According to the National Association of Children's Hospitals and Related Institutions (NACHRI) (2009), “Children's hospitals are the most specialized and regionalized centers of care for children in the United States. They provide the majority of highly specialized inpatient care for children with complex and rare conditions.” The majority of children's hospitals are nonprofit organizations that help train one-third of all pediatricians and over 50% of all pediatric specialists. They are premiere institutions focused on quality patient care and innovative research, and advocate health promotion and injury prevention.
In 2006, there were over 250 children's hospitals across the United States, with 44% of these children's hospitals within larger adult-based institutions. Another 36% are specialty children's hospitals for orthopedic, rehabilitation, or psychiatric diagnoses. Only 20% of the hospitals were considered free-standing. Each year 3 million children require hospitalization for illness or injury, and one-third of these admissions will be at a children's hospital. The leading reasons for admission to children's hospitals include respiratory (16.8%), gastrointestinal (11.9%), neonatal (11.9%), neurological (9.8%), and orthopedic (6.7%) issues. If the children's hospital is also a trauma center, those figures may change to reflect diagnoses such as multitrauma and burns.
Within the pediatric acute-care hospital, there are many specialized areas of practice for the physical therapist, including the neonatal intensive care unit, pediatric intensive care unit, cardiac intensive care unit, and medical and surgical units with subspecialties such as pulmonary, oncology, orthopedics, and general pediatrics. The physical therapist plays a vital role on the interdisciplinary health-care team within the acute-care setting. This fast-paced environment will challenge the physical therapist to stay current with age-specific competencies and diagnostic processes, as well as being psychologically prepared to work with children and their families, often following a devastating diagnosis, illness, or injury. This chapter will take a look at the complex role of the acute-care physical therapist.
The interdisciplinary team in the acute-care setting consists of a large group of individuals, each with their own area of specialty, working together to best serve the child's and family's needs. The primary physician team guiding a child's care in the hospital setting can be as small as just the attending physician or can include a nurse practitioner and/or a physician's assistant. In a teaching hospital, the team also includes a fellow and/or a resident who are training under the attending physician. Other physician specialists may also be consulted to work on the interdisciplinary team based on the child's diagnosis. For example, a child admitted to the hospital for a femur fracture is usually under the orthopedic physician service and does not typically require the consultation of other physician specialists. However, a child admitted after a car accident who has a femur fracture in addition to a head injury would require the orthopedic team, but also possibly the critical care, neurosurgical, and even neurology teams. The child's primary medical ...