According to the Children’s Hospital Association (CHA) (2019), “Children’s hospitals are essential providers, setting the standard for the highest quality pediatric care while training the next generation of pediatricians. With its members, the CHA champions policies that enable children’s hospitals to better serve children; leverages its position as the pediatric leader in data analytics to facilitate national collaborative and research efforts to improve performance; and spreads best practices to benefit the nation’s children.”
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. As of 2019, there were approximately 250 children’s hospitals across the United States, accounting for 5% of all hospitals across the country (CHA, 2019). This percentage means that each children’s hospital serves a larger geographic area than its adult counterparts, requiring families of children with complex medical needs to travel long distances, often across state lines, to access specialized care for their children.
Role of the Acute-Care Therapist
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 (ICU), and medical/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 across these settings. The physical therapist’s main focus in the acute-care setting typically surrounds restoration of function, developmental support, and discharge planning/coordination. The primary role of the physical therapist working in the ICU environment is to promote early and progressive mobility. The burden of survivorship has been examined in longitudinal studies where it is evident that patients have ongoing muscle weakness, impaired physical functioning, and neurocognitive and psychiatric symptoms collectively known as “post–intensive care syndrome” (Parry & Puthucheary, 2015). Early and progressive mobility has been proven essential in minimizing secondary complications related to immobility, such as loss of musculoskeletal strength, function, cardiopulmonary endurance, peripheral neuropathies, and delirium. The fast-paced, acute-care environment challenges physical therapists to stay current with age-specific competencies, diagnostic processes, and being psychologically prepared to work with children and their families, often following a devastating diagnosis, illness, or injury. This chapter will take a look into 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 the family’s needs. The primary physician team guiding a child’s care in the hospital setting can be as small as the attending physician alone or can include a ...