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)
- 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
- 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
- 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.
- 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?