Discharge Planning in Acute Care - HELP!!!

[Radean1]

Hello to all. I recently graduated, and went straight into travelling PT. I currently work in Acute Care, in Level One Trauma center, and I enjoy all aspects of it except for discharge planning. Do I recommend Home PT, Sub-Acute rehab or Acute rehab?

A good Samaritan in me, tells me that a higher level of care will always be more beneficial for the patient, therefore always go for acute or sub-acute, because the more rehab the patient gets, the better for them. However, I feel that this logic may be irresponsible in regard to patients' insurances, and some of them could actually have gone home.

If you work in acute care, please help me resolve this conflict!
What are your guidelines for sending someone home vs Rehab?

Much appreciated!

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[Fiveoboy11]

I work in acute care at two hospitals

If you're really a PT you need to shadow a PT or many of them where you work and ask lots of questions. Do co Evals with OT's when you can.

It's complex and involves numerous factors so don't try to dumb it down by always going with a higher level of care or by using a guideline (if one exists) that was made based upon (at best) "expert" opinion. The rec should be based on your evaluation and what you think, not someone else's and what they think.

 

[brooklynyc]

I'm doing an acute affil right now and I'm really enjoying it. PTs have a huge role in patient discharge.

I think discharge planning is one of the best parts as it requires understanding so many different things.

What's their functional status? Can the handle the 3 hours? Or would the patient best served best with shorter treatment sessions spread out over a period of time?

What does the patient want? What does the family want? If the patients want to come home and you can safely discharge them with home PT, I think it's reasonable to do so.

Insurance considerations are obviously important, as acute rehab is the most expensive rehabilitation available as it requires a tremendous amount of resources (dedicated team of PT OT SLP MD etc.). Major trauma, amputations, TBI, stroke, Parkinson's are some of the things that qualify for acute rehab for medicaid. It is irresponsible to waste all these resources on patients who can derive the same benefit from home PT.

Home PT vs acute rehab is a big difference.