Post operative physiotherapy

The surgical physiotherapy role is concerned with the assessment, education and treatment of patients admitted for either emergency or elective procedures.

Assessment can commence prior to surgery for patients who have known pulmonary disease, who may be given education and advice on chest clearance techniques, to optimise pulmonary function and prevent chest complications post-operatively.

For patients diagnosed with chest infections, or those identified at increased risk, early postoperative physiotherapy will concentrate on the management of respiratory dysfunction. This may include improving lung volumes, secretion clearance and techniques for managing breathlessness. Along with the MDT we have an important role in highlighting and escalating poorly patients at risk of deterioration.

When to refer for respiratory assessment:

• A patient has existing respiratory conditions and is at risk of developing complications
• A patient is unable to cough and clear secretions effectively
• A patient is struggling to meet their target saturations or requiring high levels of oxygen therapy
• A patient has a tracheostomy or laryngectomy and is unable to self-manage
• A patient’s chest is deteriorating out of hours and emergency input is required – on call and weekend physiotherapy cover is always available and can arrive within 1 hour

Physiotherapy staff will require an SBAR handover to obtain all relevant information. This will determine if the referral is appropriate for advice or assessment.

For patients who have reduced function during their hospital stay, physiotherapy aims to promote independence and safety.

When to refer for a mobility assessment:

• A patient is not at their baseline mobility - please determine baseline function by asking patient or family e.g. walking aids normally required and usual method of transfers
• A patient has a history of recent falls or has had a fall as an inpatient
• A patient is at risk of deconditioning e.g. following major surgery such as a laparotomy

We do not have large stocks of equipment, so If possible please ask family/friends to bring in patients’ stick/walking frames. This may also prevent a delay in them having the correct equipment therefore reducing the risk of falls and deconditioning.

Discharge planning

Once the patient is medically fit for discharge, physiotherapists will work with other members of the MDT (such as Occupational Therapists) to facilitate a prompt and safe discharge. Where possible this is back to the patients’ pre-admission place of residence or home.

• Patients will be assessed or screened to see if they can manage transfers, mobility and stairs at the level they are safe for discharge
• Patients maybe at a safe functional level for discharge but require follow up physiotherapy in their own environment to progress mobility/walking aids and exercises
• Community Response Team is suitable for patients with ongoing rehabilitation needs but would be safe at home overnight between calls. Rehabilitation therapists will visit the patient in their own home for a temporary period.
• Inpatient rehabilitation is suitable for patients with ongoing rehab goals that do not fit CRT requirements and are more dependent overnight.

It is helpful for physiotherapists to be informed of an expected date of discharge to start planning/assessment. Some patients may have reduced functional status, not progress with physiotherapy and show no rehabilitation potential. Physiotherapists may support with decision making to appropriate environments by providing assessment findings and recommendations to coordinators such as social workers