Archive: CSM 2013: Acute Care Programming

  • This is archived programming for CSM 2012. See current programming.

    Browse Acute Care sessions by day. Return to the main topic menu

    Monday, January 21 | Tuesday, January 22 | Wednesday, January 23 | Thursday, January 24

    * Should you choose to preselect regular (not preconference) Tuesday-Thursday sessions during the registration process, please be advised that preselection is not a guarantee of a seat. Attendees are asked to preselect to better determine room size and all efforts will be made to accommodate sessions in the largest rooms possible. All attendees are encouraged to show up to sessions early. Attendees are also encouraged to select alternative sessions in the event their first choice is full.

    Monday, January 21 (Preconference)

    Do It Right From the Start: Task-Specific Training for Relearning Gait After Stroke

    Location: Hilton Bayfront | Elevation Room (30th Floor)

    Time: 8:00 am - 5:00 pm

    Speakers: Karen McCain, PT, DPT, NCS; Patricia S. Smith, PT, PhD, NCS

    Level: Intermediate

    CEUs: 0.9 (9.0 contact hours/CCUs)

    Preconference Pricing: Standard Plus (1B)

    The typically slow, inefficient gait after stroke often results in sequelae, such as heart disease, diabetes, and low aerobic capacity. What has yet to be determined is if this outcome is inevitable. Based on our current knowledge, is it possible to construct clinical interventions that will produce better gait and diminish these unwanted consequences? This preconference course is designed to challenge the advanced clinical practitioner to raise expectations for gait recovery in individuals post stroke. Current evidence suggests that effective interventions must include high-intensity, task-specific training initiated as soon as possible after the onset of the stroke. Research data, case studies, and patient videos will be used to explain the development and application of early, standardized, task-specific interventions for gait recovery after stroke. Course content will include a brief review of the neurophysiology of gait control and a review of neuroplasticity principles as they apply to stroke. Specific elements of gait-training interventions will be discussed, including an in-depth look at the role of lower-extremity bracing in gait recovery. Attention also will be given to the use of effective evaluation methods for gait recovery as well as the application of these principles across the continuum of care.

    Upon completion of this course, you'll be able to:

    • Describe the post-stroke pathological gait pattern.
    • Recognize the concomitant comorbidities that accompany the pathological gait pattern for individuals post stroke.
    • Understand the current evidence for gait recovery following stroke.
    • Appreciate the role of standardized outcome measures for documenting change in gait for this patient population.
    • Acknowledge the need for task-specific training programs across the continuum of care for individuals post neurological injury.
    • Provide rationale for the choice of orthosis for gait retraining after stroke.
    • Discuss discrete treatment interventions to improve walking for individuals in the acute, sub-acute, and chronic stage of recovery from stroke.
    • Consider the long-term implications of improved gait following stroke.

    Tuesday, January 22

    Feeling the Squeeze? Strategies to Capture and Increase Productivity in the Delivery of Physical Therapy in the Acute Care Setting

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Jane K. Oeffner, PT, DPT, MBA; Edward Dobrzykowski, PT, DPT, MHS, ATC; Cathy Currier, PT, MBA; Deborah C. Wojcik, PT, MPT, MEd; Trevor Carlson, PT, DPT; Patrick J. Tarnowski, PT, MBA, SCS

    Level: Intermediate

    The discussion of therapists' productivity in the acute care setting is not new. An urgency has emerged due to economic forces driving lowered hospital payment rates and pressure on financial margins. Penalties for qualified readmissions and postacute medical management are increasing the demand for physical therapy services. Acute care physical therapists are challenged by higher patient referrals for evaluations and consultations without additional staffing resources. This interactive session will discuss measurement of therapist productivity in acute care. New models for formulating productivity metrics that reflect the actual costs, including use of support staff, will be reviewed. Attendees will learn about factors that affect productivity at an individual therapist, team, discipline, and unit level.

    A panel of clinical administrators, representing diverse regions and various types of acute care facilities, will present strategies to increase productivity. Examples include utilizing therapy aides during bedside care, implementing a triage system to decrease inappropriate consults, employing interdisciplinary patient mobility programs to optimize the utilization of skilled physical therapy services, and completing a process improvement project to increase timeliness of physical therapy interventions. The panel presentations will be followed by a rich dialogue with the audience to share successes and setbacks.

