Case of the Month
The Case
The College received a complaint from a physiotherapist about the care a member of their family received from a Physiotherapy Resident.
The patient was attending physiotherapy after being discharged from the hospital following surgery. A referral was made for outpatient physiotherapy care by a LHIN Care Coordinator. The complainant indicated that the patient’s initial assessment was only a brief post-operative phone call, followed by care assigned to a physiotherapist assistant (PTA), and that the PT Resident did not use the proper resident title.
Although the patient agreed to receive care virtually, there was no video assessment. Given the patient’s extensive health history, the complainant suggested a virtual meeting so the PT Resident could see how the patient was moving and ultimately conduct a better assessment. The PT Resident agreed and said they would follow up with a link for a virtual session, but never followed up.
The PT Resident said they were having technical issues with their computer. As a result, the virtual assessment was never scheduled, and the patient started working with the PTA.
The complainant also noted that the patient was treated by the PTA for four weeks without any reassessment by the PT Resident. The patient mentioned updated goals to the PTA, but the information was not shared with the PT Resident.
The PT Resident maintained that they were in regular contact with the PTA and ensured that the PTA had the knowledge and skills to deliver the treatment plan. Additionally, the PT Resident acknowledged that they did not use the proper title when interacting with the patient but said it was unintentional.
The Standards
Virtual care was widely used during the pandemic to ensure patients were able to continually access physiotherapy services and it continues to be used successfully in many situations today.
However, in this case the initial assessment that took place over the phone appeared to mainly be a subjective assessment. The PT Resident noted that they planned to follow up with the patient to complete a more comprehensive assessment using video conference, but this did not happen.
Conducting a thorough assessment of a patient is a key foundation for providing quality patient care that meets the College’s Standards and the expectations for the profession. In this case, it would have been challenging for the PT Resident to develop a clinical diagnosis as the assessment was only partially completed before the patient started working with the PTA.
As outlined in the Working with Physiotherapist Assistants Standard, a physiotherapist cannot assign assessments or reassessments to a PTA. In this case, the PT Resident essentially handed the patient over to the physiotherapist assistant to conduct the objective portion of the assessment. Additionally, the physiotherapist must have a communication protocol that outlines how and when they will discuss care with the PTA, and provide a level of supervision that is appropriate to the patient’s condition. While the PT Resident maintained that they were in regular contact with the PTA, there was no evidence of a discussion about the patient’s updated treatment goals.
Finally, according to the Restricted Titles, Credentials and Specialty Designations Standard, registrants with a provisional practice certificate of registration must use the “physiotherapy resident” title. In this case, the PT Resident did not clearly indicate their status to the patient.
The Outcome
The Committee determined that the concerns were significant enough to require the PT Resident to participate in a Specified Continuing Educational or Remediation Program (SCERP) focused on patient care, working with physiotherapist assistants, communication and record keeping.
All costs associated with the SCERP will be paid by the PT Resident, and a summary of the SCERP will be posted on the Public Register.
Working with Physiotherapist Assistants Standard
Essential Competency Profile for Physiotherapists
Kindly provide a full-form of LHIN.