Week 1 Flashcards
Emergency Department (ED)
Level 1
Emergency Care, unscheduled urgent care, safety net care
PT role** decrease wait times, hospital costs, less wait time for OP rx
** studies done on for LBP **
Intensive Care Unit (ICU)
Level 1
Severe life threatening illness
Continuous monitoring; mechanical ventilation, medicinal, hemodynamics
Neonates (NICU), Pediatric (PICU)
Cardiac Care Unit (CCU)
Level 1
Critically ill cardiology pts who need close monitoring
Post op cardiac procedures/illnesses
Progressive Care Unit (PCU)
Level 1
Less intensive/invasive as ICU
Lower risk of instability
Greater ability to participate on their own
1 day in hospital =
1 day in ICU =
3 days of recovery
5-7 days of recovery
ICU delirium (AKA ICU psychosis/syndrome)
State of extreme rapid confusion
-fatigue, confusion, anxiety, hallucinations.
-80% of pts who’ve been on mechanical ventilators
-Constant bright lights and sounds, interrupted sleep isolation, decreased mobility
Post Intensive Care Syndrome (PICS)
cognitive, psychological, and physical impairments that can follow illness
Most important intervention for PTs in (ICU, CCU, PCU)
Early Mobilization - bed mobility, sitting up, balance, transfers, walking
Acute Care
Level 2
Short Term: following illness, surgery, trauma
Doesn’t require intensive monitoring
3-5 day stay average, goal is immediate D/C
D/C Factors
Prior/Current level of function
Family Help
Pt’s wants
Main PT Focus in Acute Care
Assess/improve mobility
Increase independence
D/C planning
Continuum of Care
From when pt enters health care system up to D/C
Acuity
Severity of illness
Education for all Handicapped Children Act
Free and appropriate public education for all children w disabilities
IDEA Part B
3-21 y/o
Intellectual disability, hearing impairment, speech/language impairment
Services: SLP, PT, OT, psych. social worker
Section 504
Students who have disabilities but don’t aren’t SPED.
Section 504 vs IDEA Part B
IDEA: focus on education, i.e child w/ TBI
Section: focus on maneuvering, i,e child w/ prosthetic
IDEA Part C criteria
0-3 y/o, must meet 1 of the following;
a. Physical, cognitive, communication, social or emotional, adaptive development
b. have diagnosed physical or mental condition that has a high probability of resulting in developmental delay
c. at risk for substantial developmental delay if they do NOT receive early intervention services
PT role in early intervention
a. correct or minimize the problem/delay
b. maximize the child’s developmental potential
c. functional activity based strategies in natural environment
d. integrate all areas of development into sessions
e. embed strategies into family routines
f. adapt home environment
g. equipment
Home health Care settings
Level 4
Home, assisted living facilities (ALF), independent living facility (ILF), group home, adult daycare, hospice home
Typical impairments in home heath
ADL’s, self care, functional mobility, home management, instruments of ADL’s (washer, dryer, vacuum)
Home health session characteristics
Sessions: 1-1
Duration: 45-60 min
patients per day: 5-6
Length of stay: as long as pt homebound
Medicare Criteria for home health
- Homebound
- under care of physician
- POC reviewed by physician
- In need of skilled nursing, OT, SLP
Homebound Criteria One
a. due to illness/injury, need the aid of walking device or special transportation, or assistance of another person in order to leave house
OR
b. have condition that leaving house is medically contraindicated
Homebound Criteria Two
a. must exist a normal inability to leave home
AND
b. leaving home must require a considerable and taxing effort
Inpatient Rehab Settings
Level 3
LTACH (Long term acute care hospital)
IRF (inpatient rehab facility)
LTACH
extended, intensive rehab care for complex patients
Frequency: Varies
Duration: 25+ days, short session duration
LTACH pt characteristics
a. Require: intense level of care, freq. MD Oversight, advanced nursing care
b. No longer need: technology and diagnostic services required in acute care but more than SNF
c. Need a lot of assistance for: eating, bathroom, dressing, moving around
Medicare LTACH requirements
a. physician referral
b. medically complex treatment that only can be provided in a hospital setting
c. requires long stay 25 days+
Inpatient Rehab Facility (IRF) purpose
facilitate pt capacity to being reintroduced into community as independently as possible, typically after illness, injury, surgery
IRF Characterisitics
2-3 week stay, goal is immediate D/C
3hrs/day, 5-7days/wk
3x/wk face to face w/ physician
Medicare IRF Criteria
a. tolerate intense rehab 3hrs/day, 5-7days/wk
b. requires complex nursing, medical management, and rehab needs (all 3)
c. at least 2 therapy disciplines (PT, OT, SLP, audiology etc.) one must be PT or OT
d. Reasonanly be expected to actively participate in and benefit from intensive rehab therapy program
-measurable improvement within a prescribed period of time
(improvement standard)
-improve pts functional capacity or adaptation to impairments
-pt expected to be D/C back into community, cant go into a diff
facility
Types of outpatient
a. Comprehenisive Outpatient Rehab Facility (CORF)
b. outpatient hospital clinics
c. private practice/ cash based practice
d. corpororate outpatient clinics
e. outpatient care in long term care facilities
f. prevention and wellness: industrial company, athletic facility, fitness center
g. Telehealth
CORF: Comprehensive Outpatient Rehabilitation Facilities
Medicare certified facility
Requires physician, physical therapy, and psycho/social services
POPTS (physician owned physical therapy services)
A physician has an ownership interest in a physical therapy practice to which he or she refers
A physician or the physician’s practice employs or contracts with PTs to provide PT services within the physician practice
APTA opposes this
Direct Access Benefits
a. Less PT visits, lower allowable amounts, decrease overall costs of care
b. lower use of related health care use
c. no increase in health care use; still in contact w/ MD during and after PT, similarly engaged in medical care system during and after PT
Skilled Nursing Facility (SNF)
Level 3
Goal: restore/optimize function
SNF Spell of illness + length of stay
Length of stay = 100 days
Begins: being admitted to hospital
Ends: 60 days w/o being readmitted
Maintenance Therapy
documented evidence that w/o skilled intervention the pts condition will deteriorate or safety is compromised
Medicare Requirements for SNF (6)
- MD ref
- minimum 3 night stay in hospital
- services must be provided for condition received in the hospital
- meet practical matter criteria (this is the best place for the pt)
- must require skilled nursing or skilled rehab
- skilled services are provided on daily basis
