Meet Dr. Jenna Segraves PT, DPT, Board Certified Neurologic Clinical Specialist, Certified Lymphedema Therapist.
Dr. Jenna Segraves is a Board Certified Neurologic Clinical Specialist in Physical Therapy and a Certified Lymphedema Therapist. She graduated with her Masters in Anatomy and Clinical Health Sciences from the University of Delaware in August of 2014 and her Doctor of Physical Therapy degree in December of 2014. Her clinical practice involves a wide variety of settings and populations including outpatient orthopedics, outpatient neurology, lymphedema management, pelvic health, acute care with a focus on neuro/trauma diagnoses, critical care, the emergency department, and inpatient obstetrics. Dr. Segraves is passionate about expanding physical therapy services to the emergency department to optimize patient function/safety and reduce overall hospital costs.
Describe how you became involved in Emergency Department Physical Therapist Practice.
I was specifically hired to help fill a need and provide coverage in the Emergency Department due to my experience in orthopedic outpatient, neurologic outpatient, and acute care settings.
Describe your practice setting and ED PT model.
I have worked in a multitude of settings including outpatient ortho, outpatient neuro, inpatient neuro, trauma, critical care, obstetrics, and the emergency department. My most recent practice setting has been in acute care at a facility that strongly recognizes the need for physical therapy services in the emergency department. We have two clinicians who work full-time solely in the ED with 7 days/week coverage and 12 hours of coverage Monday-Friday. We have designated therapists who are “ED-trained” to cover the ED when one of the primary therapists is out. This has worked really well for the facility and has helped to create a strong relationship between the rehabilitation department and the ED providers.
Why do you think this is a valuable practice area?
The emergency department is a unique unit because it requires the clinician to utilize everything they have learned throughout physical therapy school and previous clinical experiences. Physical therapists are highly skilled at assessing gait, balance, coordination, ROM, sensation, strength, and overall safety. We are trained to identify red flags that would warrant additional testing, imaging, or referral. We also spend quality time with our patients that can lead to identifying additional safety concerns or cognitive impairments. Because of this, physical therapists in the emergency department can help reduce unnecessary hospital admissions with appropriate referrals to outpatient services, identify appropriate DME or level of supervision in order for a safe return home, or catch a significant red flag (medical instability, neurological event, or complex social situation) that would warrant admission and potentially additional rehabilitation services.
What was the biggest adjustment for you in practicing in the ED?
I initially had a difficult time realizing that I have to be the voice and advocate for the patient. My evaluation and assessment in the ED has increased responsibility attached to it – I am the one reporting directly to the providers whether the patient can return home, needs rehabilitation or specific DME, or needs to be admitted with additional work-up. This can be stressful! What if I missed a red flag?! It all comes down to this one evaluation and my clinical judgment is the one that the medical team is waiting for.
Do you have an area of specialty?
I am a Board Certified Neurologic Clinical Specialist, so I do specialize in neurological conditions and assessments. I really enjoy evaluating the “dizzy” patient to identify whether their symptoms of dizziness are coming from a cardiopulmonary source, vestibular etiology, or potential central etiology.
I have recently been involved in creating inpatient obstetric programs that provide inpatient physical and occupational therapy services immediately after birth, prior to the patient returning home. With my background as a Certified Lymphedema Therapist, my specific area of interest is providing services to individuals following a cesarean section. Patients who have had a cesarean delivery often do not plan ahead for this type of delivery. It is often an unplanned major open abdominal surgery. Let’s take a moment and think about other general abdominal surgeries including small or large bowel resection, gallbladder removal, hernia repair, partial or total colectomy. These patients often receive inpatient physical therapy orders prior to returning home. Therapists routinely educate on safe bed mobility strategies for incision protection, breathing interventions, activity tolerance assessments, and the importance of frequent mobility and ambulation. Now think about the patients who have had an unplanned major open abdominal surgery with the added task of caring for a newborn. How are these individuals not receiving physical therapy services prior to returning home?
I started an inpatient obstetrics program at my most recent facility where patients following a cesarean section have an automatic PT evaluation referral. The next phase of the plan is to include perineal tears greater than grade 2 as well as involving occupational therapy. The eventual plan is to include physical or occupational therapy following any delivery.
In the United States, the maternal morbidity and mortality rate is the highest out of all developed nations. We have increased numbers of gestational diabetes, cardiovascular disease, preeclampsia, and HELLP syndrome. I want ED PTs to be aware that patients may enter the ED while pregnant or during the postpartum phase and you can still provide them with excellent care. Assess their activity tolerance by utilizing the 6 MWT or modified RPE scale. Take vitals to make sure they are not showing signs of preeclampsia or other adverse cardiac events. ED PTs can help identify adverse reactions to activity and potentially prevent neurologic events and/or death. As Rebekah would say, “vitals are vital!”
What barriers did you have to overcome personally and within your facility to practice successfully in this environment?
I initially struggled with self-confidence in my evaluation and communication skills. I rarely communicated directly with providers, so this change was a little daunting. Typically, communication was performed with the patient’s nurse or with the provider through secure chat features. In the ED, communication takes place face-to-face. And quickly. I had to realize that I belong on the care team and that my assessment skills are unique and highly regarded. Something I noticed about myself was that when I improved with either my self-confidence or my communication, then the other seemed to naturally improve as well. For me, they have a direct relationship. Once this change occurred, the ED was no longer a scary or stressful place.
My facility worked hard for many years prior to me joining the team to get PT involved in the ED. Initially, the ED providers “didn’t see the point”, or didn’t realize what physical therapists have to offer. It took inservices on vestibular PT, daily rounds with the providers asking if they had any patients who were here after a fall, and a constant presence to ensure that physical therapists are available and can help improve outcomes.
What is your philosophy about what makes an ideal ED PT?
An ideal ED PT, in my opinion, is someone who is well-versed in vestibular examinations, musculoskeletal assessments, adaptable, confident, and with excellent communication skills. It is a fast-paced environment with typically more complex patient presentations. ED PTs really are practicing at the top of their scope and need to have exceptional skills to provide the best level of care.
What was your biggest win in the ED?
This is a difficult question for me, because there are so many to choose from.
Do I pick the one where I was able to identify the proper DME and referral for home health services in order for the patient to safely return home?
Do I choose the (many) patients who come to the ED with reports of dizziness and severe nausea/vomiting with position changes, found to have BPPV of the posterior canal, and I was able to take all of their symptoms away with the Epley maneuver?
Or do I pick the patient who came to the ED with reports of changes in her balance/falls with a negative head CT, but I identified central signs during my vestibular examination and balance assessment, recommended an MRI to the providers, and she was found to have had a stroke?
For More From Dr. Segraves
Enhanced Recovery After Delivery | Home
PTJ Perspective
For the full interview watch or listen here.