    Upon completion of this course, you'll be able to:

    • Explain the necessity of improving efficiency in the delivery of physical therapy services in the acute care setting as related to reductions in hospital reimbursement rates, system expense reductions, and patient outcomes.
    • Provide operational definitions for productivity and efficiency and current industry standards for therapists' productivity.
    • Formulate metrics that truly reflect the cost of providing physical therapy services in the acute care setting.
    • Analyze factors that affect productivity at an individual therapist, team, discipline, and unit level.
    • Compare and contrast strategies that have been utilized by acute care facilities across the nation to improve therapists' efficiency and the results of these initiatives.
    • Share experiences and lessons learned in order to collectively create novel, innovative strategies to improve productivity in the acute care environment.

    Research to Reality: Evidence and Outcomes to Change Critical Care Culture, Part 1

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Jennifer J. Cline, MS; Deanna Dye, PT, PhD

    Level: Intermediate

    The need for early mobilization in the ICU has been widely acknowledged over the past few years. Challenges still remain on many levels for physical therapists to increase access to patients who are critically ill. This course will apply change theory to the hospital environment and provide the participants with the tools needed to be the change agent within their facilities. Participants will be exposed to one change theory model and its application in the hospital environment. The course will challenge participants to consider the complexities of cultural change within their facilities and provide them with the evidence and confidence to begin the educational process.

    Upon completion of this course, you'll be able to:

    • Articulate the history of medical management and mobilization of patients in critical care.
    • Describe the physiological effects and long-term consequences of critical care stays.
    • Identify the benefits and outcomes of early mobilization as supported by the literature.
    • Apply a conceptual framework when implementing cultural change within the hospital climate.
    • Discuss strategies to anticipate and preempt barriers and resistance to change.

    So You Think You Can Write: Publishing in the Journal of Acute Care Physical Therapy

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Beth A. Smith, PT, DPT, PhD; Glenn Irion, PhD

    Level: Basic

    The Journal of Acute Care Physical Therapy (JACPT) is a recently introduced peer-reviewed journal associated with the Acute Care Section of the American Physical Therapy Association. The journal publishes research reports, case reports, clinically relevant reviews, and letters to the editor that promote evidence-based practice specific to acute care physical therapy. This session is aimed at potential authors, particularly those who are unfamiliar with or have limited experience with the peer review process. The speakers will describe the submission and peer review process for JACPT and provide examples of submitted manuscripts, the comments of peer reviewers and associate editor, and successfully revised manuscripts accepted for publication. Attendees will learn about the responsibilities of the authors, peer reviewers, and editors throughout the process. The goal of this session is to familiarize potential authors with the process in order to support and encourage the submission of appropriate manuscripts. There will be ample time during the session for discussion with the editor and deputy editor.

    Upon completion of this course, you'll be able to:

    • List the steps of the submission and peer review process for JACPT.
    • Describe the roles of the peer reviewers and editors in the review and publication process.
    • Suggest suitable topics and formats for manuscripts for JACPT.

    Research to Reality: Evidence and Outcomes to Change Critical Care Culture, Part 2

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Deanna Dye, PT, PhD; Jennifer J. Cline, MS

    Level: Intermediate

    A continuation of Part 1, this session will explore recent evidence supporting the need for a cultural change within the critical care environment through the application of early mobilization and the systematic use of outcome measures. Attendees will be encouraged to examine best practice within the ICU through identification of skilled physical therapy interventions. Outcomes measures designed specifically for the ICU, in addition to others that show potential for application in the ICU, will be identified. Attendees will be challenged to consider the ramifications of implementing specific outcome measures in order to track individual progress over time, compare across patient populations, and enable data collection for future systematic review.

    Upon completion of this course, you'll be able to:

    • Recognize conditions that may contraindicate early mobilization.
    • Using current research, cite possible adverse events and the frequency in which they occur when mobilizing patients in the ICU.
    • Identify outcome measures that have prognostic value within and outside the ICU.
    • Recognize modifications of commonly used functional outcome measures to enable application within the ICU.
    • Identify components needed to enhance test-retest reliability of a functional outcome measure.

    Acute Management of the Patient With Critical Illness: Applied Clinical Decision Making and Knowledge Translation

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Speakers: Michelle E. Kho, PT, PhD; Jennifer M. Zanni, PT, DScPT

    Level: Multiple Level

    Randomized controlled trials support implementation of early rehabilitation in patients with critical illness. For some patients, it may be clinically appropriate to initiate active physical therapy within 24 hours of ICU admission. However, knowledge translation of evidence into clinical practice in the acute care setting poses clinical decision-making challenges for acute care physical therapists because of patient acuity, complex technology, and resource requirements. While knowledge of a patient's lines and tubes in situ is important, physical therapists need to integrate many other factors about a patient's clinical condition before initiating physical therapy interventions.

