Intern Encyclopedia
Workflow for discharging a patient
See Rehab slides in Orientation 2023-24 powerpoint.
Generally speaking, every patient needs clearance to safely go home from PT / OT after surgery. Exceptions are when patient is extremely well-appearing and attending simply doesn't care.
Steps to sending someone home
1. PT / OT Consult ("comprehensive rehab services)
- Should happen on POD1
- Order as "discharge today" to force PT and OT to see them, but don't abuse this.
| Verbage in PT / OT Form | Interpretation |
| N | Home |
| intermediate | SNF |
| comprehensive / intensive | IPR |
Jump to step 3 if SNF or Home.
2. PMR Consult
- generally speaking you only place PMR consult when PT / OT recommends it.
- However some people get an "early PMR consult" when they will clearly need rehab e.g. TBI who will definitely need BIM. Many DOO patients will fit this category.
- Trauma Rehab rounds are when we fight for borderline patients to go to rehab.
NOTES FOR ACCELERATING DISPO TO REHAB:
- Make sure trach is cuffless (see below for how to check)
- Turn off labs if not needed, you're looking for trouble.
- Take patients off IVF and IV pain meds ASAP.
- Document medically ready for discharge in your A & P.
- Generally speaking PMR will require PT / OT recs within 72 hrs of discharge.
- If someone has a white count and are taking steroids, just document it's likely from steroids
- Can always give fluid bolus to dilute a CBC if no clinical concern.
3. Case Management
Home with assistance (HHPT / HHOT):
- Order Home care ASAP
- Ask care manager to order durable medical equipment.
- See discharge instructions (TBA)
Home with outpatient PT / OT
- See discharge instructions (TBA)
Home without assistance:
- just send them home
How to intubate people for an MRI
- Coordinate this with charge anesthesiologisy 412-647-4441 and Presby MRI (# in phone book)
How to stand a patient for an Xray
This is ok to do as long as there is no unstable spine on CT / MRI. As long as you can push the patient through the pain, load them up with some dilaudid right before. Often this will be the difference between operative / conservative management.