Physiotherapy Department
What to do if you will be absent?
If you are absent for whatever reason, you must contact your clinical supervisor by calling the department (leave voicemail if necessary) or contacting them directly AND advise the academic clinical coordinator at your university.
OPPQ Charting Guidelines
You will be doing a lot of charting over your career. As a student, we know it can be difficult to learn how to chart efficiently, timely and effectively. Here is a review of proper documentation: https://oppq.qc.ca/membres/tenue-dossiers/
To assist in your charting, here is a useful cheat sheet for writing a SOAPIE note:
MUHC Adult Physiotherapy DATABASE/SOAPIE
I.D. Age, sex, presenting complaint, date of admission, transfer from facility if appropriate.
PMHx. List medical history, can include physiotherapy hx if outpatient (brief).
PSHx. List surgical interventions.
HPI. Details of present complaint, diagnosis and its course.
OR-date and procedure
Additional information obtained from Consults ie. Cardiology, Neurology, Internal medicine.
MEDS. Pre and/or post medications for admission/current outpatient meds.
TESTS. Pertinent test results and dates.
SOCIAL Hx. Home situation, occupation, functional level prior to admission/referring.
Complaint, information which will help in discharge planning.
Hx of risk factors in health ie. Smoking
SUBJECTIVE.
OBJECTIVE. Please remember to use ‘Continuation Sheet’ if necessary for lengthy objective findings in more involved patients.
ASSESSMENT. Should be written on the ‘face page’ of referral.
PLAN. Goals and treatment to be written on the ‘face page’ of referral and signed.
INTERVENTION. Details/parameters of your treatment (use flowsheet)
(E)POST-INTERVENTION EVALUATION. Subjective or objective data post-treatment.
REMEMBER.
- Write legibly
- Be brief in notes
- Use a Flow Sheet
- Sign and have counter signed all documentation
Please Note:
- Students are expected to sign their charts as PTM1 or PTM2. (Ex: John Smith, PT M1)
- DO NOT FORGET to have your supervisor co-sign all documentation!
Charting Example
Here is an example of a physio consult that you may find on the units of the hospital. Familiarize yourself with the flow of the SOAP and type of patient but not necessarily the style as everyone has their own style.
Here is an example of a physio consult that you may find in the out patient department. Again, the database and SOAP format are important to note but not necessarily the style.
Student Presentation
As part of the professional development and non-clinical aspect of physiotherapy, you are expected to prepare a presentation which will take place in the last few weeks of your rotation.
The guidelines for the presentation are as follows:
PHYSIOTHERAPY CLINICAL PROGRAM - Guidelines for Case Presentations
Purpose: The presentation gives the student the opportunity to:
- develop skills in the presentation of clinical material to a group
- gain experience in ‘fielding’ questions before a group
Objectives:
- to provide experience in oral presentation of information clearly and concisely.
- to encourage use of audiovisual aids, thereby enhancing presentation
- to demonstrate the information gathering and decision-making process, includes related physiotherapy intervention
- to integrate the presentation with a wider knowledge of the involved condition
- to provide treatment techniques used for patient
- to stimulate participation via discussion of the physiotherapy approach chosen
Format:
- Introduction – Condition/topic, brief overview of presentation headings
- [RVH] A topic/condition you have seen in your rotation which is new/interesting or has conflicting evidence for treatments
[MGH] History – Should include relevant psychosocial history, past physiotherapy intervention and effectiveness.
The rest of this list pertains to MGH case presentation:
- Medical Treatment – Significance of tests taken, effects of medication regimen.
- Surgical Treatment – Brief review/discussion of procedure, any complication intra/post-operatively.
- Assessment findings – Detailed and concise, applicable to presenting problem(s).
- Analysis – Problem list and differential diagnosis/impression when appropriate.
- Planning Process – Goal setting, coordination of other services, treatment outline.
- Progression and Modification – Includes patient response, family response, exercise programs and discharge planning.
- Patient Demonstration – Demonstration by student of treatment techniques with actual patient before a group, either in gym, clinic, ward or ICU.
- Question Period – If time permits, the group may discuss further any approaches/other case examples when patient has left.
Please Note:
- Valuable time is taken by the group to attend the presentation, be prepared.
- No numerical value is placed on the presentation.
- All students must attend all of their colleague’s presentations.
