Acute Inpatient Rehab Therapy Criteria

Kettering Health Network Inpatient Rehab Therapy Criteria for Evaluation and Treatment of Suspected or Confirmed COVID-19 Patients

  • Efforts should be made to limit all non-essential staff interactions with suspected or confirmed COVID-19 patients especially during the most contagious period of the virus, this would include ancillary staff such PT/OT/SLP, unless the following criteria occur:
    • All orders received on patients on COVID19 designated units are to be reviewed for appropriateness by designated Rehab Medicine Leader(s).
    • Reviewing leaders will review order, patient chart, and speak to the healthcare team to confirm appropriateness of order as well as patient’s current functional status.
    • If additional information is needed – the patient or their family can be contacted remotely to determine patient’s premorbid functional status and use of any assistive devices.
    • Every attempt will be made to manage a patient’s functional status and safety remotely by providing mobility and self-care instruction to the healthcare team. 
    • If a patient is at risk for developing complications or long-term deficits if therapy is held then the leader will instruct the designated COVID19 unit therapist that they are to see the patient.
    • The therapist will verify the precaution status and follow all PPE procedures.
    • Remote vs direct consultation should be considered where feasible in collaboration with the healthcare team.
  • Proactively… therapy/nursing should ensure the following:
    • Nursing is Competent in SAFE Handling techniques and trained in the necessary equipment such as: Maxi Move *(PT/OT can provide training if requested).
    • Unit is equipped with appropriate DME designated to this unit: Walkers, BSC, Drop Arm BSC.
    • Nursing will be trained and provided handouts of home exercise programs such as:
      • Benefits of Early Mobilization (EMOB)
      • Passive Range of Motion
  • Dysphagia Services (SLP):
    • Nursing swallow screen should be performed to determine need for dysphagia services.
    • Once the patient is deemed appropriate for PO intake and after the patient has failed a Nursing Swallow Screen.
    • No videostroboscopy or Functional Endoscopic Evaluation of Swallowing (FEES) procedures will be performed on suspected or confirmed COVID-19 patients.
    • For videofluoroscopy procedures SLP will coordinate with medical team/radiology to transport adhering to appropriate PPE and precautions.
  • OT/PT:
    • Physician referral/order in extreme cases when EMOB cannot be adequately/safely provided through nursing with the appropriate SAFE handling equipment.
    • Patients requiring therapy input to facilitate discharge planning. 
    • Patients that require therapy intervention to prevent long-term or permanent dysfunction.

Logistical Considerations:

  • One discipline (PT or OT) will be the gatekeeper for the other; initial therapist will evaluate patient and assess need for additional services. This will help limit staff exposure when no other skilled disciplines are required.
  • We will designate one PT/OT/SLP per day to treat suspected or confirmed COVID-19 patients; these staff members will follow appropriate PPE guidelines when entering the unit and patient rooms.
  • Staff will use the appropriate PPE per the guidelines.
  • If referrals are low, will encourage therapy staff to hold on evaluation/treatment until the end of their shift. This will allow for efficient utilization of staff to eval/treat other patients that are on therapy caseload not located on this designated unit.

It is unclear currently if these patients that were under investigation will be moved to another unit should they test negative for COVID-19 or move beyond the 14-day contagious period.

If patients are moved to another unit, therapy evaluation/treatment should resume as normal.

March 23, 2020

March 25, 2020