RE: Acute Care Referral Guidelines

[Guest guest]

Collen,

I am finding it disheartening lately when I hear PT's call referrals

inappropriate for PROM & transfers. We are experts in transfers and PROM is

within our scope of practice. I think we have to exercise caution when we

say something " isn't our job " . We need to be the individuals to educate

family and other health care professionals as to the mechanics of simple or

difficult transfers and the proper technique for PROM. I dont think either

of these referrals are inappropriate for PT's, especially if we wish to keep

both of them within our scope of practice and not surrender them to less

qualified individuals.

Mike Connors, MPT

Greater Therapy Centers

Carrollton, TX

Acute Care Referral Guidelines

>

>

> I am curious if anyone has acute care referral guidelines to help

physicians

> refer appropriate patients in the acute care setting. We are being bogged

> down with orders for PROM on patients and simple transfer orders for

patients in

> our ICUs. If anyone is willing to share them it would be great. Thanks

in

> advance.

>

> Collen Queen, PT, MBA, CHE

> Administrative Director

> Valley Baptist Health System

>

>

>

[Guest guest]

Collen,

I am finding it disheartening lately when I hear PT's call referrals

inappropriate for PROM & transfers. We are experts in transfers and PROM is

within our scope of practice. I think we have to exercise caution when we

say something " isn't our job " . We need to be the individuals to educate

family and other health care professionals as to the mechanics of simple or

difficult transfers and the proper technique for PROM. I dont think either

of these referrals are inappropriate for PT's, especially if we wish to keep

both of them within our scope of practice and not surrender them to less

qualified individuals.

Mike Connors, MPT

Greater Therapy Centers

Carrollton, TX

Acute Care Referral Guidelines

>

>

> I am curious if anyone has acute care referral guidelines to help

physicians

> refer appropriate patients in the acute care setting. We are being bogged

> down with orders for PROM on patients and simple transfer orders for

patients in

> our ICUs. If anyone is willing to share them it would be great. Thanks

in

> advance.

>

> Collen Queen, PT, MBA, CHE

> Administrative Director

> Valley Baptist Health System

>

>

>

[Guest guest]

Collen,

I am finding it disheartening lately when I hear PT's call referrals

inappropriate for PROM & transfers. We are experts in transfers and PROM is

within our scope of practice. I think we have to exercise caution when we

say something " isn't our job " . We need to be the individuals to educate

family and other health care professionals as to the mechanics of simple or

difficult transfers and the proper technique for PROM. I dont think either

of these referrals are inappropriate for PT's, especially if we wish to keep

both of them within our scope of practice and not surrender them to less

qualified individuals.

Mike Connors, MPT

Greater Therapy Centers

Carrollton, TX

Acute Care Referral Guidelines

>

>

> I am curious if anyone has acute care referral guidelines to help

physicians

> refer appropriate patients in the acute care setting. We are being bogged

> down with orders for PROM on patients and simple transfer orders for

patients in

> our ICUs. If anyone is willing to share them it would be great. Thanks

in

> advance.

>

> Collen Queen, PT, MBA, CHE

> Administrative Director

> Valley Baptist Health System

>

>

>

[Guest guest]

My opinion on this issue of " inappropriate referrals " may be slightly

different than those already expressed.

First, the appropriateness of a referral can only be determined after a

patient has been examined. We don't treat diagnoses, we treat people. This

is why I am a firm believer in " blind referrals " . I say this because the

referrer's diagnosis is unlikely to be my treating diagnosis. I am more

interested in past med-surg hx, than the referrer's opinion of what I will

be treating.

Secondly, would we prefer that too many referrals be made, or too few?

While both situations have financial implications for an organization for a

facility or clinic, these considerations should be secondary to quality

care. ly, I would prefer that the referrer NOT decide whether this is

an appropriate referral, and leave that decision up to me. If we attempt to

leave this decision up to others, we will probably be unhappy with the

results.

Finally, are we really discussing referrals, or " orders " ? We don't take

orders, but we certainly do take referrals. I suspect that this is really

the heart of the problem.

A referral that is made with a mandate of results is really not a referral.

That kind of referral occurs when the referrer thinks he/she knows what is

needed. We all know that this is not the case with most referrals we

receive, appropriately or otherwise. If a referral is made, and our

findings are that this was an inappropriate referral, our findings need to

be the final word. If these findings are being ignored or " superseded " ,

than that is our real problem.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Acute Care Referral Guidelines

Collen,

I am finding it disheartening lately when I hear PT's call referrals

inappropriate for PROM & transfers. We are experts in transfers and PROM is

within our scope of practice. I think we have to exercise caution when we

say something " isn't our job " . We need to be the individuals to educate

family and other health care professionals as to the mechanics of simple or

difficult transfers and the proper technique for PROM. I dont think either

of these referrals are inappropriate for PT's, especially if we wish to keep

both of them within our scope of practice and not surrender them to less

qualified individuals.