    In this session, attendees will be introduced to the knowledge-to-action framework and learn how to apply it to patients with critical illness. The speakers will review and critically appraise the evidence supporting early physical therapy interventions in patients with acute critical illness receiving life-sustaining therapies (eg, mechanical ventilation, dialysis, vasopressors). The session will use case examples to discuss explicit clinical decision-making strategies to initiate, conduct, and evaluate physical therapy interventions in patients with acute critical illness. The speakers will demonstrate how therapists can successfully integrate many types of data to inform their clinical decision making, including vital signs, laboratory results, mechanical ventilation settings, pharmacological therapies, and delirium assessment, . Attendees will take away practical strategies to measure implementation success.

    Upon completion of this course, you'll be able to:

    • Apply the knowledge-to-action framework to early physical therapy with patients with critical illness.
    • Discuss the evidence surrounding early mobility and rehabilitation in the ICU.
    • Describe possible complications of early mobilization in the ICU and strategies to minimize these risks.
    • Identify clinical decision-making strategies in the ICU based on current literature and clinical experience.
    • Describe how to successfully integrate many types of data to assist with clinical decision making, including vital signs, laboratory results, mechanical ventilation settings, pharmacological therapies, and delirium assessment.
    • Discuss practical strategies to measure implementation success.

    Wednesday, January 23

    Early Mobilization in the Intensive Care Unit

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Diane E. Madras, PT, PhD; David Kennedy, PT, MS, CCS

    Level: Basic

    Early mobilization of patients in the intensive care unit has been the subject of research since the 1990s. In light of the increased national attention on evidence-based, cost-effective medicine, there is no better time than now to highlight the benefits of early mobilization in high-risk patients in the intensive care setting. This program will discuss the effects of prolonged bedrest coupled with mechanical ventilator support, and the role of the physical therapist in the health care team in providing appropriate exercise, secondary prevention, and positive, cost-effective care, while improving physical and psychological patient outcomes.

    Upon completion of this course, you’ll be able to:

    • Articulate the factors that contribute to poor outcomes in patients treated in the intensive care unit.
    • Explain the physiological and neuromuscular effects of deconditioning observed in patients with prolonged intensive care unit stays.
    • Discuss the contributions by the physical therapist for prevention of deconditioning due to immobilization in the intensive care unit.
    • Explore the risks and opportunities encountered by physical therapists while working with severely impaired patients in the intensive care unit.
    • Cite evidence to support early mobilization by physical therapists in the intensive care unit.

    Unicondylar Knee Arthroplasty: Rapid Recovery Pathway and Length of Stay Considerations, and Functional Milestones

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Michael S. Silverman, PT, MSPT; Maya Caspi, PT, DPT; Elizabeth Niedbala, PT, DPT

    Level: Basic

    Surgical techniques regarding joint arthroplasty have evolved over the years. Unicondylar knee arthroplasty (UKA) is an alternative to the traditional total knee arthroplasty (TKA) that has been gaining in popularity among surgeons and patients. This educational session will allow attendees to gain knowledge regarding the surgical techniques, inpatient rehabilitation considerations, as well as a review of functional milestones associated with UKA at the Hospital for Special Surgery.

    Upon completion of this course, you’ll be able to:

    • Recognize the surgical technique involved with UKA.
    • Identify the differences between indications and contraindications for UKA and TKA.
    • Incorporate rapid recovery guidelines into your UKA rehabilitation protocol.
    • Describe the reasons for revision status postUKA.
    • Identify the functional milestones used at the Hospital for Special Surgery for tracking progress in the acute care setting.

    Applying Evidence to Discharge Planning in the Acute Care Setting

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Laura C. Driscoll, PT, DPT; Mary Beth Holmes, PT, NCS

    Level: Multiple Level

    This course will use a case-based approach to examine different ways in which acute care physical therapists can use the current literature to support their recommendations and advocate for discharge planning. The session will encourage discussion to break down the thought process behind the discharge recommendations of an acute care therapist. The speakers will provide useful guidelines to write more compelling assessment statements to help achieve the most appropriate outcome for the patient. They also will demonstrate how outcome measures can aid in decision making in the hospital setting and discuss the importance of a multidisciplinary team-based approach to discharge planning.

    Upon completion of this course, you’ll be able to:

    • Use the current body of literature to support a patient's physical therapy potential and use this information to advocate for appropriate discharge destinations.
    • Identify appropriate outcome measures and interpret the meanings in order to aid in decision making for discharge planning.
    • Identify the importance of a team approach to patient advocacy and discharge planning.
    • Formulate an assessment statement which will incorporate current evidence along with APTA's Guide to Physical Therapist Practice language.

