Patient Care vs. Productivity in Acute Care
During my acute care rotation, I was faced with the challenge of determining which clients were appropriate for therapy. In order to meet my productivity demands, I would have to have around 24-28 units per day. So, if one of my clients were inappropriate for therapy, I would usually pick up another client on the list to make up for my lost units. One day, I was about to complete my last evaluation in the ICU. I checked with the nurse to see if the client was okay for therapy, and she said that he was medically stable, but that we were not going to get much out of him because he was heavily sedated. The physical therapist and I performed half of our evaluation, but the client was unable to follow any commands and could not participate in MMT or ROM testing. He could barely keep his eyes open. We were in the room for a total of 9 minutes, so that was enough time to bill for an evaluation. However, I did not feel comfortable billing for an evaluation when the client was unable to participate and was inappropriate for therapy services at this time. I was running low on my units that day, so I asked the physical therapist if he was going to bill for a complete evaluation. He stated that we were in the room for nine minutes, so he would. I was very conflicted about the situation, because I felt like I did not perform anything therapeutic for the client, and I was unable to obtain enough information to even offer my professional opinion. Even though I needed the units to meet productivity, I chose not to bill for the evaluation. I put a note in the system to reconsult when the client was more appropriate. After talking to my supervisor about the situation, she said that I could have chosen either way, and it would not have been wrong, but I felt better about a reconsult rather than billing for an evaluation. I learned that in these situations, it is easy to only think about yourself and productivity demands, but we have to remember to be ethical and do what is best for our clients.