As an occupational therapist, especially in an interdisciplinary setting, it’s more than likely you’re going to work with a physical therapist. While your interaction may be in a daily, weekly, or quarterly timetable, many patients who work with OT will be working with PT at a similar time.
So, how do you make the most of this partnership to provide the best patient outcomes and promote the carryover of learned techniques and interventions?
While it may seem very obvious, effective communication can be difficult to put into practice, especially if you're not in the same facility (such as working at different schools on different days), have different start times, do not work in a shared gym or office, or attend different meetings throughout the day.
By setting up and utilizing an effective communication system, you can ensure that you both are up to date on patient progress, barriers, and so on. This system might take the form of:
- keeping everything on email
- meeting at a certain time each day
- scheduling a weekly meeting
It’s important to communicate with your PT partner, especially on goals, use of assistive devices, family training, times your patient may be more or less responsive to intervention (such as timing around a dialysis or medication schedule), intervention techniques that may have proved fruitful during a session (such as playing music, working outside) etc. Things can change with patients, their families, discharge plans, and medical status daily, so it is incredibly important that you are both on the same page as much as possible.
Consistency is key for improved patient outcomes and can even help to reduce patient anxiety, so you want to make sure that the same information is being passed along from therapist to patient.
An example of this in a SNF is toileting. While a PT may clear a patient from an ambulation perspective to independently ambulate to the toilet, you as an OT may have worked with them on toileting. From this experience, you know that they can experience difficulty with the descent and stand from a toilet and suggest supervision during this task. For patient safety, you want to ensure that the patient is hearing consistent directions about their need for supervision. You never want the patient to say, “Well the other therapist told me I could get up by myself!” Stay consistent!
Timing is Everything
When you are communicating with your PT partner, you should make sure that you’re both aware of which assistive devices, orthotics, splints, slings, braces, shoes, etc. are being used for the patient. To improve patient outcomes and carryover, especially around discharge time, you want to make sure that the patient is as independent as possible in donning these devices, especially if assistance will be limited upon discharge. A few ways to stagger your timing so goals are accomplished include:
- While dressing is not a PT goal, you can make sure that you are scheduling appropriately with your partner so that the patient is able to get functional practice in independently donning these devices (as appropriate) prior to ambulation, balance, transfers, etc. and that the PT is not doing this for the patient.
- If the patient is working on improving activity tolerance, you and your PT partner may want to stagger your schedules. For example, you may want to do ADLs and have the patient eat their breakfast in a chair, but make sure that the PT will be coming later for ambulation at a certain time.
- This not only gives the patient a goal (sit up until PT comes), but it also ensure that they do not end up sitting up all day and becoming fatigued before the rest of their therapy. Timing is key for patients who are healing, and we want to help them be as successful as possible.
Transfers are an important part of functional participation in ADLs, whether this means getting in and out of the shower, on and off the toilet, in and out of a wheelchair, in and out of a car, etc. So when you educate your patients in their transfers and safety throughout, we want to promote carryover between therapies. It is important to use devices patient have been working on and are familiar with as well as similar safety strategies and movements.
By pointing out similarities between transfers, such as a rise from a bed and a rise from a toilet, you can increase patient knowledge, confidence, comfort level, and carryover of learned techniques.
In most settings, it is the PT’s role to decide the device that the patient is going to discharge with. As an OT, we certainly want to respect this decision, but we also want to make this functional for our patients, especially if this is new.
If the PT decides that a patient will be using a rollator, we want to make sure we are training the patient on not only how to use it during functional transfers, activities, ADLs, etc. but also making sure that the device is accessible for our patients. A few good questions to ask include:
- Do they know how to safely use the seat to take a break?
- Do they know how to use the lift-up seat to store things they are used to carrying?
- Does the rollator fit in their bathroom?
This adaptability is the same for wheelchairs, rolling walkers, and any other devices they are assigned for discharge. It is important to think of a few things to prepare a patient’s device for discharge, such as:
- Can we adapt a wheelchair and add a cup holder for the patient in so they are not spilling their drink during meal prep and can still navigate the kitchen?
- Is the patient educated on use of a walker basket and the weight that it can hold without tipping/falling over, so that they are still able to use their walker safely but can transport appropriate items as well?
Listening to your patient and their experience so far can go a long way in working with them. Getting advice from a patient perspective can ensure they are getting all of the information they need from you, and you can carry that forward!
Share your knowledge and collaborate
Each discipline spends plenty of time in school and both PTs and OTs have the degrees (and debt!) to prove it. However, nobody learns everything, and both disciplines have knowledge that can work together toward the goal of helping patients. You can always take the time to evaluate the way you're measuring outcomes and share that with your PT partner! Here are some outcome measures you didn't learn in school that could benefit both of you. Sharing all of your knowledge with your partner is amazing, but ask questions as well.
If your PT partner has no idea how to apply the upper extremity splint for your hemiplegic patient, show them, and that will help ensure carryover of splint donning and upper extremity protection during their therapy sessions. Additionally, if you see your partner doing a new technique, transfer, or balance exercise that you’ve never seen or experienced, ask them about it! You’ll learn something and become a better practitioner because of it.
Overall, while you and your PT partner each have different goals, the end goal is the same. Working with an interdisciplinary healthcare team can present challenges, but know that you're a team. We want our patients to improve, and we use every opportunity we can to educate, promote safety, grow confidence, and give them the best outcomes possible. Definitely dialogue, respect, and work with your PT partner as much as possible to promote these outcomes and have a productive, educational work environment.