question

List the four categories that classify health care facilities

answer

think, the health care facility 'STOL' my money - size - type - ownership - length of stay

question

define acute care facility

answer

- a category of a 'type' of health care facility - typical stay is 3-5 days - if continued hospitalization is expected then discharge planning for transfer to a place like St. David's or Seton

question

define size

answer

- number of beds available in hospital - can range from 24-500 or more

question

define subacute [long term acute care] facility

answer

- a category of a 'type' of health care facility - typical length of stay is 2 weeks to several months - patient typically continues to require acute care type services - examples: Cornerstone Nursing or a floor in an acute care hospital

question

define rehabilitation facility

answer

- a category of a 'type' of health care facility - expected length of stay can be from days - weeks - high intensity focus on rehabilitation 3-4 hours per day - examples: HealthSouth or Reliant

question

list the categories of health care facility types

answer

- acute care - subacute [long term acute care] - rehabilitation - specialty care - ambulatory care

question

define specialty care

answer

- a specific population catered to - examples: Dell Children's or Heart Hospital

question

define ambulatory care

answer

- outpatient hospitalization - examples: walk-in clinics like Concentra

question

list the categories of ownership

answer

- Private - Public-local government owned

question

define private ownership

answer

- For profit like Reliant and HealthSouth - Not for profit like St. David's and Seton

question

define public ownership

answer

local government owned - city: Brackenridge Hospital [managed by Seton] - county: Parkland [county hospital for Dallas] - state: Austin State Hospital - federal: Veterans Affairs [VA] Hospital

question

list the types of long-term facilities

answer

think SIR - Skilled nursing facilities [SNF's] - Intermediate [assisted living facilities: ALF's] - Retirement

question

describe Skilled nursing facilities [SNF's]

answer

- provide 24 hour per day extensive, intensive, medical nursing services with RN's on all units and during every shift - examples: Summit, West Oaks and Gracy Woods

question

describe Intermediate facilities [ALF's]

answer

- provide minimal medical services [assisted living facilities] - examples: Summit, Heritage @ Gaines Ranch and Carestone

question

describe Retirement facilities

answer

- provide very limited or no medical services located on the premise - example: active 55+ living communities like Sun City

question

what are the five benefits of the interdisciplinary team approach

answer

• enhances the knowledge of the other health care professionals • more effective utilization of time [team members can share info] • increased direction of goals and treatment due to increased supervision and coordination of team efforts • encourages communication between team members to exchange ideas, brainstorm problems, and share knowledge • provides leadership opportunities and encouragement between team members

question

list different health care providers we may come in contact with in our profession

answer

- Primary Care Physician [PCP] - Internist - Neurologist - Orthopedist - Surgeon - Physical Therapist

question

describe role of a Primary Care Physician [PCP]

answer

general practice

question

describe role of a Internist specialty in particular physiological system

answer

specialty in particular physiological system

question

describe role of a Neurologist

answer

specialty in neuromuscular disorders

question

describe role of a Orthopedist

answer

specialty in musculoskeletal disorders

question

describe role of a Surgeon

answer

specialist in invasive treatment

question

describe role of a Physiatrist

answer

specialty in physical medicine and rehabilitation

question

describe role of a Psychiatrist

answer

specialty in mental disorders

question

describe role of a Clinical Psychologist

answer

doctorate in clinical psychology

question

describe role of a Chiropractor

answer

doctor of chiropractic medicine

question

describe role of a Osteopath

answer

medical doctor who utilizes a holistic treatment approach

question

describe role of a Licensed Professional Counselor

answer

therapist, social worker, case manager

question

describe role of a Certified Orthotist/Prosthetist

answer

trained in evaluation and fabrication of braces and prostheses

question

list various Allied Health Professionals

answer

o Physical Therapist Assistant o Occupational Therapist o Respiratory Therapist o Speech and Language Pathologist o Certified Orthotist/Prosthetist

question

list the major classifications of health insurance companies

answer

think PIG: • Private Health Insurance Companies • Managed Care • Government Health Insurance

question

describe Private Health Insurance Companies

answer

- reimbursement is on a fee for service basis - the subscriber can use any doctor, hospital, or health care facility - there is a deductible and the subscriber pays a percentage of the cost - example: ChampVA