Mike Connors, MPT

Greater Therapy Centers

Carrollton, TX

Acute Care Referral Guidelines

>

>

> I am curious if anyone has acute care referral guidelines to help

physicians

> refer appropriate patients in the acute care setting. We are being bogged

> down with orders for PROM on patients and simple transfer orders for

patients in

> our ICUs. If anyone is willing to share them it would be great. Thanks

in

> advance.

>

> Collen Queen, PT, MBA, CHE

> Administrative Director

> Valley Baptist Health System

>

>

>

[Guest guest]

My opinion on this issue of " inappropriate referrals " may be slightly

different than those already expressed.

First, the appropriateness of a referral can only be determined after a

patient has been examined. We don't treat diagnoses, we treat people. This

is why I am a firm believer in " blind referrals " . I say this because the

referrer's diagnosis is unlikely to be my treating diagnosis. I am more

interested in past med-surg hx, than the referrer's opinion of what I will

be treating.

Secondly, would we prefer that too many referrals be made, or too few?

While both situations have financial implications for an organization for a

facility or clinic, these considerations should be secondary to quality

care. ly, I would prefer that the referrer NOT decide whether this is

an appropriate referral, and leave that decision up to me. If we attempt to

leave this decision up to others, we will probably be unhappy with the

results.

Finally, are we really discussing referrals, or " orders " ? We don't take

orders, but we certainly do take referrals. I suspect that this is really

the heart of the problem.

A referral that is made with a mandate of results is really not a referral.

That kind of referral occurs when the referrer thinks he/she knows what is

needed. We all know that this is not the case with most referrals we

receive, appropriately or otherwise. If a referral is made, and our

findings are that this was an inappropriate referral, our findings need to

be the final word. If these findings are being ignored or " superseded " ,

than that is our real problem.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Acute Care Referral Guidelines

Collen,

I am finding it disheartening lately when I hear PT's call referrals

inappropriate for PROM & transfers. We are experts in transfers and PROM is

within our scope of practice. I think we have to exercise caution when we

say something " isn't our job " . We need to be the individuals to educate

family and other health care professionals as to the mechanics of simple or

difficult transfers and the proper technique for PROM. I dont think either

of these referrals are inappropriate for PT's, especially if we wish to keep

both of them within our scope of practice and not surrender them to less

qualified individuals.

Mike Connors, MPT

Greater Therapy Centers

Carrollton, TX

Acute Care Referral Guidelines

>

>

> I am curious if anyone has acute care referral guidelines to help

physicians

> refer appropriate patients in the acute care setting. We are being bogged

> down with orders for PROM on patients and simple transfer orders for

patients in

> our ICUs. If anyone is willing to share them it would be great. Thanks

in

> advance.

>

> Collen Queen, PT, MBA, CHE

> Administrative Director

> Valley Baptist Health System

>

>

>

[Guest guest]

A good admissions screening process works well in eliminating inappropriate

referrals

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

A good admissions screening process works well in eliminating inappropriate

referrals

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

It was suggested by a JCAHO consultant that we put a screening tool in place for

our acute patients. He suggested a type of " functional scoring tool " , to be

performed by nursing with their admission assessment.

Would anyone like to share such a tool that they may be using?

You know the old story about the wheel!

Kim , MPT

Manager, Physical Medicine & Rehabilitation

North Oakland Medical Centers

461 W. Huron

Pontiac, MI 48341

Phone:

Pager:

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

It was suggested by a JCAHO consultant that we put a screening tool in place for

our acute patients. He suggested a type of " functional scoring tool " , to be

performed by nursing with their admission assessment.

Would anyone like to share such a tool that they may be using?

You know the old story about the wheel!

Kim , MPT

Manager, Physical Medicine & Rehabilitation

North Oakland Medical Centers

461 W. Huron

Pontiac, MI 48341

Phone:

Pager:

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

Let me add to my comment as it supports Ken's well stated comments. Our

therapists do these screens and determine appropriateness of a referral.

The MD is actually the last person contacted.

Again, notification of the need for a screen is a process that has taken our

organization quite some time to fine tune, but a " must have "

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

Let me add to my comment as it supports Ken's well stated comments. Our

therapists do these screens and determine appropriateness of a referral.

The MD is actually the last person contacted.

Again, notification of the need for a screen is a process that has taken our

organization quite some time to fine tune, but a " must have "

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We did a lot of education with nursing and our Admitting nurses perform our

screening for us and then the staff nurse screens during their stay should

their status change. This has worked well for us and has prevented

non-revenue producing time with the therapists. The quality of our nursing

referrals is good.

Ann

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We did a lot of education with nursing and our Admitting nurses perform our

screening for us and then the staff nurse screens during their stay should

their status change. This has worked well for us and has prevented

non-revenue producing time with the therapists. The quality of our nursing

referrals is good.

Ann

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We added several critical-key questions to the Nursing Admission History

Assessment that would lead to a refer as appropriate. These key questions

center around recent decline in function, swallow, etc. We provided a key

to what is an appropriate referral to PT/OT/ST on the back of their form for

guidance followed by education and training.

