5 rules of the rehab screen
Shelly Mesure, MS, OTR/L
What is the purpose of a rehabilitation screen? Very simply, we attempt to identify long-term residents' needs and possible rehab potential. If there are no needs or rehab potential, we simply write out a screen only, but if we determine the opposite, we request the orders and initiate the evaluation process.
Our industry standard usually sounds like this, “hands-off, 15 minutes or less, etc.” Sound familiar? While that may be ideal, we don't really have an industry standard on what should take place during a screen. So, I thought this blog would be a great opportunity to explore the various interpretations of screening residents.
The problem with the screening process is that your skill sets as a clinician are completely dependent with on-the-job training. This is not something we learn in therapy school, and if we don't have good mentors, we're left on our own to figure out the best practices. So, let me share my thoughts on performing a good screen.
1. A screen is NOT an evaluation. The screen is meant to determine if an evaluation is required
2. An evaluation is NOT a guarantee of establishing goals and a plan of care. Many times we need to perform evaluative services to determine if further rehab potential can be established, or the current needs/goals of the resident may be accomplished with only the single “eval and treat” visit.
3. Hands off, hands on — does it really matter? It should be rephrased to, “Are you using clinical reasoning skills to determine if the patient is not at their prior level of function or is demonstrating potential for rehab goals?”
4. If you are using clinical reasoning skills, what is the difference between your thoughts during this screen vs. what you would do during an evaluation?
5. Clinical reasoning skills are thoughts that require the trained skilled licensed healthcare professional; so if your thoughts would be the same as anybody else, it's not skilled or rehab-based. For example, “That patient needs leg rests on their wheelchair” – you, nursing, the roommate, etc. can all have the same conclusion. However, if you expand on this thought into developing a completely different seating and positioning program, you've demonstrated medical necessity of rehab services to initiate the evaluation and begin the plan of care.
Sometimes a resident is screened but you determine another therapy is more appropriate. That's perfect, and it now takes on the description of “inter-disciplinary screens.”
A screen does NOT require a physician order, but on occasion a physician may request “PT/OT referral” — this is not an evaluation order but should be followed up with a screen. The other benefit to completing the screen is the use of the document to provide the evaluation with supportive documentation. If you are screening a resident and determine the need for an evaluation, I highly recommend continuing to complete the screening forms. This will provide additional supportive documentation on the evaluation findings and help to strengthen the claim and your clinical reasoning skills.
At the end of the day, it doesn't matter if the screen is based on a clinical referral, quarterly or annual review, or any other reason. All screens should be treated the same, and used as the reason to justify or not justify the need to evaluate.
Shelly Mesure ("measure"), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.