Thesis on "Physical Therapy Involves the Rehabilitation of Injured"

Thesis 12 pages (3137 words) Sources: 1+

[EXCERPT] . . . .

Physical therapy involves the rehabilitation of injured and disabled persons. Physical therapists and facilities are subject to many of the same risks as any other health care facility, Managing these risks and avoiding liability from them is a key factor to the success of the facility. This report discusses many of the general concerns regarding risk at the Get Well Group, a new facility that provides both physical and occupational therapy to individuals that are injured or in need of other rehabilitation services. It will serve as the basis for the development of policies that are more specific and procedures to help the new facility manage risk.

Understanding the Domain of Practice

Guidelines for Practice

Need for Guidelines

Addressing Legal Concerns

Recommendations and Conclusion

References

List of Tables and Figures

Fig 1. Domain of Occupational and Physical Therapy Practice

Fig 2. Relative Risk of Phases of Treatment

Managing Liability Risk in the Physical Therapy Setting

Chapter 1: Introduction

Physical therapy is an integral part of the healthcare system. Many who are injured or recovering from surgery must undergo some type of physical therapy as part of their rehabilitation and recovery process. These patients are often at a weakened state when they begin their therapy session. These patients pose a potential for liability claim as a result of their physical therapy. These claims arise from claims that therapy exacerbated their injury, or that it created a new one. Many times, these claims are unsubstantiated, but there are times when the claims are real, resulting in a large cash awards that the company or their insurance carrier must pay. If the insurance company has to pay, the business will be likely to have higher insurance rates in the future.

Risk in the physical therapy setting cannot be completely eliminated. There will always be hidden conditions that will pose a risk in the treatment process. However, reducing risk as much as possible is an essential element for the success of the facility. This research study will address ways in which risk can be reduced to the minimum level possible. The Get Well Group has asked my firm to explore ways in which they can reduce or minimize the risks associated with the physical therapy setting.

Understanding the Domain of Practice

When completed, the Get Well Group will be the largest provider of occupational and physical therapy services in the area. It will be associated with the five major hospitals in the area, as well as many individual and group practices in the area. The following figure describes the most common domains associated with rehabilitation services as they apply to this facility.

Domain of Occupational and Physical Therapy Practice

Fig. 1. Source: Center on Human Development and Disability (2009).

Rehabilitation in these areas requires a number of different therapy techniques and processes in order to achieve the goals of rehabilitation. The most common source of malpractice stems from the area of developing motor skills. This domain poses the greatest potential for risk of physical injury. Among these potential risks are sprain and strains from over use and extension of the affected parts. Falls can be a source of contusions and fractures, as well as sprains and strains. If these occurrences are the direct result of participation at the facility, they can greatly increase claim liability. This domain should be the main focus of the risk management plan.

Performance in Occupation is the second most important risk domain. Facilities may be at risk for liability if the patient feels that they have not been able to meet the expectation of therapy. However, this risk is secondary to the potential of physical risk and these cases are difficult to win, particularly if the injury is severe and the client has unrealistic expectations of the results.

The third domain of occupational and physical therapy is the establishment of habits, routines, and roles. This area poses little liability risk. The client is the one that has the most control over their ability to follow the routines. The client must be willing to participate fully with the instructions in order for it to have the maximum benefit. Encouraging full participation is a key element to limiting risk in the other two domains.

Chapter 2: Guidelines for Practice

Need for Guidelines and the specialty of physical and occupational therapy is no exception. According to the American Physical Therapy Association, the frequency and severity of malpractice claims has increased dramatically over the past twenty-five years. This increase is affecting all areas of the medical profession and the specialty of physical and occupational therapy is no exception. The development of promotion of guidelines to decrease the risk of malpractice if more important now than it was in the past.

Malpractice and ordinary negligence are the most common forms of liability in the physical and occupational therapy setting. These risks are a result of changing roles for therapists. Demand for physical and occupational therapy services arises from the extreme costs associated with work related injuries. Injuries on the job increase liability for the company, as well as representing other tangible and intangible losses. The role of the physical therapist was solely centered on the client in the past. Now, they must work for the company as well, serving to reduce the amount of time lost and other costs associated with the injury as well. The physical therapist has a dual obligation, which increases their risk exposure to legal liability in direct proportion to there obligations to various parties.

Addressing Legal Concerns

Addressing the legal concerns associated with performance of their legal obligations, must be approached in a systematic manner in order to reduce the risks associated with liability claims. According to APTA (2008), physical therapy can be divided into three distinct phases, each one with its own set of risks.

The first phase is the examination, which involves a systematic review of patient history, a review of their physical systems, as well as any tests or measures that are necessary. This evaluation also included job-task analysis, worksite/workstation analysis, and functional capacity evaluation (APTA, 2008). The key risk in this phase is the failure to uncover conditions that could pose a risk to the patient or to the success of the therapy plan.

The second phase of the process is Evaluation, Diagnosis, and Prognosis. In this phase, the physical therapist must make clinical judgments based on the data gathered in the evaluation phase. In this phase, a plan of care is developed and the goals and outcomes of the therapy are determined. This phase of the process is the source of many legal liability claims. It is important that the client is a full participant in the process and that they do not develop unrealistic expectations about the speed and extent of their recovery. Negligence claims poses the greatest risk at this phase of the process. If the patient or the company does not feel that goals are met, legal liability could arise from any of the parties involved.

The intervention phase is the most active phase of the physical and occupational therapy plan. It is during this phase that the actual intervention takes place. It includes exercise, ergonomics analysis, training, coaching, education, and work hardening / conditioning (APTA, 2008). This phase of the recovery process is the riskiest in terms of liability. The client is at risk of injury as a direct result of the intervention phase. Work hardening and conditioning involves pushing the injury in order to strengthen it. It is often painful and stressful for the client. It is difficult for the physical therapist to gauge when they are pushing too hard, as individual responses to pain and stress are highly variable. The following summarizes the three phases of physical and occupational therapy in terms of relative legal liability risk.

Fig 2. Relative Risk of Phases of Treatment

As one can see, the intervention phase represents the greatest risk for liability arising from physical and occupational therapy. The risk manager's responsibility is to limit risk to the entire facility. This means paying close attention to the intervention phase, while avoiding ignoring the risks associated with the other two phases. The plan needs to address all phases of the therapy process in order to reduce risk on a facility-wide basis. The nature of litigation in the current state of the legal system is that typically when one claim is filed, it will result in multiple claims in other areas (APTA, 2008).

Documentation is an essential element of the risk management process. The physical therapist must document the progress of the therapy, as well as any patient responses that could affect future liability claims. All members of the facility should be trained to take proper notes during the course of therapy. This is a key element in avoiding liability claims.

However, one must also be aware that documentation can lead to liability and represent a source of risk itself. For instance, the physical therapist should avoid making any comments that could be construed… READ MORE

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