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Meet Conrad! He is an ICU Physiotherapist at the beginning of his journey working in public health. Having recently graduated, he is now working in the Intensive Care Unit at Austin Health in Victoria, Australia. Rotations are integral to developing well-rounded clinicians during the New Grad year for Physiotherapists. As such, Conrad is excited to rotate across various acute and sub-acute wards this year to improve health outcomes and help patients move toward their individual goals.
A typical day for an ICU Physiotherapist
First, let me describe a typical day for an ICU Physiotherapist: attend ward round; triage and analyse the caseload to determine which patients are appropriate for physiotherapy and, if so, a treatment plan, and; finalise an overall team plan with other physios — all this before the morning physiotherapy department meeting where caseloads across all wards are discussed to direct roving clinicians to stress points around the hospital.
And that’s just the start. Seeing each patient becomes an intricate dance, fitting treatments into a full patient timetable of medical team rounds, diagnostic imaging, family visits, dressing care, and patient rest times. It’s full-on; intense, if you will! But, the fine art of multidisciplinary collaboration builds a host of essential skills — among them clinical reasoning, prioritisation, and communication.
What does a physiotherapist in ICU actually do?
When you think of physiotherapy, you probably think: rehabilitation. It may surprise you that beyond encouraging exercise (where physios employ walking frames, bed bikes, tilt tables, and motorised assisted standing tools when patients need assistance), we also focus on respiratory health. Physios use ventilators to help clear sputum (called ‘ventilatory hyperinflation’), most commonly in patients with spinal cord injuries. We instigate various positive airway devices to ‘puff up’ lungs of patients who aren’t able to ventilate effectively. Even the most obvious of physiotherapy interventions — exercise — is used to target the lungs; increased ventilation during exercise augments focal physiotherapy airway clearance that can reduce the effects of a chest infection. So, now you know that mobility is just one reason physiotherapists help patients get out of bed.
Even so, you might ask: why is it important for nurses to know about a physiotherapist’s daily tasks?
Certainly, patient outcomes improve when healthcare teams recognise appropriate referrals (e.g., patients needing physical rehabilitation). Importantly, nurses and physiotherapists can make excellent use of each other to benefit their shared interests — keeping patients moving to prevent skin breakdown, optimising day-night routines to manage delirium, preventing hospital acquired infections, and achieving patient-centred goals. Indeed, a physiotherapist’s main goal is to help patients regain independent mobility; and an independently mobile patient means fewer backaches for the rest of the healthcare team!
How to double up on Allied Health to get the job done
Physios and nurses help each other in the ICU in several ways: physios often move patients in bed for assessment or treatment — this is an opportunity for nurses to attend to bowel care, change lines and attachments, and even swap in fresh sheets while the patient is turning in bed.
When physiotherapists move patients away from bed nurses are freed up to restock supplies, prepare medications, and catch up on notes. Combining physiotherapy and nursing clinical goals might result, for example, in a physio-led gait training session ending in the bathroom so that nurses can carry out toileting or showering. And, remember: physios are experts at movement — if you have questions about how best to get a patient moving in or out of bed physios can offer alternatives that are safe for both you and the patient. Timing is everything in the ICU.
Physios typically screen and prioritise every ICU patient based on a variety of factors, including: imminent discharges needing review; patients at risk of respiratory deterioration requiring immediate intervention, and; heavy transfers requiring multiple therapists. An efficient day requires planning for nursing breaks, scheduling between other interventions (e.g., planned imaging, haemodialysis, and so on), and fitting physiotherapy interventions between the constant stream of medical and family visitors.
Ultimately, all allied health professionals strive to improve patient outcomes. Planning together, making the most of opportunities, and combining efforts helps everyone achieve their clinical goals. And, best of all, by working together everyone reaps the benefits of the other’s expertise.
For more info on physiotherapy go to the Australian Physiotherapy Association
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