RE: acute care evaluations

[Guest guest]

In my opinion, therapy goals in acute care should be written in the

context of how long it will take for this person to achieve the goals

needed to achieve Independence/Baseline performance. If you expect the

patient to achieve independence or baseline performance in < 3-5

sessions, call it your LTGs. If the patient appears to need extensive

rehab, the time frame for your goals should reflect just that by setting

STG for 5-7 days and LTGs for 1or 2 weeks. The time frmae in your goals

in the acute care setting is what rehab units need to justify to

insurance companies a patient's need to get rehab.

Arley MS, OTR/L

Operations Manager

Rehabilitation Services

Pennsylvania Hospital

P:

B:

C:

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of ,

Sent: Thursday, August 16, 2007 11:49 AM

To: PTManager

Subject: acute care evaluations

When completing evaluations in acute care, how do your therapists

structure their goals in term of long and short term expectations? With

the LOS being so short, some of our therapists are struggling with

writing short and long term goals that are different from each other

without requiring that the short term goals be revised on a daily basis.

Any suggestions are welcome :-)

Thanks!

Andi MS CCC SLP

Coordinator, Inpatient / Acute Rehab

Floyd Medical Center

Rome GA

[Guest guest]

In our acute care area we set goals; not short term and/or long term.

Since length of stay is so short they are really discharge goals. If the

patient is one of those very complex, involved cases that we know will

be in acute care a while--we set 1 week goals.

We don't set goals for other places in the continuum of care. Our goals

are for our acute setting only. The patient will continue to progress in

SNF, Rehab, OP and/or home health but we don't set those goals.

Bonnie Swafford, PT

Manager of Physical Therapy

University of Kansas Hospital

phone:

>>> " , Arley " 8/16/2007 11:36 AM

>>>

In my opinion, therapy goals in acute care should be written in the

context of how long it will take for this person to achieve the goals

needed to achieve Independence/Baseline performance. If you expect the

patient to achieve independence or baseline performance in < 3-5

sessions, call it your LTGs. If the patient appears to need extensive

rehab, the time frame for your goals should reflect just that by

setting

STG for 5-7 days and LTGs for 1or 2 weeks. The time frmae in your

goals

in the acute care setting is what rehab units need to justify to

insurance companies a patient's need to get rehab.

Arley MS, OTR/L

Operations Manager

Rehabilitation Services

Pennsylvania Hospital

P:

B:

C:

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of ,

Sent: Thursday, August 16, 2007 11:49 AM

To: PTManager

Subject: acute care evaluations

When completing evaluations in acute care, how do your therapists

structure their goals in term of long and short term expectations?

With

the LOS being so short, some of our therapists are struggling with

writing short and long term goals that are different from each other

without requiring that the short term goals be revised on a daily

basis.

Any suggestions are welcome :-)

Thanks!

Andi MS CCC SLP

Coordinator, Inpatient / Acute Rehab

Floyd Medical Center

Rome GA

[Guest guest]

We usually write the time frame of our goals independent of the medical team

because they are concerned only about the time frame to resolve the medical

issues, not the rehab issues. I believe our goals should be written in the

context of the needs of the patient and how long it would take for this patient

to achieve the established LTGs. I don't think we hold the ultimate power to

determine a patient's LOS, therefore we should not place all of our eggs in that

one basket.

The medical team can quickly alter the LOS based on many factors (change in

medical status, placement issues, etc) that may extend the patient's acute care

LOS. All too often at my previous facility, the trauma team extended the LOS

beyond the predicted DC date. In these situations, do you complete a re-eval

since your LTG may have been mod assist for transfers in 3 days anticipating a

transfer to a rehab facility and they may stay for another 4 days to resolve an

illeus, pneumonia, or another acute medical change?

Arley MS, OTR/L

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Snedden

Sent: Thursday, August 16, 2007 2:46 PM

To: PTManager

Subject: RE: acute care evaluations

During some of our recent surveys- it was strongly suggested that we

have both LTG and STG on acute. Even if the STG are written as to be

achieved in 1-2 visits and LTG in 1-2 days. The goals should match the

POC and the POC should be based around the estimated length of time the

pt will be in the facility. If our average LOS is 4 days, we should set

our goals approximately around the average LOS. Why would be set LTG at

7 days when we know the pt won't be in our facility to attain???

