Tips for navigating co-treating with physical therapy in the acute care setting

Interdisciplinary teamwork is a topic that was discussed in various classes during my occupational therapy studies. From three dedicated semester-long courses to informal conversations during lectures, we covered it all – at least in theory. But what about in the real world? As a new graduate working at a Level I trauma center in acute care with a team of about 120 therapists, I quickly learned that interdisciplinary teamwork is the name of the game. Especially when it comes to working alongside and co-treating with our physical therapy (PT) counterparts.

Daily collaboration with PT in the acute care setting is bound to happen. So, how can we navigate this aspect of the job, foster our confidence as a new graduate, and build a robust set of clinical skills? In true interdisciplinary fashion, I reached out to a close PT friend, Vanyssa, and worked with her to bring you practical tips and advice on co-treating in acute care.

How has co-treating shaped your view of the other discipline?

Kenzie - Before starting my first OT job, I had worked in IPR as an aide and had a level II fieldwork in acute care, so I had a good idea of how PT worked in the inpatient setting. Co-treating during my level II fieldwork was only acceptable under certain circumstances, so my view was limited. As a practitioner, I have learned so much more about PT through co-treating, including how to clearly communicate our distinct roles to patients – and how to be a better therapist overall.

Vanyssa - Prior to working as a PT, my understanding of OT’s role in patient care was limited to the outpatient orthopedic setting. Through co-treating in acute care, I’ve shifted how I structure my sessions by intentionally integrating functional mobility with ADL performance to better prepare patients for safe and effective function at home. This approach allows for a more comprehensive, patient-centered treatment session.

What helps you determine if a patient should be co-treated?

Kenzie and Vanyssa - There are a variety of details we both consider when we are determining if a patient should be co-treated. Some of the most important ones we look out for are:

• Assistance level (one-person versus two-person)
• Cognition/mental status
• Medical fragility
• Activity tolerance
• Prior level of functional mobility
• History of traumatic brain injury (TBI)
• Limiting factors to previous sessions

What are some pros and cons of co-treating as a new graduate?

Kenzie - A major pro is that co-treating boosts my confidence with my patient care, which carries over to my solo sessions, making me a better practitioner. Trying something new or providing patient/family education can feel overwhelming or scary at times. Knowing that my PT counterpart is there for support during a co-treated session has made all the difference. On the other hand, co-treating for several days or weeks in a row can also have the opposite effect. It is easy to become reliant on your counterpart, but co-treating is not always an option. It is important to balance my days with co-treats and solo sessions to build my clinical skills and become the practitioner I want to be.

Vanyssa - One thing that I have really enjoyed about co-treating is learning from my occupational therapy partner. Each OT I have worked with brings unique education and intervention strategies that I try to incorporate into my own sessions in ways that best support my practice style. One con that I have noticed, however, is that co-treating can occasionally limit my ability to provide certain education or interventions, especially when a patient doesn’t require a co-treatment.

What are three tips you would give to a new graduate to navigate co-treating?

Kenzie - During the interview process, clarify if co-treating is practiced and familiarize yourself with any policies surrounding co-treating during the onboarding process. Make co-treating a collaborative decision during your morning chart reviews and communicate with each other throughout the day to use your time efficiently. Lastly, the best way to improve your solo OT skills and avoid defaulting to co-treating to get through the day is to practice! At first, it may feel uncomfortable or awkward to treat patients alone, but the more you try, the more confident you’ll become.

Vanyssa - Always start by speaking with your therapist counterpart about treatment plans and ideas that you would like to try during the session. This provides an opportunity to review a patient's medical history and discuss any details that could have been overlooked. Also, keep an open mind when collaborating or planning the session. Your therapist counterpart may have approaches or session structures that you may want to try on your own in the future. During the session, it’s equally important that you contribute your own education and interventions, as co-treating is a great opportunity for mutual learning and professional growth.

Co-treating with your PT counterpart provides valuable opportunities for professional and personal growth. As you continue to gain experience, your clinical judgement and reasoning will strengthen, boosting your confidence to complete solo sessions and lead co-treatments. Challenge yourself to step outside your comfort zone and become the practitioner you want to be!

Kenzie Hiler, OTD, OTR/L, currently serves as the Editor-in-Chief of the OT Student Pulse and works as an occupational therapist in the acute care setting at a level I trauma center in Middle Tennessee. She completed her OTD in May 2025 from Carlow University in Pittsburgh, PA. Kenzie enjoys reading books and spending time with family and friends.

Vanyssa Marlin, PT, DPT, is currently a physical therapist on a cardiac stepdown unit at a level I trauma center in Middle Tennessee. She completed her DPT at East Tennessee State University in January 2025 from Johnson City, TN. Vanyssa enjoys being active, socializing, and exploring.