In addition to some of the already mentioned suggestions, we focus a lot on
activity & participation domains throughout the course of care. We explicitly
discuss how to translate improved performance in the clinic to other
environments & how the gains in therapy can be used to increase activity &
participation roles in the home & community. We find this often helps the
patients to get back in to pre-injury activities which fosters increased self
efficacy, increased quality of life and focus on function (rather than
impairments and dis-abilities). By the time discharge comes, the patients are
already thinking about the “next step” (commonly volunteer work, return to
work, etc).
kimberly a. m iczak
________________________________
From: neuropt-bounce@xxxxxxxxxxxxx <neuropt-bounce@xxxxxxxxxxxxx> on behalf of
Nima Tabloei <tabloei@xxxxxxxxxxx>
Sent: Sunday, November 6, 2022 9:09 PM
To: neuropt@xxxxxxxxxxxxx <neuropt@xxxxxxxxxxxxx>
Subject: [neuropt] Re: Outpatient difficult discharges
Hello Kathleen. This is has come up many times in both my private practice and
hospital outpatient roles and the options you’ve outlined for continuing some
form of care are all good ones that we have used. One common theme that stands
out is that because we see our patients for extended episodes of care (compared
to other specialties in PT), there develops a sense of belongingness which can
become part of the patient’s new identity. So at time of discharge, there can
be a strong emotional bond to manage. One strategy that has been successful
(although not always) has been to use data throughout the episode of care to
show changes in functional ability. For example, we might administer a battery
of 4-6 standardized assessments at eval, every 4 weeks, and at discharge and
spending 15-20 minutes with the patient each time to go over the progress
they’ve made can help them visualize their success and not necessarily reduce
the emotional bond they have to PT but to transform it to a sense of
accomplishment (i.e. they did the work and we just catalyzed it a little bit).
As we near discharge and certainly on the date of discharge, we always have a
conversation about a follow up session in 3, 6 or sometimes 9 months to
reassess their progress and priorities. In private practice, I also make myself
available to them via phone and email. This is all geared toward helping with
the transition.
I know it’s not a cure-all but I hope this helps.
Regards,
____________________
Nima Tabloei, PT, DPT, MPH, CSCS
Doctor of Physical Therapy
Board Certified Neurologic Clinical Specialist
LinkedIn: <https://www.linkedin.com/in/nima-tabloei-dpt-mph-842424159> Nima
Tabloei<https://www.linkedin.com/in/nimatabloei>
On Nov 6, 2022, at 6:03 PM, Kathleen Hines
<kathleen.buzzeo@xxxxxxxxx<mailto:kathleen.buzzeo@xxxxxxxxx>> wrote:
Hello All!
I am giving a presentation to my outpatient clinic on discharge planning in
the outpatient setting specifically with neurological clientele. I work in
Massachusetts for Spaulding and we have a large outpatient neuro caseload. As
outpatient is the “end of the line” in rehab often the discharges are emotional
for family and clinicians.
I am aware this is a very broad question but how do you all prepare these
patients for their last day in PT?
I usually will connect them with a social worker early on in their care,
introduce them to community resources and day rehab programs if applicable,
talk about discharge early so they are aware of the plan and encourage them to
return for a “tune up” as needed and guided by their neurologist. I am very
specific that this tune up is for one of 3 reasons: their neurologist wants
them to return, they had a fall or new weakness or pain (ect.) or their home
exercise is no longer challenging. We do not have a neuro-focused gym that I
am aware of on the south shore. Prior to the pandemic the YMCAs had assistants
who would assist clients get onto and off of equipment this program is no
longer running unfortunately. I do refer to our outpatient clinic at a gym so
they can be set up with a gym program if they are interested and family and or
friends can be trained to help Them In a gym setting.
What else do others do to prepare for this difficult phase in their journey?
Thank you in advance!
Sincerely,
Kathleen Buzzeo PT, DPT, CBIS
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