Just another thought

" If you're not gonna make your dreams epic, why bother to dream anything

at all. "

M. Snedden, PT, MBA/HCM

Director of Rehab Services & Sleep Lab

p:

f:

christine.snedden@... <mailto:christine.snedden%40hcamidwest.com>

<mailto:christine.snedden@...

<mailto:christine.snedden%40hcamidwest.com> >

________________________________

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf Of Bonnie Swafford

Sent: Thursday, August 16, 2007 1:16 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: RE: acute care evaluations

In our acute care area we set goals; not short term and/or long term.

Since length of stay is so short they are really discharge goals. If the

patient is one of those very complex, involved cases that we know will

be in acute care a while--we set 1 week goals.

We don't set goals for other places in the continuum of care. Our goals

are for our acute setting only. The patient will continue to progress in

SNF, Rehab, OP and/or home health but we don't set those goals.

Bonnie Swafford, PT

Manager of Physical Therapy

University of Kansas Hospital

phone:

>>> " , Arley " <Arley.@...

<mailto:Arley.%40uphs.upenn.edu>

<mailto:Arley.%40uphs.upenn.edu> > 8/16/2007 11:36 AM

>>>

In my opinion, therapy goals in acute care should be written in the

context of how long it will take for this person to achieve the goals

needed to achieve Independence/Baseline performance. If you expect the

patient to achieve independence or baseline performance in < 3-5

sessions, call it your LTGs. If the patient appears to need extensive

rehab, the time frame for your goals should reflect just that by

setting

STG for 5-7 days and LTGs for 1or 2 weeks. The time frmae in your

goals

in the acute care setting is what rehab units need to justify to

insurance companies a patient's need to get rehab.

Arley MS, OTR/L

Operations Manager

Rehabilitation Services

Pennsylvania Hospital

P:

B:

C:

________________________________

From: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com> ]

On

Behalf Of ,

Sent: Thursday, August 16, 2007 11:49 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

<mailto:PTManager%40yahoogroups.com>

Subject: acute care evaluations

When completing evaluations in acute care, how do your therapists

structure their goals in term of long and short term expectations?

With

the LOS being so short, some of our therapists are struggling with

writing short and long term goals that are different from each other

without requiring that the short term goals be revised on a daily

basis.

Any suggestions are welcome :-)

Thanks!

Andi MS CCC SLP

Coordinator, Inpatient / Acute Rehab

Floyd Medical Center

Rome GA

[Guest guest]

Regarding this: " During some of our recent surveys- it was strongly suggested

that we

have both LTG and STG on acute. Even if the STG are written as to be

achieved in 1-2 visits and LTG in 1-2 days. "

In the world of bureaucratic review and control, there are times when the

commonest of common sense is lost. Above is a clear example.

Long term means just that: Long term. We're talking standard English here---even

the Joint Commission must defer to that! To redefine the meaning of " long "

because somebody discovered that there's no time for " long " in a short-term

hospital stay, is really nonsense. To allow that sort of thing to take hold is

dangerous. It's not in the best interests of patients or clinicians, and it

feeds an already morbidly obese bureaucracy that's growing ever more comfortable

forcing individuals into group slots.

Apparently somebody gave a hapless reviewer an inch, and well... it's all

downhill from there. Such " suggestions " (which can be fairly translated into:

" This is my idea; it is not an official standard. " ) must be challenged,

forcefully if necessary, to prevent them from taking hold both particularly and

in theme.

" A strong conviction that something must be done is the parent of many bad

measures. " Webster

Dave Milano, PT, Director of Rehab Services

Laurel Health System

acute care evaluations

When completing evaluations in acute care, how do your therapists

structure their goals in term of long and short term expectations?

With

the LOS being so short, some of our therapists are struggling with

writing short and long term goals that are different from each other

without requiring that the short term goals be revised on a daily

basis.

Any suggestions are welcome :-)

Thanks!

Andi MS CCC SLP

Coordinator, Inpatient / Acute Rehab

Floyd Medical Center

Rome GA