Ann

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We added several critical-key questions to the Nursing Admission History

Assessment that would lead to a refer as appropriate. These key questions

center around recent decline in function, swallow, etc. We provided a key

to what is an appropriate referral to PT/OT/ST on the back of their form for

guidance followed by education and training.

Ann

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help physicians

refer appropriate patients in the acute care setting. We are being bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We developed one, but the problem was getting nursing to consistently

utilize it.

Carol Rehder

Genesis Medical Center

>>> kallen@... 12/17/2004 8:49:08 AM >>>

It was suggested by a JCAHO consultant that we put a screening tool in

place for our acute patients. He suggested a type of " functional

scoring tool " , to be performed by nursing with their admission

assessment.

Would anyone like to share such a tool that they may be using?

You know the old story about the wheel!

Kim , MPT

Manager, Physical Medicine & Rehabilitation

North Oakland Medical Centers

461 W. Huron

Pontiac, MI 48341

Phone:

Pager:

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help

physicians

refer appropriate patients in the acute care setting. We are being

bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great.

Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

We developed one, but the problem was getting nursing to consistently

utilize it.

Carol Rehder

Genesis Medical Center

>>> kallen@... 12/17/2004 8:49:08 AM >>>

It was suggested by a JCAHO consultant that we put a screening tool in

place for our acute patients. He suggested a type of " functional

scoring tool " , to be performed by nursing with their admission

assessment.

Would anyone like to share such a tool that they may be using?

You know the old story about the wheel!

Kim , MPT

Manager, Physical Medicine & Rehabilitation

North Oakland Medical Centers

461 W. Huron

Pontiac, MI 48341

Phone:

Pager:

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help

physicians

refer appropriate patients in the acute care setting. We are being

bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great.

Thanks in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

Is your hospital staffed adequately with patient care techs/nursing

assistants to ensure patients are simply mobilized regularly (vs.

passing this " nursing " responsibility on to rehab staff when skilled

rehab services intervention is not indicated) ??

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help

physicians

refer appropriate patients in the acute care setting. We are being

bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks

in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

Mike,

Let me clarify. I agree that teaching and educating patients/family is part

of our professional responsibility. My issue is related to continued requests

to treat patients past the initial education phase or that there is no family

to educate so PT is continually asked to continue PROM or perform transfers

with patients that are not training issues but manpower issues (i.e., lift

team).

I do not believe that having a therapist perform PROM or routine transfers is

skilled or provides value to the patient or good stewardship of human

resources. I am a firm believer in the right therapy for the right patient at

the

right time. Otherwise we have what we have know a continual escalation in our

healthcare costs because everyone is " entitled " to have every possible

treatment available. Thanks for your comments

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

Mike,

Let me clarify. I agree that teaching and educating patients/family is part

of our professional responsibility. My issue is related to continued requests

to treat patients past the initial education phase or that there is no family

to educate so PT is continually asked to continue PROM or perform transfers

with patients that are not training issues but manpower issues (i.e., lift

team).

I do not believe that having a therapist perform PROM or routine transfers is

skilled or provides value to the patient or good stewardship of human

resources. I am a firm believer in the right therapy for the right patient at

the

right time. Otherwise we have what we have know a continual escalation in our

healthcare costs because everyone is " entitled " to have every possible

treatment available. Thanks for your comments

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

I have created a LPN Rehab Nurse position. This person is responsible to

carry out rehab (OT/PT/ST) POC after discharge from skilled rehab.

Activities such as ambulation, transfers, feeding set up , ADL set up as

well as administering pain meds prior to PT/OT . Position also has nursing

responsibilities and serves as liaison between teams. Working great and

hoping to expand program.

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help

physicians

refer appropriate patients in the acute care setting. We are being

bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks

in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System

[Guest guest]

I have created a LPN Rehab Nurse position. This person is responsible to

carry out rehab (OT/PT/ST) POC after discharge from skilled rehab.

Activities such as ambulation, transfers, feeding set up , ADL set up as

well as administering pain meds prior to PT/OT . Position also has nursing

responsibilities and serves as liaison between teams. Working great and

hoping to expand program.

Ron Barbato P.T.

Corporate Director , Rehabilitation

Ephraim McDowell Health

Voice (859 )239-1515

Fax (859 )936-7249

rbarbato@...

" PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that

is privileged, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it and

be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is STRICTLY

PROHIBITED. If you received this transmission in error, please immediately

advise me, by reply e-mail, and delete this message and any attachments

without retaining a copy in any form. Thank you. "

Acute Care Referral Guidelines

I am curious if anyone has acute care referral guidelines to help

physicians

refer appropriate patients in the acute care setting. We are being

bogged

down with orders for PROM on patients and simple transfer orders for

patients in

our ICUs. If anyone is willing to share them it would be great. Thanks

in

advance.

Collen Queen, PT, MBA, CHE

Administrative Director

Valley Baptist Health System