On primary TKAs I assist from exposure through closure, place the adductor canal catheter, and set a POD0–1 mobilization pathway; what’s working for you to consistently hit 50–75 ft by POD1 without bounce-backs? We page PT at 0600 rounds and use an SBAR smartphrase in Epic, but I’m hunting for a tighter, repeatable handoff that holds up on 8–10 case days.
We added a ‘PT-ready’ Epic order that auto-pages PT when PACU documents MAP >65, pain ≤4, and quad motor >=4/5 so therapy is in the room within 60 min of PACU arrival; it’s been the most reliable way to lock in 50–75 ft by POD1, but it only works if anesthesia/PACU owns the checklist. Would your team let PACU trigger that instead of you paging at rounds?
We tied the PT page to “skin closed + 75 min” off the live OR board and bundled a single TKA fast-track order that prepopulates WBAT/precautions + ACB details, so therapy shows up predictably and nursing can start once SLR ≥10 s and orthostatics auto-post — no more telephone game. Caveat: it flops if PACU skips the orthostatics, so we made that a required field — @nashley76 have you tried a functional trigger like “SLR 10 s” instead of MAP/pain alone?
Quick example: we built a nurse-driven orthostasis bundle in PACU plus pre-PT midodrine; do you limit it to neuraxial cases, @jlporter90, or use it across the board? If standing MAP <65 or drops >20%, nursing gives 250–[redacted] LR and [redacted] PO midodrine 30–45 min pre-walk (hold for SBP >160 or significant CAD), and our banner one-liner — ‘WBAT, ACB [redacted]/hr, motor 4/5, last standing MAP 78, cleared for hallway’ — keeps PT from fishing around; coffee for the vessels…
We use a mobility tech–led “micro-walk” in PACU within 2 hours, logged as walk‑0, so PT can hit distance later while the block’s still sweet — a dress rehearsal. Gate is simple: pain controlled on PO meds and a 5‑sec march at bedside without knee buckle; if they don’t pass, nursing retries in 60–90 min and PT takes the second lap. @jlporter90 do you let techs handle that first lap, or does PT own it?
We switched the trigger to a discrete “first‑stand timestamp” in PACU, then auto-page PT at +45 min with two required SBAR fields (ACB rate and pain ≤4) so the handoff’s a baton, not a novel — and our POD1 50–75 ft rate climbed without extra calls. @r_thompson22 do you document first‑stand in a discrete field or still key off skin‑close?
Made the SBAR a binary “PT-ready” banner in Epic: three required clicks — “WBAT confirmed,” ACB site dry/intact, walker sized at bedside — then PT sweeps instead of waiting on the 0600 page. On 8–10 case days it cut our bounce-backs by catching the missing WB order/walker before PACU ambulation. @taylor_g90 would a simple banner like that slot into your flow?
We added a simple PACU ‘SLR gate’: if they can do a straight‑leg raise and clear the heel, nursing fires the PT page with orthostatics and last analgesic time; if not, we drop the ACB [redacted]/hr and recheck in 20 min — fewer Bambi-on-ice moments. @PT_Jen, it bumped our POD1 50–75 ft hit rate without slowing throughput, though late-day cases sometimes need a second pass. Curious if anyone else pairs a motor check with the handoff.
Quick example: at skin closure I record a 20–30 sec Haiku voice SBAR tagged to the PACU bed — WBAT, ACB rate, last analgesic, MAP range — and Secure Chat auto-routes it to PT so they plan the sweep without chasing us; it’s been faster than clicks and survives 8–10 case days, though late add-ons still need a quick ping. @owen67 think voice notes would slot into your flow?
In our derm PA clinic, we filled a remote esthetics instructor slot fast when applicants included a tight 2‑minute demo lesson — think of it like a hiring patch test. If you’re going remote, attach a mini‑lesson and note your LMS/Zoom chops so you can “apply promptly” with substance. Small caveat: confirm 1099 vs W‑2 and ask about class caps; anything over about 25 on Zoom tends to tank outcomes.