Multidisiplinary Team
The team of professionals and healthcare workers collaborating on each of the in-patient units is extensive. Here are the people who work together to ensure quality care for the patients and are available on almost every floor:
- Medical Team: Physician/Surgeon, Resident (multiple levels of years depending on specialty but known as senior or junior)
- Nursing: Nurse Manager, Assistant Head Nurse, Nurse Practitioner, Clinical Nurse Specialist, Liaison nurse, Nurse educator, staff nurse, GPL, RNA (nursing assistant)
- PAB (prepose aux beneficiaires)
- Physiotherapy: Physical Therapist, TRP (therapeute en readaptation physique/physio technician), Physio Assistant
- Respiratory Therapy: Respiratory Therapist, Respiratory Therapy Technician
- Occupational Therapist
- Nutrition: Nutritionist, Dietary Technician
- Social Work: social worker, social work technician
- Pharmacy: Pharmacist, Pharmacy Technician
- Medical Imaging Technician
- Blood Technician
- Administrative Agents: Unit Coordinator, Receptionist
- Spiritual Care Worker
- Research Team: Research Project Manager, Research Assistant
- Housekeeping
- Patient Transport
- Building Services
- Archivist
Computer access
You can use any computer at any MHUC sites. You can log in using an identification codes that will be given to you during your first day of stage. Make sure you don’t leave your workstation unattended and log out once you are done. Please ensure you are familiar with regards to information security for proper use.
Finding your way
Montreal General Hospital Layout
The MGH is divided into 5 wings over 19 floors. Physiotherapists offer in-patient care on E (east)/D (west) wings from floor 9-18. Each floor may have either a central nursing station or one on each wing. Not each floor has a patient unit.
A, B and C wings on floors 2-8 consist of other departments and clinics.
Out-Patient Physio Department (C2):
The out-patient department consists of 2 clinics and the Hand center. The major patient populations seen are: musculoskeletal, orthopedic trauma, pain and hands. It is essential to have a good working knowledge of anatomy (limbs/spine). You will hone your assessment/analysis skills as well as treatment progression
Emergency Department (A1):
The ER department of the MGH is a busy place and fluctuates in the number of physio consults per day. It takes an adaptable therapist and also someone who is quick at coming to a clinical impression and decision. This is a nice place to hone treatment and analysis skills as well as becoming an integral part of the geriatric team. Patients have many different reasons for needing physio ranging from falls to stroke to back pain. The quick-paced nature of this rotation means that you must be able to modify your sessions and think quickly on your feet. Expect a lot of initial evaluations and a lot of ‘detective work’.
ICU:
The ICU is a unit that is covered by mainly 1 therapist. There are 3 major patient populations: newly operated, acutely ill (medical and trauma), and chronically acute patients who may or may not be on a ventilator. It is important to know about hemodynamics here and to understand ventilator settings for this rotation insofar as they pertain to the physio session. The nurse plays a key role in this rotation and there is an expectation of teamwork. You may not have the opportunity to be unsupervised in the ICU as the patient population can be extremely critical. This does not mean that you will be seen as incapable or lacking competence for assessment and treatment of these sometimes complex patients, so do not worry about it for evaluation purposes.
Cardiology/CCU:
The CCU - cold side is where the less critical cardiology patients are found. Myocardial infarcts and congestive heart failure are the more common ailments on this floor. A lot of the consults are for discharge planning and evaluation of the patients’ activity tolerance.
The CCU - hot side is where the acute cardiology patients are. Often patients are on ventilators here or on special medications that require close monitoring. This is often an area where more direct observation will be given by your supervisor and you will not necessarily be left alone.
Internal Medicine:
The internal medicine unit is split in 2 but both wards have mainly the same patient population. Commonly mainly geriatric patients with comorbidities are found on these units so make sure to review the AAPA on this orientation site. There are also a multitude of other issues that these patients present with which will mean constant research and literature reviews of diagnoses and symptoms to keep up-to-date on your patients. Team work is big on this unit with multidisciplinary rounds taking place daily to ensure that all patient plans are cohesive and patient-centered.
General Surgery/OMF/Thoracic Surgery:
This rotation will be mostly involving patients who have various abdominal or thoracic issues (including cancer, often requiring surgery) and can involve heavy transfers of patients who are quite deconditioned. OroMaxillaryFacial (OMF) patients are part of the general surgery unit. Discharge planning and exploring criteria for rehab will be honed on this unit as well as cardiorespiratory skills.
Orthopedic/Trauma:
This rotation consists of evaluation and treatments of post operative patients of elective orthopedic surgeries such as hip and knee replacements/spine /musculoskeletal oncology and trauma cases (such as hip and ankle fractures) including polytraumas. This is a very busy unit and initial evaluations and detailed treatments need to be done promptly. Some patients are returning home in a short period of time. Skills in ROM and strengthening exercises are required and effective mobilization for prompt discharge planning is key on this unit.