question

describe Managed Care

answer

has two components: 1. a predetermined payment schedule 2. a provider network consisting of providers who contract with the insurance company and agree to accept the payment schedule for their services - example: BlueCrossBlueShield [BCBS]

question

list the types of Managed Care

answer

- Health Maintenance Organizations [HMO] - Preferred Provider Organizations [PPO] - Point-of-Service Plan [POS]

question

describe Government Health Insurance

answer

- administered by the federal government - includes: Medicare, Medicaid, and workers compensation

question

define policy

answer

- what will be done within an organization - example: vacation or sick leave

question

define procedure

answer

- how things will be done within the organization - the 'process' of requesting leave for vacation or sick time

question

differentiate between a policy and a procedure

answer

both must be: - clear - concise - easy to read - accurate - comprehensive - enforceable - consistent - accessible - up to date - positive

question

explain the steps required in a grievance procedure

answer

Chain of Command: 1. verbally discuss with supervisor [wait 3 days] 2. written complaint to supervisor [wait 3 days] 3. written complaint to department head [wait 5 days] 4. written complaint to administrator [wait 30 days] 5. written complaint to Board of Directors [if no reply, request a hearing] 6. if still no reply, hire legal representation

question

define incident report

answer

a report must be filed that day of injury/accident to include: - date/time injury/accident - what happened - who was involved - who witnessed the event - what was done afterwards

question

explain the significance of an incident report

answer

- if you or a patient is injured and you are involved, you have legal proof of what happened - it could help exonerate you in a situation where someone may be blaming you for something that is not your fault - it could also provide proof that you were injured on the job if you end up needing short or long term disability

question

define philosophy

answer

a statement of purpose, common goal, or mission that can include definitions, relationships, clarifications, and limitations of the scope of the facility

question

define and explain the purpose of an organizational chart

answer

- delegates lines of authority and communication; who is in charge - shows the structure of a business, leadership, and departments within the organization

question

list the four factors one must consider when designing a physical therapy department

answer

1. Safety 2. Space 3. Efficiency 4. Environment

question

define safety

answer

be sure when considering your design both patients and staff will be safe while participating in activities and therapy

question

define space

answer

- be sure your space is functional - need room for equipment, interventions and space to walk around while others are performing their treatments

question

define efficiency

answer

- do you have a properly sized waiting room? - is bathroom easily accessible? - are the people able to walk around others that are doing activities without interrupting them?

question

define environment

answer

- the space should feel like a place where people go to work hard and get better - if too calm, it may discourage - if too much gym, may turn some off who are not motivated to work out

question

define Medicare, Part A

answer

in general, covers: - Hospital care - Skilled nursing facility care - Nursing home care - Hospice - Home health services

question

define Medicare, Part B

answer

covers 2 types of services: - Medically necessary services: services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice - Preventive services: health care to prevent illness [like the flu] or detect it at an early stage, when treatment is most likely to work best - examples: ambulance services, durable medical equipment [DME], second opinions

question

What are the factors that should be considered when purchasing equipment?

answer

- types - variety - quantity - maintenance

question

describe types of equipment

answer

useful for the types of interventions to be used in PT department

question

describe variety of equipment

answer

- to accommodate patients with different needs - two different varieties of a machine that works on the same body parts

question

describe quantity of equipment

answer

enough bought so no conflicts arise when you have multiple patients performing therapy at same time

question

describe maintenance of equipment

answer

easily maintained so it can be used consistently for a long period of time without having to spend money to replace or fix it

question

list some fiscal management factors

answer

think ABCD...U: - accurate recording of financial information - budget for optimal use of resources - considers option of pro-bono services [charity case: patient without health insurance but requires treatment] - direct and indirect expenses - uses a fee schedule consistent with the cost of therapy services

question

list some indirect expenses

answer

- equipment depreciation - insurance - taxes

question

define prospective payment system [PPS]

answer

methods of paying hospitals, health systems and organizations in advance regardless of the costs they incur during the course of treatment

question

What do Resource Utilization Groups [RUGS] categorize?

answer

patients based on their level of resources used, which determines payment to the facility

question

Why are budgets necessary?

answer

for optimal use of resources

question

define productivity

answer

the amount of time spent with the patient and the amount of units used within the treatment session

question

What are diagnostic related groups [DRGs]?

