Decision Making & Clinical Handover

Question 1

What needs to be considered when making decisions in cardio physio?

Answer 1

• Info from medical file
• Info from patient (subjective)
• Physical assessment findings
• Tests & investigations
• Evidence from literature
• Clinical experience
• Patient preference
• Availability, cost time

Question 2

What is the step by step process of making decisions?

Answer 2

• Clearly understand the story so far
• Conduct patient-specific assessment (subjective/objective)
• Interpret data
• Select best treatment
• Implement and evaluate

Question 3

What is involved in understanding a patient’s story so far?

Answer 3

• Why is the patient here (HPI)
• Background (PHx, SHx)
• What investigations have been done/what do the results mean
• What is the current diagnosis (impression)
• What is the medical plan
• Who has referred the patient to physio

Question 4

What are the different types of referrals?

Answer 4

Blanket referral:

• Screening list of patients on a ward
• Identify those who may benefit from physio
• Liase with MDT

Referral from other HCP:
- Requires clinical handover

Question 5

What is a clinical handover?

Answer 5

Transfer of professional responsibility for care of a patient to another person

Question 6

What is the ISBAR method of clinical handover?

Answer 6

Introduction
- Yourself/role
- Patient (age, location, context)
Situation
- Main symptoms/problems/concern
- Patient stability/urgency of concern
Background
- Relevent medical/surgical history
- May include SHx
Assessment
- Current findings/interpretation
- What have you done so far
Recommendation (plan)
- What you want done
- Treatment that requires monitoring
- Review (when/by whom)

Question 7

What data needs to be interpreted following an objective assessment?

Answer 7

• Vital signs
• Observation/palpation
• Auscultation
• ABGs
• CXR/CT/MRI
• Comparison to normal values
• What is normal for the patient

Question 8

What are the 3 main respiratory problems amenable to physio?

Answer 8

• Increased WOB (dyspnoea)
• Impaired sputum clearance
• Lung collapse (atelectasis)

Question 9

What are some of the acute respiratory problems that are not amenable to physio?

Answer 9

• Acute pulmonary oedema (APO)
• Pleural effusion (only resolved by catheter)
• Pneumothorax
• Bronchiolitis (babies)
• Asthma (bronchoconstriction)
• Pulmonary embolism
• Consolidated pneumonia (no evidence of sputum)

Question 10

What should you do if you identify a problem that is not amenable to physio?

Answer 10

• Go back to the referral source
• Explain why physio can’t help
• Document accordingly

Question 11

What needs to be considered when selecting a treatment?

Answer 11

• What does the evidence suggest
• What does the patient prefer (what has worked well in the past)
• What is available
• What is practical/feasible
• What is cost-effective
• Short term vs long term
• Contraindications & precautions

Question 12

What are the treatment options for increased WOB?

Answer 12

• Support accessory muscles
• Pursed lip breathing
• IMT (long term)

Question 13

What are the treatment options for impaired sputum clearance?

Answer 13

• Mobilisation
• PEP
• ACBT
• Postural drainage
• Percussion & vibration

Question 14

What are the treatment options for lung collapse (atelectasis)?

Answer 14

• PEP
• Gravity
• Positive pressure
• Mobilisation

Question 15

What is an important thing to remember when selecting a treatment?

Answer 15

Explain to the patient how the treatment will help them with their problem

Question 16

What needs to be considered during re-evaluation?

Answer 16

• What changed

- Is it improving/worsening/staying the same

Question 17

What follows evaluation?

Answer 17

Goal setting (short term & long term)