"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, May 12, 2011

Physical Therapists Can Improve Patient Safety in Hospitals

One of the "failure modes" in preventing hospital-acquired venous thromboembolism (VTE) - a blood clot - is that risk assessment is not routine or standardized.

Physical therapists who treat post-surgical patients can provide screening to diagnose this problem in high-risk patients. Screening rules, such as the Wells' Criteria can aid the physical therapist in diagnosing a blood clot.

But, one physical therapist cannot create a culture of safety.

To create a culture of safety in preventing hospital-acquired infections the Agency for Healthcare Research and Quality has sponsored a Comprehensive Unit-based Safety Program (CUSP). The CUSP is a structured strategic framework for safety improvement that integrates communication, teamwork, and leadership to create and support a culture of patient safety that can prevent harms.

The program features: evidence-based safety practices, staff training tools, standards for consistently measuring infection rates, engagement of leadership, and tools to improve teamwork among doctors, nurses, and other members of the health care team.

The CUSP uses a checklist of evidence-based safety practices; staff training and other tools for preventing infections that can be implemented in hospital units; standard and consistent measurement of infection rates; and tools to improve teamwork among doctors, nurses and hospital leaders.

Step 1 Staff are educated on the science of safety.

Step 2 Staff complete an assessment of patient safety culture. Safety is everyones' responsibility - we as physical therapists cannot continue to defer our responsibility to physicians on the "sharp end" of healthcare.

Step 3 A senior hospital executive partners with the unit to improve communications and educate leadership. Staff (MDs, nurses, PTs, etc) need to know we have support from the top.

Step 4 Staff learn from unit defects. These defects get reported by staff members unafraid of personal attacks.

Transparency, like in the airline industry, celebrates the reporting of medical errors as the opportunity to learn and improve. Instead, in healthcare, we've had a habit of "naming, blaming and shaming" people who make mistakes. A broken tort system of punitive legal redress is the product of these habits.

Step 5 Staff use tools, including checklists and electronic decision support, to improve teamwork, communication, and other systems of work.

Clinical decision support tools, with reminder pop-ups, prompts and suggestions can help physical therapists provide guideline-adherent care.

The most common preventable cause of hospital death is VTE.
"Over 1 year, a 300-bed hospital that lacks a systematic approach to VTE prevention can expect roughly 150 cases of hospital-acquired VTE.
Approximately 50 to 75 of those cases will be potentially preventable because of missed opportunities to provide appropriate prophylaxis.
Approximately five of those patients will die from potentially preventable PE."
Highly focused initiatives using these five principles have achieved success in reducing preventable infections, such as central line-associated blood stream infections (CLABSIs), catheter-associated urinary tract infections, and ventilator-associated pneumonia, in intensive care units (ICUs) and other hospital units.

Healthcare leaders can address the growing rate of blood clots by attacking this problem with teams of providers implementing a standardized approach.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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