answer

a classification scheme developed by the federal government as a means to establish a uniform reimbursement for a variety of diagnostic conditions - patient's diagnosis determines the amount the provider will be paid

question

list some direct expenses

answer

- benefits - building rent - equipment - wages

question

define fee scheduling

answer

the listing of health care services in which a specific amount of money is associated with each service

question

explain what 'skilled and medically necessary' means

answer

that all care needs to be skilled and medically necessary in order for third party payers [insurance companies] to reimburse healthcare organizations

question

reimbursement for physical therapy services can be received through what means

answer

- diagnostic related groups [DRGs] - prospective payment systems [PPS] - resource utilization groups [RUGs] - retrospective methodology [i.e. fee for service]

question

How can a physical therapy facility manage to create a profit?

answer

- create a good payor mix - decrease patient cost by increasing efficiency - increase volume - negotiate for increased capitation rates

question

define capitation

answer

one payment per patient per year regardless of utilization of services

question

define quality assurance

answer

the objective measurement of quality of patient care including responsibility to correct deficiencies

question

define peer review

answer

an assessment of service done by professional equals

question

define quality improvement

answer

to make the changes that will lead to better: - patient outcomes [health] - system performance [care] - professional development

question

define criteria

answer

specific elements of medical care considered appropriate and or relevant to each diagnosis or condition

question

explain the purpose of Professional Standards Review Organization [PSROs]

answer

- reviewed and controlled both costs and quality assurance for patients covered by all federal programs - PSROs eventually replaced by Peer Review Organizations [PROs]

question

define audit

answer

the method of assessing the quality of patient care

question

What is the purpose of a utilization reviews?

answer

- to evaluate the use of equipment, staff, and facilities - to determine if care is medically necessary and appropriate

question

Define and explain the role of the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]

answer

- a national accrediting body whose job is to review hospitals - also called the Joint Commission - at first established to focus on structure but now focuses on outcomes

question

list the requirements for a quality assurance system

answer

think MIA: - monitor patient care - improve patient care - assess patient care

question

list the objectives of a quality assurance system

answer

think AEI...RR: - assist in management decisions - evaluate the level of patient care for the department and staff member - improve documentation - relate levels of patient care to productivity - relate results of care to specific diagnosis, therapeutic interventions, and intensity of services

question

What areas may a quality assurance system assess?

answer

think OPS: - outcome - process - structure

question

list types of structures

answer

- equipment - licensure - physical plant - policies and procedures - records - staff

question

list types of processes

answer

provision of services: - approach - efficiency - intensity - intervals

question

define and state the importance of outcomes

answer

- status at discharge relative to admission - will ultimately gauge the quality of care

question

What was the impact of reimbursement on access to physical therapy?

answer

caused a shift from a retrospective reimbursement methodology to a prospective payment system [PPS]

question

What did the reimbursement shift force Physical Therapists to look at?

answer

the actual costs of providing care on an ongoing basis

question

The reimbursement shift caused an implementation of new approaches to staffing and services to ensure what?

answer

o cost-effective care o maintaining quality care o productive care

question

What do managed care organizations [MCOs] require?

answer

- documentation of medical necessity - a limit on the number of visits - documentation of functional gains

question

What are drawbacks to the reimbursement shift?

answer

Physical Therapists frequently invest unreimbursable time to: - advocate for more treatment sessions - more documentation time required for the same reimbursement amounts

question

list four quality improvement strategies for therapists

answer

- enhance employee contribution - hold yourself accountable to areas where the facility falls short - make patient and family a partner - treat the whole patient

question

vital signs consist of what

answer

- blood pressure [BP] - pain [ :( ] - pulse [HR] - respiration [RR] - temperature [T]

question

define temperature

answer

indication of intensity or degree of heat within the body [balance between heat produced and heat lost]

question

define pulse [heart rate = HR]

answer

movement of blood in an artery that can be palpated at various sites of the body or measured through auscultation over the apex of the heart with a stethoscope

question

define blood pressure

answer

- reflects the effects of cardiac output, peripheral vascular resistance and other hemodynamic factors - it is the force exerted by blood against any unit area of the vessel wall

question

define respiration

answer

the measurement of the rate, rhythm, volume and character of respiration - the exchange of fresh oxygen [O2 in] and removal of carbon dioxide [CO2 out]

