In the world of an acute care therapist working in a large metropolitan hospital, we live day to day knowing that we will not be able to provide treatment to the number of patients who need our services because of high patient volumes. We spend most of our time trying to figure out some sort of priority list that tells us which patients are going to make the cut for treatment. New evaluations, patients returning home, patients who need rehab placement. Who needs us the most? It’s the question that physical therapists in acute care struggle with every day. Did we help the right patient at the right time and were we the right provider?
Helping people to understand the role of the acute care therapist can also be a daunting task. No, we aren’t just here to provide a discharge recommendation. We aren’t just the resident lift team for the hospital either. We are skilled professionals, experts in mobility and regaining function in the presence of disease, musculoskeletal impairments and critical illness. We are here to help a patient regain their independence. We are here to listen to what their goals and needs are so we can help them achieve those things. Both of these issues are on the forefront in the life of acute care therapy on a regular basis, but then came Covid-19…
In the midst of the chaos trying to accommodate the significant number of patients with Covid-19 in a hospital right in the epicenter of Michigan’s coronavirus outbreak, we began to see our volumes for therapy decline. Decline is probably an understated way of describing it. It was more of a drastic, mind blowing decrease in the number of patients on our schedules. Our ICU’s, where we have a robust early rehab program were filled with patients so sick, the only goal was survival. Therapy wasn’t even a thought in those initial phases. General practice units were being turned in to ICU’s to accommodate the volume of critically ill patients we were admitting. For the first time in an extremely long time, we were needing to completely restructure our department to be able to utilize our staff. We deployed some of our staff to a prone team for Covid-19 patients. Others became “screeners” and worked on identifying patients that would benefit from therapy services so discussions could be had with physicians to place orders for a therapy consult. It was a whole new world for us, however it led us to the path that we had always wanted to be on.
With this new world came a new sense of empowerment for therapists. Having the ability to see the patients who truly needed skilled therapy services daily. After all, this was potentially the only therapy they were going to receive related to their hospitalization. There were so few rehab facilities accepting patients, especially patients with Covid-19 after hospital discharge. Physical therapists getting the chance to do what they do best- help a person reach their full potential for functional independence and return home. The outpouring of appreciation from patients so energized to receive therapy in the hospital so frequently was invigorating during a period of crisis that felt like it could swallow us whole. These patients were isolated. There were no visitors, minimal contact with hospital staff to prevent over exposure, and no going to the hallway. They were isolated to 4 walls with the door closed. The therapy sessions were a bright spot for these patients. They were eager to work. They were eager to get better and stronger. They were eager to return home. For once we didn’t have to justify why we couldn’t see a patient daily because our time needed to be divided by an enormous number of patients. We had the ability to do it and it felt right. It was the right thing to do - for the right patients. And we were the right providers.
What’s more is that the absence of therapy for our severely critically ill ICU patients, made other healthcare providers realize just how important physical therapists were to a patient’s recovery. Upon our return to the ICU’s, we were greeted with “we missed you,” or “I’m so glad you are back working with these patients.” We weren’t just there for a discharge recommendation or to lift someone who couldn’t be moved by the nursing staff. They wanted us there for our ability to get patients stronger and assist in their overall healing process. Our impact in those ICU’s was brought to light by Covid-19.
While Covid-19 will leave a long-lasting impact on us all, if we had to find a silver lining in the trauma and sadness, this would be one of those things. When you hear about your co-workers contracting Covid-19, being put on a ventilator or worse, the look of gratitude on a patients face is just the thing you need to keep you going when you feel like you can’t take another step.
Romina, we are grateful for your leadership and passion! Beautifully explained what we’ve gone through. Adele