I am not asking anyone to do my homework or anything but my IM attending asked me to look up some literature on medical goals that need to be met before tranfer to a rehab facility (inpatient, subacute, SNF.) Any books or articles someone can recommend?
Clinical Question: What makes a good rehab candidate?
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With the new 75/25 rule....
as long as PMR docs stay passive to passive aggrsive and have to meet the administrator's financial goals.
A heartbeat is essential.
Proposed criteria to allow admission are at the mercy of administrators and not attendings.
I have seen GCS 7 patients come to rehab. I have seen patients with sats in the low 80's, Tep >102.5, and acute PE transferred to rehab. I have seen cancer patients in the hospital for CTX and XRT come to rehab to manage the side effects of their therapy. I have seen babies and toddlers admitted to an inpatient rehab feeding program for oral aversion. (I hated this while a resident- but probably wound up being rewarding for the child, the peds rehab dept, and overall cost effective from a global healthcare standpoint.)
Anyone can come to rehab. As long as there is a heartbeat...
as long as PMR docs stay passive to passive aggrsive and have to meet the administrator's financial goals.
A heartbeat is essential.
Proposed criteria to allow admission are at the mercy of administrators and not attendings.
I have seen GCS 7 patients come to rehab. I have seen patients with sats in the low 80's, Tep >102.5, and acute PE transferred to rehab. I have seen cancer patients in the hospital for CTX and XRT come to rehab to manage the side effects of their therapy. I have seen babies and toddlers admitted to an inpatient rehab feeding program for oral aversion. (I hated this while a resident- but probably wound up being rewarding for the child, the peds rehab dept, and overall cost effective from a global healthcare standpoint.)
Anyone can come to rehab. As long as there is a heartbeat...
So are you familiar with administrative guidelines for transfer? I guess he wants to know what he needs to do to get the patient out of his unit. Some background: pt is 89 yo male previously healthy who presented with SOB secondary to bacterial PNA currently intubated now with generalized motor weakness attributed to deconditioning and possible cervical stenosis.
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YMMV- your mileage may vary.
Where I trained- not with a 10' pole.
On a limb- SNF- his potential for a rapid recovery to make the PPS numbers work out for deconditioning means he'd lose the unit money. Also depends on number of beds/number of empty beds on your rehab.
When he weans off the vent- he'll need PT/OT consult to see what his FIM is. Also- investigate the possibility of a critical illness neuropathy/myopathy/ See the archives study guides for a review article (2-3 years ago). Cervical stenosis is a chronic condition and unless he had weakness coming in with rapid progression, this is not a factor currently.
Has he been getting DVT prophylaxis with a LMWH? Check US doppler for DVT- he has them is more likely than he doesn't. They always do.
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Fozzy,
Here's the link and pdf that will answer your question: Standards for Assessing Medical Appropriateness Criteria for Admitting Patients to Rehabilitation Hospitals or Units.
http://www.aapmr.org/hpl/legislation/mirc.htm
Unfortunately, the state of the science is low. Predicting functional recovery is largely a crapshoot. So, asking "what makes a good rehab candidate?" is sort of like asking, "what makes a good omelette?"
In general, a patient has to 1) Have functional goals; 2) Be able to participate in an AVERAGE 3 hours of therapy per day over the their length of stay; 3) Require medical supervision; 4) Not be bettered served at a lower level of care.
Okay, let's pick these a part for a little fun...
1) Have functional goals -- Hell, I've got functional goals! Should I be admitted to rehab unit?? Functional goals can fall on a theoretical spectrum ranging from "independent tissue perfusion" to "bench press 240lbs 8 times."
2) Participate in average of 3 hours per therapy -- This is not really a rule per se, but is often thrown around. The problem is **HOW** you count an hour of therapy. If it takes you an hour to sit up to the edge of the bed and tie your shoes is that an hour of therapy well spent?? Your therapists will revolt if you bring patients to rehab who require an hour to do even the simplest of tasks.
3) Require medical supervision -- Okay, so this what I used to tell patients when "it was time to leave." They didn't require a specialist rehab doctor looking after them any more...Nothing makes a little old lady break down and cry more than the dreaded "NH" words ie "Nursing Home." So, after their INR was therapeutic and I tweaked their meds in whatever direction they needed to be tweaked, their requirements for "medical supervision" were really quite low and it was time to go...
4) Not better served at a lower level of care -- Well, again, a subjective call. There are some SNF's with good rehab services and motivated therapists. The food might be better. Maybe the rehab dog is nicer. Who knows...
The point is that some times patients are "too good to come to rehab." They still need services, but those pesky 72 hour admits to acute rehab kind of make auditors a little suspicious and really piss off the housestaff.
Alternatively, maybe they have functional goals, but it will take a long, long time to reach them. The LOS in rehab units is plummetting. In some parts of the country it's down to about 14 days per admission. There are many things you can do in 14 days, but you can't "unboil an egg."
So, there you go: Knock yourself out.
Here's the link and pdf that will answer your question: Standards for Assessing Medical Appropriateness Criteria for Admitting Patients to Rehabilitation Hospitals or Units.
http://www.aapmr.org/hpl/legislation/mirc.htm
Unfortunately, the state of the science is low. Predicting functional recovery is largely a crapshoot. So, asking "what makes a good rehab candidate?" is sort of like asking, "what makes a good omelette?"
In general, a patient has to 1) Have functional goals; 2) Be able to participate in an AVERAGE 3 hours of therapy per day over the their length of stay; 3) Require medical supervision; 4) Not be bettered served at a lower level of care.
Okay, let's pick these a part for a little fun...
1) Have functional goals -- Hell, I've got functional goals! Should I be admitted to rehab unit?? Functional goals can fall on a theoretical spectrum ranging from "independent tissue perfusion" to "bench press 240lbs 8 times."
2) Participate in average of 3 hours per therapy -- This is not really a rule per se, but is often thrown around. The problem is **HOW** you count an hour of therapy. If it takes you an hour to sit up to the edge of the bed and tie your shoes is that an hour of therapy well spent?? Your therapists will revolt if you bring patients to rehab who require an hour to do even the simplest of tasks.
3) Require medical supervision -- Okay, so this what I used to tell patients when "it was time to leave." They didn't require a specialist rehab doctor looking after them any more...Nothing makes a little old lady break down and cry more than the dreaded "NH" words ie "Nursing Home." So, after their INR was therapeutic and I tweaked their meds in whatever direction they needed to be tweaked, their requirements for "medical supervision" were really quite low and it was time to go...
4) Not better served at a lower level of care -- Well, again, a subjective call. There are some SNF's with good rehab services and motivated therapists. The food might be better. Maybe the rehab dog is nicer. Who knows...
The point is that some times patients are "too good to come to rehab." They still need services, but those pesky 72 hour admits to acute rehab kind of make auditors a little suspicious and really piss off the housestaff.
Alternatively, maybe they have functional goals, but it will take a long, long time to reach them. The LOS in rehab units is plummetting. In some parts of the country it's down to about 14 days per admission. There are many things you can do in 14 days, but you can't "unboil an egg."
So, there you go: Knock yourself out.