question

define pain

answer

- an unpleasant sensory and emotional experience associated with actual or potential tissue damage - highly subjective - a self-report is the most reliable indicator

question

ranges for Temperature [T]

answer

oral: 96.8 - 99.3 F rectal: 97.8 - 100.3

question

ranges for Respiration Rate [RR]

answer

[respiration: in/out = 1] - adult: 12 - 18 per minute - infant: 30 - 50 per minute

question

ranges for Pulse [HR]

answer

- adult: 60 - 100 beats per minute [bpm] - child: 80 - 120 beats per minute [bpm] - newborn: 100 - 130 beats per minute [bpm]

question

ranges for Blood Pressure [BP]

answer

- elderly: 120/80 - 140/90 - adult: 120/80 - adolescent: 100/65 - 120/75 - children: 100/60 - 108/70 - infant: 3 months - 1 year: 90/60 - 100/67 - infant: birth - 3 months: 85/35 - 90/65

question

How can one accurately record and document vital signs?

answer

- for Temperature [T], record method: rectal [R], axillary [Ax] & degrees in Fahrenheit [°F] - for Respiration Rate [RR], record number of breaths per minute - for Blood Pressure [BP], record systolic pressure above diastolic pressure

question

What factors may affect Temperature [T] and how can it be affected?

answer

- time of day: lower earlier, higher in afternoon - age: decreases slightly with age and increased slightly in very young - infection: increases - physical activity: increases - emotional Status: increases - site of measurement: compared to oral, higher when rectal, lower when axillary - oral cavity temperature: eat/drink hot/cold within 30 minutes of temperature recording

question

What factors may affect Pulse [HR] and how can it be affected?

answer

- age: older decrease; younger increase - gender: males slightly lower than females

question

What factors may affect Respiration Rate [RR] and how can it be affected?

answer

- age: very young and elderly have higher rates - physical activity: increases - emotional status: increases with stress - air quality: can cause increase or decrease - altitude: increase until acclimated - disease: usually increases

question

How can you correctly utilize the data collection tools used in the assessment of pain?

answer

- document onset of pain - ask patient to point to exact location of pain on body, or using pain questionnaire - ask if pain radiates or spreads to other parts of body - description of pain [example: "burning or tingling" can indicate neuropathic cause] - ask what activities increase or decrease pain [helps design better Plan of Care] - ask what the current pain is on a scale [may use visual or verbal scale]

question

describe the etiology of pressure ulcers

answer

- pressure, friction or shearing - temperature - aging

question

How do pressure, friction or shearing play a role in pressure ulcers?

answer

they are more likely to cause damage than the pressure ulcer alone

question

How does temperature play a role in pressure ulcers?

answer

an increase in body temperature compromises the metabolism of ischemic tissue

question

define ischemic

answer

loss of blood supply resulting in tissue death [necrosis]

question

How does age play a role in pressure ulcers?

answer

- after 30 years of age, the skin's pliability and elasticity decreases - after 50 years of age, the skin's blood flow decreases - the elderly have a greater lack of mobility, poorer nutrition, complicated medical problems, and longer periods of confinement

question

What type of patients are considered "high-risk" for pressure ulcers?

answer

those with: - loss of sensation and or lack of mobility [SCI, MS, TBI, PD, etc] - loss of consciousness [comatose or heavily sedated] - an unwillingness to move due to pain - contractures to limbs - incontinence - specific diseases [example: diabetes]

question

define contractures

answer

limbs frozen in position from lack of movement

question

define incontinence

answer

inability to control bladder and/or bowels

question

list some preventive measures for the development of pressure ulcers

answer

think ERIE: - Eliminate pressure [turn and reposition every 2 hours] - Recognize skin breakdown [inflammation, redness, non-blanchable erythema] - Identify high risk patients - Educate patient and family [good skin care, etiology, consequences, patient morbidity]

question

Identify and explain the mechanism involved in the signs of impending skin breakdown.

answer

red flags: inflammation, redness [blanchable or non-blanchable] action: remove pressure to reverse damage if untreated: ulceration progresses rapidly and the patient is at risk for a more serious pressure ulcer

question

How are pressure ulcers are managed?

