Inpatient Rehab Pearls and Principles – Slater

CONSULT, CONSULT, CONSULT!

When to consult?

  • Patient is well below their baseline functional status with potential for this to improve in a reasonable amount of time.
  • Medical needs beyond typical capability of subacute care (SNF).
  • Rehab diagnosis:  60% have to have a “rehab diagnosis”
    • stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, femur fracture, brain injury, polyarthritis (inc RA), and others…
  • Special problems related to TBI, SCI, etc.:  neurogenic bowel/bladder, spasticity, agitation, hypoarousal, musculoskeletal pain issues (outside opioid management)

Admission considerations:

  • able and willing to participate in 3 h/day and two therapy disciplines (PT, OT, speech)
  • rehab dx and complexity
  • family support and viable discharge to community
  • 5-7 days of therapy per week

Avoid pitfalls:

  • have an exit strategy – avoid the “lodgers”
  • don’t move patients simply to move patients
  • plan for 3 hours therapy before admission (dialysis, radiation, completed studies, etc)
  • can’t be on:  IV antihypertensives, EtOH withdrawal ongoing, telemetry
  • CAN DO:  not-brand-new trachs, PCAs for a day or two, agitation from brain injury
  • don’t send people to rehab who are going to go to a SNF anyway – that eliminates the benefit from rehab

Logistics:

  • do a Discharge Med Rec – not a Transfer Med Rec!  (This is similar to discharging to a SNF)
  • Write discharge order.  Rehab will write the admit order
  • Please let rehab help with the transition from rehab to acute, if that is needed
  • Communicate!  signing off, major studies needed, follow-up plan changes, etc.

Ordering Therapy

  • before ordering PT/OT, please assure assessment is really needed
  • has the nurse walked the patient, and has assistance been needed for ADLs?
  • is skilled therapy needed, or just someone to walk them?
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