Neurology/TBI:
This rotation will involve a combination of mostly CVA and TBI patients, as well as the occasional patients having other neurological diagnosis.
Students will learn the fundamentals of evaluation and treatment of these patient populations and will become more adept at progressing acute rehabilitation programs based on the patient’s response to PT interventions.
The ability to determine rehabilitation potential as well as appropriately planning for discharge will be skills the students will develop and refine during their clinical placement.
The skills required for safely and appropriately performing transfers with the neurologically compromised patient will also be developed.
A multi-disciplinary approach involving not only the health care team but also the patient and their families is used for both treatment and discharge planning. Weekly multi-disciplinary meetings take place for the TBI and CVA populations.
GDH:
The Geriatric Day Hospital’s (GDH) goal is to facilitate and promote the ability of the frail elderly to live in the community. The GDH provides comprehensive geriatric assessments/evaluations using interdisciplinary team approach (PT, OT, RN, MD etc.) as well offering short term rehabilitation in PT and OT.
These frail elderly often present with multifactorial problems including: mobility impairment with falls, loss of functional autonomy, cognitive decline and chronic pain with polypharmacy.
The Montreal Neurological Hospital
The layout of the hospital is corridor-like with patient rooms on both sides and a central nursing station in each specialized patient care area. There is a staff room for the department on the second floor and the out-patient therapists work in condition-specific clinics.
The third floor is a mix of neurology and neurosurgery patients with a specialized monitoring area for seizure patients. The patient population includes variability with anything from multiple sclerosis to a brain tumor. The patients also vary in terms of length of stay so discharge planning will be very important.
The fourth floor is the stroke unit and the ICU. The stroke unit is where you will learn to treat and assess both hemorrhagic and ischemic CVAs. You will also learn how to improve and refine noticing progression and potential for improvement in this patient population. Ensuring rehab criteria will also become a skill.
You may not have the opportunity to be unsupervised in the ICU as this patient population can be extremely critical. This does not mean that you will be seen as incapable or lacking competence for assessment and treatment of these very complex patients, so do not worry about it for evaluation purposes.
The Glen Site – Royal Victoria Hospital Layout
The RVH is divided into blocks. Physiotherapists offer patient care in Block C and D. Each block has multiple levels, not each level has an in-patient care unit.
The in-patient care units or wards of the hospital are divided into three sections referred to as ‘pods’. There is a NORTH, CENTER, and SOUTH pod. The north pod can be identified by the smaller numbers starting at 1. The center pod is where the bigger and more central doors are located with respect to the public elevators. The south pod encompasses the bigger numbers (usually ending in 35 or 36). There is a grey section in the middle of all the pods with elevators meant for transport and for staff only; please avoid giving patients and patients’ family members directions via these areas.
Out-Patient Physio Department:
If your rotation is in the out-patient department, there are many services offered here. The major patient populations seen are: musculoskeletal, orthopedic, pain, oncology, lymphedema, cardiopulmonary and newly pelvic floor. The cardiopulmonary out-patient clinic is unique in that it has group therapy.
It may not be possible for students to see all the services offered depending on the supervisor you are with. Let your supervisor know of any interest you may have and they will see if they can accommodate to let you get a glimpse.
Emergency Department (DS1):
The ER department of the RVH is a busy place and fluctuates in the number of physio consults per day. It takes an adaptable therapist and also someone who is quick at coming to a clinical impression and decision. This is a nice place to hone treatment and analysis skills as well as becoming an integral part of the geriatric team. Patients have many different reasons for needing physio ranging from falls to stroke to back pain. The quick-paced nature of this rotation means that you must be able to modify your sessions and think quickly on your feet. Expect a lot of initial evaluations and a lot of ‘detective work’.
ICU (D3):
The ICU is a large unit that is shared among 2 therapists. There are 3 major patient populations: newly operated, acutely ill, and chronically acute patients who may or may not be on a ventilator. It is important to know about hemodynamics here and there may be more supervision given as the patients are in critical condition. It is important to understand ventilator settings for this rotation insofar as they pertain to the physio session. The nurse plays a key role in this rotation and there is an expectation of teamwork.
PACU (C3):
The PACU (aka recovery room) is where patients are sent after a procedure or surgery for close monitoring. Very few physio consults are given here and they are usually for patients who need either chest physio or discharge planning.
Pre-Ante-Post Partum (D6) :
This floor is for women either before, during, or after giving birth. The majority of physio consults are given for women on bed rest for complications in their pregnancy. Other consults are given post-partum for complications the mother incurs during the birth process (i.e. sacroiliatis). Many other reasons for consultation exist.