answer

- wound care - a strict turn and repositioning schedule

question

What are the common areas for pressure points?

answer

Think Bony Prominences: "I've got a bone to pick with you!" - head - ears - shoulders - elbows - spine - hips - coccyx [tailbone] - knees - ankles - feet - heels - toes [5th metatarsal]

question

Why is repositioning important?

answer

- prevents soft tissue injury, pressure, and joint contracture - provides patient comfort - provides support and stability for the trunk and extremities - provides access and exposure to areas to be treated - promotes efficient function of patients' body systems - relieves excessive, prolonged pressure on soft tissue, bony prominences, and circulatory and neurologic structures

question

How are pressure ulcers categorized?

answer

- "staged" I, II, III, or IV, based on their severity and amount of tissue damage - all are categorized as chronic wounds

question

explain what an Unstageable pressure ulcer is

answer

full thickness tissue loss in which the base of the ulcer is covered by slough [yellow, tan, gray, green or brown] and/or eschar [tan, brown or black] in the wound bed

question

Which body position simultaneously relieves pressure from both the sacrum and the trochanter?

answer

- a 30-degree lateral position - if needed, use pillows or a foam wedge to help the patient maintain the proper position

question

What are the characteristics of a Stage I pressure ulcer?

answer

"the beginning stage": - skin intact - skin appears red or ashen and doesn't blanch [lighten in color] when touched - area may be painful, firm, soft, warm or cool

question

What are the characteristics of a Stage II pressure ulcer?

answer

"an open wound": - may look like a shallow, pinkish red bowl-like wound - may appear as an intact or ruptured blister

question

What are the characteristics of a Stage III pressure ulcer?

answer

"a deep wound": - has a crater-like appearance - deep damage may expose a fat layer - bottom of the wound may have some yellow dead tissue [called slough]

question

What are the characteristics of a Stage IV pressure ulcer?

answer

"large scale tissue loss": - wound exposes bone, muscle or tendons - bottom of the ulcer contains slough and/or dark, crusty dead tissue [called eschar] - deep damage is extensive and well beyond the original wound

question

When positioning a patient in sitting, the hips and knees should be...

answer

flexed to 90 degrees

question

Your patient's BP is 120/60. What does 120 represent?

answer

systolic number

question

The first step in a grievance procedure is what?

answer

verbally discuss problem with supervisor

question

Patient call systems and emergency procedures are considered when designing a P.T. department. Which of the following factors would these be listed under?

answer

safety

question

The term used to describe a decreased pulse [less than 50 bpm] is...

answer

bradycardia [abnormally slow heartbeat]

question

You need to take your patient's pre- and post-exercise heart rate. Documentation of your findings will include what?

answer

think RRV: - rate - rhythm - volume

question

The difference between the cost of the treatment [expenses] and the charge for the treatment [revenue] is what?

answer

profit

question

Shearing force is more damaging than direct pressure and occurs in which of the following positions?

answer

semi-reclining

question

Your patient will require 24 hour intensive medical services and physical therapy following discharge from the hospital. Which type of long term care or nursing care facility will your patient will most likely go to?

answer

skilled

question

True/False: Pre-exercise HR for a patient you are seeing is 70 bpm. Exercise HR at peak intensity is 100 bpm. This is a normal response to increase in activity.

answer

True

question

Your PT clinic is the preferred provider for X insurance company. Your patient must gain access to your service through a primary care physician and pays a co-pay for the treatment. X will not reimburse for PT provided by any company but yours. Their healthcare plan is most likely a:

answer

Health Maintenance Organization [HMO]

question

A pressure ulcer that is very painful with partial thickness skin loss [sometimes referred to as a red wound] is a:

answer

Stage II pressure ulcer

question

A patient with an existing pressure ulcer should receive instruction in what?

answer

- pressure relief - skin care - prevention of infection - nutrition

question

The normal adult range for respiration is what?

answer

12-18 breaths/minute

question

When taking blood pressure with the brachial artery, where should the diaphragm of the stethoscope be positioned over?

answer

palpable brachial pulse

question

Healthcare insurance provided by the government for the economically indigent is called...

answer

Medicaid

question

True/False: Medicare part B typically reimburses for inpatient hospital and rehab stays.

answer

False

question

When positioning a patient prone, the shoulders are supported with towel rolls to prevent what?

