- General Practioner (GP)
- Occupational Therapist (OT)
- Respiratory Therapist (RT)
- Social Worker
- Speech Language Pathologist (SLP)
- Family Member (e.g. spouse) or Friend/Caregiver
- Community Programs
- Counsellor or Behavioral Interventionist (BI)
- Dietician
- Physiotherapist
- Physiotherapy Assistant (PTA)
- Registered Massage Therapist (RMT)
- Chiropractor
Nurse (in-patient setting)
Consultation:
* Time pain meds with PT Rx sessions
* Time PT Rx sessions with any patient activities (e.g. meal time, investigation)
* If there are any changes in the patient’s status (e.g. signs of infection, a significant increase in pain, active bleeding)
Surgeon or Physician (in-patient setting)
Consultation:
- any post-op protocols or precautions that are in place if required
- any adverse reactions or concerns (e.g. signs of infection, a significant increase in pain, issue with medication, changes in patient’s status)
General Practioner (GP)
Reasons for a referral back to GP
1. Pt/their legal guardian/SDM has questions or concerns regarding medication
2. There has been a worsening of symptoms associated with the patient’s condition
3. You feel the Pt could benefit from physiatry, neurology or other specialists that can only be referred to by the patient’s GP
Collaboration/consultation
- Consult and collaborate regarding the patient’s progress and status
Occupational Therapist (OT)
Reasons for a referral
1. The Pt has difficulty with ADLs.
* OTs would be able to assess the Pt and provide suggestions to increase independence with ADLs
2. The Pt has cognitive impairments
* OTs can assess a Pt’s cognitive function, identify impairments and implement strategies/tasks to assist with cognitive functioning
- The Pt requires* home/equipment modifications* to adjust to a change in physical abilities (e.g. ramp, bars/raillings, wheelchair seating)
Collaboration & Consultation
- Consult with OT and collaborate by incorporating their ADL and cognitive strategies into your physiotherapy sessions.
Social Worker
Reasons for a referral
1. Pt and their family/caregiver need assistance with living arrangements/supports (e.g. community referrals, home care, long/short-term care, transportation)
- Pt and their family/caregiver need assistance with financial aid/funding
- Pt and their family/caregiver need emotional support/counselling
Collaboration & Consultation
1. Consult with SW to help ensure the Pt/ their family successfully navigate the health care system and have access to necessary resources
Respiratory Therapist (RT)
Reasons for a referral
* Assistance is needed with managing the Pt’s cardio-respiratory goals or concerns
* Pt is critically ill and requires advanced airway support
Collaboration & Consultation
* Consult with the RT regarding any cardiorespiratory concerns (e.g. increased secretions,decreased O2 saturation, increased work of breathing.)
* Collaborate with the RT on positioning or mobilization techniques to improve the Pt’s dyspnea or O2 desaturation
Speech Language Pathologist (SLP)
Reasons for a referral
- Pt requires assistance with speech/language/swallowing
Collaboration & Consultation
- the Pt is struggling with any speech/language or swallowing issues to improve your interactions and address the patient’s needs.
Family Member (e.g. spouse) or Friend/Caregiver
Collaboration & Consultation
1. Consult with the Pt (or their SDM) to gain consent to speak to family/friend/caregiver involved in their care
2. Consult with family/friend/caregiver regarding patient needs to maximize Pt outcomes
E.g. provide assistance with the following:
- Home exercise program
- Mobility/transfers
- Home adaptations/equipment
- Transportation
- Organizing/booking follow-up appointments
Community Programs
Reasons for a referral
- Pt with chronic condition can improve their overall health and management of their co-morbidities
Endless options!!
Reflect on programs that you have referred to in the past
- Community balance/fitness programs
- Community support groups (e.g. local stroke recovery group, Parkinson’s support group
- Cardiac/ pulmonary rehabilitation program
- Health and wellness programs (smoking cessation, substance abuse program, weight loss program)
Counsellor or Behavioral Interventionist (BI)
Reasons for a referral
1. The Pt present with psychological distress/anxiety about returning back to sport/work due to fear of re-injury
2. Pt with developmental delays or neurodivergence (e.g. CP, Autism)
3. Pt has depression, anxiety or other mental health concerns
4. Pt is looking to manage an addiction (e.g. quit smoking)
Collaboration & Consultation
1. Consulat with the counselor or BI to understand if you can incorporate any techniques into your care to specifically help the Pt’s needs
E.g. It was recommended that Pt with an eating disorder perform an exercise in a room without a mirror.
Dietician
Reasons for a referral
1. Pt requires assistance with weight management (under/overweight)/diet.
E.g. Pt with CF who is severely underweight. You address their low BMI and the Pt admits that they have lost a lot of weight lately. You suggest that they speak to a dietician and provide the patient with a list of local resources.
Collaboration & Consultation
1. Consult with dietician if necessary to maximaize Pt outcome
E.g. you notice that your Pt in the medical ward has not been eating musch of their meals throughout the day. You consult with the dietician to ensure they are aware that the Pt is not eating much of their food which can negatively impact their ability to participate in PT and their overall recovery
Physiotherapist
Reasons for a referral
1. Pt would benefit from (or is requesting) a type of treatment (e.g. acupuncture) that is beyond your skill set/knowledge
E.g. LBP Pt→heard about IMS can be helpful in managing low back tightness and would like to try including this in their treatment plan. You are not trained to perform intramuscular stimulation (IMS) but agree that it could be beneficial to the Pt. You provide your Pt with a list of local PT who are trained in IMS
- Pt is requesting treatment for a condition that is beyond your skill set/knowledge (e.g. pelvic floor rehbailitation)
Collaboration & Consultation
1. Collaborate and consult with other physiotherapists to maximize patient outcomes
E.g.1: If co-treating with another PT→ensure ongoing collaboration and consultation to ensure that there is no duplicaiton of treatment and that the services are beneficial
E.g. 2: Pt has shoulder pain due to supraspinatus impingement. You feel that they are not responding well to your treatment approach. After gaining consent from your Pt, you consult with a colleague to see if there are additional treatment strategies that could help you improve Pt outcomes
E.g. 3: Pt with AKA→Obese and have significant weaknesses. You would like to stand them for the first time post-op but you need additional assistance. You ask your colleague who works on the same ward if they could assist you with this Pt. By collaborating with your colleauge, you are able to mobilize the Pt while maximizing safety.
Physiotherapy Assistant (PTA)
Reasons for a referral
1. When appropriate, the use of a PTA can allow for an increase in the number of PT sessions and improve Pt participation and outcomes
E.g.1: Pt in a coma would benefit from regular daily PROM to maintain muscle length and joint range. By adding in the PTA, the Pt would receive more frequent PROM sessions that would physically benefit them
E.g. 2: Pt recovering from knee surgery is unmotivated to carry out their bed exercises on a daily bases. The use of a PTA can ensure that the Pt is adhering to their daily exercises to prevent post-op complications such as loss of ROM, muscle atrophy, DVT etc.
E.g. 3: MS Pt attending private PT to work on general strengthening and functional mobility. You feel that the Pt would benefit from additional weekly sessions to work on basic strength exercises and transfer practice. After gaining consent from the patient to involve a PTA in the program, you create a PT program and review it with the PTA to ensure they are competent to carry out the program with the patient.
Collaboration & Consultation
1. Consult with the Pt/SDM to gain consent for the involvement of a PTA
- Consult with the PTA and review the PT program to ensure the PTA is competent to carry out the PT program
- Check-in and monitor the PTA program at timely intervals