    Strategies to Address Interprofessional Communication and Behaviors That Hinder Acute Care Practice

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Jennifer M. Ryan, PT, DPT, MS, CCS; Sharon L. Gorman, PT, DPTSc, GCS

    Level: Advanced

    Many therapists practicing in acute care encounter multiple health care professionals who lack understanding of the fast-paced, complex decision making required to determine a safe physical therapy plan of care that challenges a patient without exceeding his or her physiological limits. Conversations occur in which the therapist is confronted with statements such as, "Just get them up" or, "Just walk them." The word "just" diminishes the comprehensive clinical reasoning and decision making of the therapist. These interactions also raise ethical questions related to the use of best available evidence, over or underutilization of scarce physical therapy resources, and increased variability in practice. A broader view of clinical reasoning, not solely focused on deductive reasoning, is necessary for therapists to recognize and resolve these difficult situations. This presentation seeks to define the cultural limiters to therapists’ autonomy and professional development, as well as address strategies to address these concerns. Discussion of these clinical challenges in hospital culture, methods to improve the lack of interprofessional understanding of the therapist's expertise and clinical reasoning, and strategies to use to overcome these challenges will be explored using current research.

    Upon completion of this course, you’ll be able to:

    • Describe the immediate and long-term physiological response to gravitational forces.
    • Articulate the complexities of hospital environment decision making by the physical therapist and physical therapist assistant.
    • Discuss the role of the physical therapist and physical therapist assistant in determination of patient disposition from the hospital.
    • Describe the comprehensive analysis used to determine a patient's response to mobility.
    • Describe the potential outcome measures that are used to determine a patient's readiness for hospital discharge.

    Visions of Excellence in Inpatient Settings: A Workshop for Advancing Physical Therapist Practice

    Time:11:00 am–1:00 pm (See Program for Room)

    Speakers: Mary Fran Delaune, PT, MPT

    Level: Advanced

    There are many standard setting and visionary documents that can guide physical therapists and physical therapy program toward quality of care. Examples include APTA's Standards of Practice for Physical Therapy, the Criteria for the Standards, the Code of Ethics, and Vision 2020. Together these documents set forth the profession's statements of conditions and performances that are essential for the provision of quality physical therapy. This workshop will help attendees identify key strategies for building and sustaining strong organizational principles to support safe, high-quality patient care.

    Upon completion of this course, you’ll be able to:

    • Describe best practices for physical therapy in inpatient settings for safe and high-quality provision of care to inpatients.
    • Appraise your current facility while reviewing the self assessment tool for APTA's Principles for Excellence in Acute Care Environments, a document based on the Standards of Practice and Criteria and Vision 2020 that identifies the important elements of the inpatient physical therapy environment and culture for excellence.
    • Design an individual action plan based on the self assessment to implement for future quality improvement.
    • Identify any resources necessary for your action plan and develop key metrics for success.

    Weakness in the Critically Ill: Clinical Implications for Physical Therapists Across the Continuum of Care

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Christiane Perme, PT, CCS

    Level: Multiple Level

    Critical illness polyneuropathy (CIP) and myopathy (CIM) are complications of critical illness that result in complex challenges for physical therapists working in the intensive care unit (ICU). Muscle weakness is a common complication of prolonged critical illness and is associated with ventilator weaning failure, prolonged rehabilitation, and hospital mortality. Survivors of critical illness can experience muscle weakness, fatigue, decreased exercise tolerance, and decreased quality of life long after hospital discharge. This course will address CIP and CIM diagnosis, current approaches to treatment, and physical therapy implications. Case reports will be incorporated to demonstrate how an early rehabilitation program can positively impact functional recovery. The purpose of this presentation is to review and discuss the available evidence-based literature, which will assist physical therapists in the management of patients CIP and CIM across the continuum of care.

    Upon completion of this course, you'll be able to:

    • Identify terms used to describe motor weakness in ICU.
    • Recognize clinical features of critical illness polyneuropathy (CIP) and myopathy (CIM).
    • Become familiar with the clinical consequences of motor weakness in ICU on functional outcomes.
    • Recognize the challenges associated with functional recovery of patients who survive a critical illness.

    3rd Annual Acute Care Lecture: Leveraging Technology to Advance Acute Care Practice

    Time: 6:30 pm–7:30 pm (See Program for Room)

    Speakers: Sharon L. Gorman, PT, DPTSc, GCS

    Level: Basic

    The acute care environment exemplifies the height of technological sophistication, yet in many aspects physical therapists have not used these advances in their practice. How can acute care physical therapy continue to grow and advance if therapists don’t take advantage of technology in the realms of education, research, and practice?