answer

scapular protraction [abduction; shoulder blades moves away from the midline]

question

An arthritic patient or a post-op patient may be considered a high-risk patient for pressure ulcers because he has what?

answer

increased pain

question

If a patient's pulse has decreased volume and is easy to obliterate, it would be recorded as what?

answer

weak and thready

question

Hospitals can be classified by the size, type, ownership and what?

answer

length of stay

question

The PTA student is working in a large rehabilitation hospital. During the morning treatment, the student and a COTA worked together with the patient on standing at the counter and cooking a meal. The OT, PT and SLP are all working together to help the patient meet their goals. The student is asked to report the patient's progress toward the goal in therapy during a team meeting in which the doctors, case mangers and family are present. The SPTA recognizes this method of communication and collaboration as the ______________________ team.

answer

interdisciplinary

question

Which of the following health care professionals is not categorized as an allied health provider?

answer

Physiatrist

question

According to the American Heart Association, the recommended adult blood pressure is?

answer

less than 120 mm Hg [systolic]/less than 80 mm Hg [diastolic]

question

A physical therapist assistant is working with a student PTA when the student tripped over a patient's walker and sprained his ankle. After elevating the LE and placing ice on it, the PTA showed the student how to fill out the incident report. All of the following belong in the report except:

answer

the insurance company for the injured

question

A PTA is working in the hospital with a 65 yo patient recovering from a right hip fracture. The PTA recognizes that this patient most likely is covered by the following health insurance:

answer

Medicare, Part A

question

Medicare legislation requires facilities who participate in the federally funded program to prove medical necessity of the treatment, skilled interventions and quality of care. Facilities do this through a retrospective process called:

answer

Utilization review

question

A physical therapist assistant is working in a long term care facility with a patient who is on the skilled nursing floor [SNF]. The services are reimbursed by resource utilization groups [RUGs] and the therapist notes the minutes of treatment on the MDS. This system is called:

answer

a prospective payment system [PPS]

question

Which of the following terms is defined as difficulty breathing while lying down?

answer

orthopnea

question

A patient status post THA is requiring max assist for bed mobility due to pain. He tells the PTA that his backside really hurts. The PTA inspects the area and notes that it is red, hot and swollen. The PTA recognizes these as the signs of _________________. After repositioning the patient, she notifies the nursing staff and documents it in the medical record.

answer

inflammation

question

How does one fit a patient for crutches [axillary] to be used in gait training?

answer

- with patient trunk erect, the hips straight, the pelvis level, the knees slightly flexed, and the feet flat on floor - measure from point at the anterior axillary fold [two finger space between fold and crutch] to a point on the floor approximately 2 inches lateral and 4-6 inches anterior to the patients toes for the overall crutch length

question

How does one fit a patient for Lofstrand [forearm] crutches to be used in gait training?

answer

- top of forearm cuff should be located approx 1.0-1.5 inches distal to the olecranon process when the patient grasps the handpiece with the cuff applied to the forearm which is inverted and the wrist in neutral flexion-extension should be approximately 20-25 degrees

question

How does one fit a patient for canes to be used in gait training?

answer

- hand grip of the cane should be placed at the level of the patients greater trochanter, the wrist crease, or the ulnar styloid process with the arm straight along the side - place the cane parallel to the femur and tibia with the foot [tip] of the cane on the floor or at the bottom of the heel of the shoe

question

How does one fit a patient for quad canes to be used in gait training?

answer

- position cane so tip is approximately 2 inches lateral and 4-6 inches anterior to toe of shoe - observe angle of elbow flexion; should be approximately 20-25 degrees

question

How does one fit a patient for standard walker to be used in gait training?

answer

- hand grip of walker should be placed level with the patients wrist crease, ulnar styloid process, or greater trochanter with walker positioned in front of and along the patient's sides and with the patients arms straight along the side - feet of walker should be resting on floor or even with the heels - the hips and knees should be straight and shoes should be worn

question

How does one fit a patient for rolling walker to be used in gait training?

answer

- determine the distance from patient's greater trochanter to heel, with shoes on and with hips and knees straight - observe angle of elbow flexion, should be approximately 20-25 degrees when the patient grasps the handpiece and positions the device in preparation for ambulation

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