Cardiac Surgery and Plastic Surgery(D7):
This rotation mainly involves seeing patients through the cardiac pathway after their cardiac surgery. The more common surgeries seen are the aortocoronary bypass graft (ACBP) or valve repair/replacement among many others. The patients usually stay for 5-6 days post surgery. There are also patients who have a more prolonged stay due to complications and these are sometimes the more interesting physio cases. A specialty on the floor is the mechanical hearts (left ventricular assist device – LVAD) patients. Team work is a VERY important part of this rotation.
Various plastic surgery patients and at times vascular surgery patients are seen on this floor as well.
Cardiology/CCU/Vasular Surgery (C7):
The Cardiology unit (aka cold side) is where the less critical cardiology patients are found. Myocardial infarcts and congestive heart failure are the more common ailments on this floor. A lot of the consults are for discharge planning and evaluation of the patients’ activity tolerance.
The cardiac care unit (CCU aka hot side) is where the acute cardiology patients are. Often patients are on ventilators here or on special medications that require close monitoring. This is often an area where more direct observation will be given by your supervisor and you will not necessarily be left alone.
The vascular surgery floor is most commonly known for upper/lower extremity bypasses, thoracic/abdominal aneurysm repairs and amputations. Physio consults and treatment are integral to patient care on this unit. There will be a lot of discharge planning here.
Respirology/Pulmonary ICU (D8):
The Resp floor is for patients with acute respiratory issues that are needing medication and monitoring. Patients have access to a full team including physio and respiratory therapists (who work together quite closely on this floor). Most notably, this unit has cystic fibrosis patients for which your pulmonary hygiene skills will most definitely be put to work.
The Chest ICU is where the critical respiratory patients are. They are often on ventilator and they often require chest physio. Knowing how to adapt to patients limitations and adapt to their changing status will become a skill here. The physio here is an integral part of the weaning program to decrease dependence on the ventilator and eventually aid in ability for its removal.
Gyne/Gyne-Onc/Urology/General Surgery (C8):
This floor is a mix of surgical patients with very differing and specific needs. A lot of the physio intervention is needed for discharge planning in the continuum of care. Also, pulmonary hygiene skills, management of surgical pain and palliative care expertise is developed as these are common issues in this patient population.
Internal Medicine (D9/C9):
The internal medicine unit is split in 2 but both wards have mainly the same patient population. Commonly mainly geriatric patients with comorbidities are found on these units so make sure to review the AAPA on this orientation site. There also a multitude of other issues that these patients present with which will mean constant research and literature reviews of diagnoses and symptoms to keep up-to-date on your patients. Team work is big on this unit with multidisciplinary rounds taking place daily to ensure that all patient plans are cohesive and patient-centered.
PCU or Palliative Care (D9N):
The PCU is a special floor where a very specialized attention is given to people requesting palliation of their disease. This does not always mean imminent end of life. A certain skillset is needed in the way of interviewing your patient and teasing out their particular needs. Discharge planning is a very crucial element of the physio role on this floor.
Heme-Onc/Medical Oncology (D10):
This entire unit is axed on oncology. There are different doctors for each patient and different things expected of each patient depending on what their issue is and how they are projected to progress. The middle section (mainly hematology-oncology patients) has rooms that are all under positive pressure isolation for the patients that are immune-compromised so be careful with entering and exiting the floor and the rooms. Be careful with discussing of medical information, things discussed in rounds and plans with these patients as, at times, things are still under investigation and unknown to the patient or their family.
Transplant/Hepatobiliary/General Surgery/ENT (C10):
The rotation will be mostly involving patients with liver issues (including cancer, often requiring surgery) and has been known to involve heavy transfers of patients who are quite deconditioned. ENT patients are special to this unit and often require an extensive amount of pulmonary hygiene. Discharge planning and exploring criteria for rehab will be honed on this unit.
Lymphedema (on consult):
Lymphedema consults are done by a trained therapist with special certification. The consults are requested throughout the hospital and some patients are seen in the out-patient clinic. You will learn to recognize this chronic inflammatory condition and become familiar with the treatment options.
Wellness
It is important to take care of yourself especially when your job involves caring for others. If your physical, mental and social well-being is nurtured, then you will have the necessary tools to be a physical therapist who is open to the holistic care of one’s patients.
If ever you feel an imbalance in one of the spheres of your wellness, please seek immediate guidance. This can be done in any way that you feel works for you. However, the School of Physical and Occupational Therapy suggests that students contact The Well Office. Here, you can find all the necessary means (including professionals) to get you back on track! Because there is no future of this profession without YOU!!!