heart of florida regional medical center physical, occupational and speech therapy
TRANSCRIPT
HEART OF FLORIDA REGIONAL MEDICAL
CENTER
Physical, Occupational and Speech Therapy
ACUTE THERAPY SERVICES
• Acute phase of patient’s hospital stay.• Focused on the skilled aspect of patient care and
determining discharge disposition.• The key is to use our resources appropriately.• Other: Therapy services are also delivered in rehab
facilities, skilled nursing homes, home health, outpatient etc. Goals depend on the setting.
SKILLED SERVICESServices that require skills of a therapist to perform
• Requires the judgment, knowledge and skills of a licensed therapist/therapist assistant to evaluate and treat patients to improve functional outcomes
• Must meet frequency, duration and treatment standards that are considered reasonable, necessary and effective for the patient’s condition
• Requires predictable improvement in a reasonable timeframe
• Requires ongoing assessments• Requires a physician referral
Inpatient therapy gym
UNSKILLED SERVICESServices that do not require skills of a therapist to perform
• Routine Services – General maintenance feeding, dressing, transferring or
mobilization– Sitting a patient up in a chair or Out of bed orders– Maintenance PROM (Passive Range of Motion)
• Conditions that are transient or easily reversible without professional skills.– UTI, elevated blood sugars
• Patients at baseline level of functioning• Patients unable to demonstrate new learning
Dementia, LOC, combative, disorientation, sedated, unable to follow commands
• Maintenance of skills or preventing decline
SCREENS
• Nursing completes functional screens for each patient: There must be a RECENT CHANGE and REASONABLE EXPECTATION FOR IMPROVEMENT to trigger therapy.
• Speech therapy is indicated if there has been a recent change in communication and swallowing.
• Occupational therapy is indicated if there has been a recent change in strength and movement of the upper body or functional abilities.
• Physical therapy is indicated if there has been a recent change in mobility, functional abilities, strength and movement and a history of falls.
• We can only view record and speak to patient, family and staff during a screen we are not allowed to evaluate.
CONSULTS ARE NOT INDICATED IF:
• Patient is on paralytics• Sedated and unable to follow commands• Unstable vital signs• Unstable medically• Agitated and combative• No diagnosis established• Patient has been immobile and no prognosis for
improvement• Pending test results to rule out acute cardiac or neuro
changes, fractures or DVT• Patient at prior level or baseline level• Simply wanting to get patient OOB.
Skilled Acute OT, PT & ST Patient Care Decision Tree
Is Patient atbaselinelevel of
functioning?
Is Patient athighest level
of functionbased on
anticipateddischarge?
Is Patient’sprognosis forimprovement
fair or greater?
Is Patientable toretain
therapeuticeducation /
intervention?
Is a caregiverable to
follow throughwith therapeutic
intervention /training?
YES
NO
No therapyrecommended
YES YES YES
YES
No therapyrecommended
No therapyrecommended
Provideskilled
therapy
Provideskilled
therapy andContinueeducation
Is Patientmaking significant
functional improvementwith therapy?
YESContinueskilled
intervention
NO
Will Patientdeteriorate
withoutintervention?
NO
YES
Designate maintenance program: Floor ambulation, home program,
ambulation program
Provide education toPatient / caregiver
No therapyrecommended
NONO
Activity Skilled for therapy Unskilled for therapy
Patient Positioning X
Patient positioning for tone reduction X
Development of an exercise program X
Passive range of motion other than post surgery X
Performance of established exercise program for deconditioning X
Bed mobility training X
Getting patient out of bed X
Bed to chair transfer training X
Assisting a patient to the BSC X
Bathing the patient X
Instructing patient/family in use of adaptive equipment (reacher, long shoe horn...) X
Dressing the patient X
Gait training X
walking the pt in the room/hallway X
Instruction on use of assistive device (walker, cane…) X
Feeding patient an established modified diet X
Instructing patient/family on swallowing precautions X
Determination of correct diet level for patient X
Communication training X
Follow through with memory strategies X
General information
• We need new orders when a patient moves to a higher level of care eg. Medical to ICU.
• We do not need new orders when a patient moves to a lesser level of care eg. ICU to PCU.
• We need physician clearance to continue services after certain procedures.
• Patients are placed on hold pending test results to rule out fracture, stroke, DVT etc. or with unstable vital signs and medical condition.
Outaptient Programs
• Sport injury rehab
• Post surgical rehab
• Orthopedic and total joint rehab
Outpatient Programs
• Vestibular rehab
• Mobility and balance programs
• Wheelchair fitting
Outpatient Programs
• Stroke and Neuro rehabilitation
• Back and neck rehabilitation
• Hydrotherapy
Outpatient Programs
• Hand and upper extremity rehab
• Amputee and prosthetic limb training
• Custom orthotics
Patient education is priority
Hands on therapy
Custom Orthotics
Contact usHeart of Florida Therapy Center
40100 HIGHWAY 27, DAVENPORT,FLORIDA 33837
TEL. (863) 419 2500 or 422 4971 FAX (863) 419 2503
WWW.HEARTOFFLORIDA.COM
REFERENCE• Vanessa Sandarusi, MHSA, MBA, Joseph Tod, Lisa Holscher, PT, Anita Marie Greer, SP, Daniel McNulty, OT
(2010), Acute Therapy Practice changes presentation for Miami Valley Hospital Premier health Partners