    Upon completion of this course, you'll be able to:

    • Reflect upon the importance of advancing skill sets to incorporate technology into acute care practice.
    • Describe recent advances that are well suited to acute care practice, education, and research.
    • Challenge barriers to technology implementation and usage by acute care physical therapists.

    Thursday, January 24

    Acute Care for Elders (ACE)—Physical Therapy in an Interdisciplinary ACE Consult Team: Dementia, Delirium, and Beyond

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Jacqueline Pokorney, PT, MSPT, GCS; Amanda Lalonde, PT, MPT

    Level: Multiple Level

    With an ever-growing aging populace, improvements in health care that allow for longer lifespans, and the significant ongoing cuts to health insurance, physical therapists working in geriatrics and acute care are in an optimal position as health care providers to address these challenges. This session plans to demonstrate the unique way that physical therapists can practice within an Acute Care for Elders (ACE) team, advocate for starting an ACE team at their respective institutions, and practice autonomously to promote the best evidence-based interventions when dealing with geriatric patients in the acute care setting. As patients who have dementia and/or delirium are common in acute care, this course will address strategies for working with these prevalent patient diagnoses.

    The speakers will describe the components of an ACE team with various implementation strategies, the role of physical therapy within the ACE team as participant and advocate for best practices when it comes to mobility, and the specific components of the ACE consult team at the University of Wisconsin Hospital in Madison, Wisconsin. The course will provide a review of how ACE was implemented, how it has grown, the financial aspects of justifying the team and its growth, and plans for future demonstration projects within the hospital. Additionally, the speakers will discuss the ACE team in relation to other aspects of an organization, including home health, outpatient, the geriatric medical home, and the transitional care program.

    Upon completion of this course, you'll be able to:

    • Identify terms used to describe motor weakness in ICU.
    • Recognize clinical features of critical illness polyneuropathy (CIP) and myopathy (CIM).
    • Become familiar with the clinical consequences of motor weakness in ICU on functional outcomes.
    • Recognize the challenges associated with functional recovery of patients who survive a critical illness.

    Implementing Lean Processes in Rehabilitation Programs

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Jose Kottoor, MS; Kathryn Meyvis, PT; Michael Cagle, OTR

    Level: Basic

    Many health systems have implemented process improvement initiatives into their operations to cope with changes in health care. Lean processes are not about changing the clinical practices, but rather to improve patient safety, reduce waste, and improve efficiency. Hospitals have implemented several versions of lean processes. The principles of the speakers' lean process are to specify what creates value for customer; identify all the steps of process chain; make those processes flow; make what is pulled by the customer; and strive for perfection by continually removing wastes or "heijunka," which is the Japanese word for "production leveling." The speakers, from Beaumont Health System, took an approach of "find it and fix it." This improves processes, in a short time period, with sustainability. The lean concept of "kaizen" (or "improvement" in Japanese) was used to make process improvements in the department, which produced immediate results. The real power of the kaizen process is the continuous, small improvements in all aspects of the health care system. In this session, attendees will be shown how to apply lean principles and kaizens to improve patient safety and staff efficiency.

    Upon completion of this course, you'll be able to:

    • Identify the basics of "lean principles."
    • Recognize the importance of applying lean principles to health care
    • Apply some of the lean principles to your clinic/department.
    • Use the kaizen process within your work setting.

    PTJ Symposium: Rehabilitation of Patients With Critical Illness

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Jan Reynolds; Patricia J. Ohtake, PT, PhD

    Level: Multiple Level

    Rehabilitation in the critical care setting is emerging as an important strategy in improving functional outcomes in the acute care population. The latest research suggests that early interventions aimed at restoring and maintaining physical function in patients with critical illness are associated with improved physical function and well being. During this session, authors who contributed the recent special issue of APTA's Physical Therapy journal (PTJ) will share their insights on the role of rehabilitation in the management of critical illness; outcome measures; new rehabilitative interventions; and issues related to optimal timing, intensity, and dosage.

    Upon completion of this course, you'll be able to:

    • Discuss the roles of physical therapy, occupational therapy, and other disciplines in the critical care setting.
    • List underlying mechanisms of critical illness neuromyopathy.
    • Describe the latest findings on efficacy and effectiveness of rehabilitation interventions on activities of daily living, quality of life, physical function, activity, participation, and disability.
    • Explain what is known about the use of rehabilitative services by patients following critical illness.
  • ADVERTISEMENT
  •