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Identifying the Right Referral for Your Patients

Published On 3.4.21

By Caitlyn Rose, MOT, OTR/L

Occupational Therapist

Who else gets to do what we [do]? To contribute in the most intimate way to other people’s lives…to be trusted with their single most valuable possession, their health (Performance of Medicine p 166, 2018).

Being a health care provider can be exhausting. We are all learning to quickly adapt to significant changes in our daily work lives. One of which is the shift from a fee-for-service model to a more patient-driven model. What was once an intimate experience with our patients has become nearly all about the business of customer satisfaction.

At the end of the day, we all know why we keep coming back to work. We are here to contribute to other people’s health and wellbeing. What better way to remove some of the business burdens than by supporting each other and working as a team to improve our work-life balance and our patient’s quality of life.

By referring your patient to FOX we can create a customized plan of care for each patient, with each referral. For those of your patients who cannot get to an outpatient clinic, we can provide their outpatient therapy needs right in the patient’s home, or assisted living facility. For those of your patients who still need more support after homecare discharges, we can provide additional support.

Which Patients Make Good Candidates for Rehab Referrals?

Patients who need assistance to get to your office such as those accompanied by a caregiver, physical assistance or verbal cueing for safety, use of DME, bumping into walls, shuffling gait, need rest breaks, are still breathing heavily at rest, is in a wheelchair but would normally walk. These are red flags for physical/occupational therapy referral.

Ask your patient questions such as, who helped you get ready this morning? Who helped you get here to your appointment today? These are red flags for an occupational therapy referral.

Look at any paperwork filled out by the patient/caregiver. Is the handwriting the patient’s? If not, why? If so, how legible is it? These are red flags for an occupational therapy referral.

Can your patient express themselves well? Can your patient hold or follow a conversation? Does your patient have any difficulty swallowing their pills? Have you observed your patient drooling? These are red flags for a speech-language-pathologist referral.

Did your patient screen for depression and/or complain of loss of independence/dignity? Does your patient require more assistance than in previous visits? Has your patient experienced any change in life roles, such as retirement, caregiver for a sick loved one, experienced any losses? These are red flags for an occupational therapy/speech-language-pathologist referral.

Has your patient experienced any recent falls, weight loss/gain? Is your patient compliant with medications? Does your patient complain of chronic pain, or ask for more pain medication? Has your patient been coming into the office more regularly? Has your patient been asking for more/new referrals? Is your patient’s posture worsening? Is your patient complaining of fatigue, weakness, decreased appetite, increased sleeping? Is your patient moving/walking slower? These are red flags for a physical/occupational/speech-language-pathologist referral.

Patients preparing for surgery, recovery post-surgery. These are red flags for a physical/occupational/speech-language-pathologist referral.

Patients who were recently hospitalized, admitted to an inpatient facility, referred to homecare – what is the transition plan? These are red flags for a physical/occupational/speech-language-pathologist referral.

Does your patient have any new diagnoses or are struggling to manage any chronic diseases such as CHF, COPD, HTN, HBP, neurological diagnoses, orthotic conditions, arthritis, chronic pain, CAD, high cholesterol, DM, obesity. These are red flags for a physical/occupational/speech-language pathologist referral.

Ask your patient how active they have been. Ask your patient what kind of hobbies/activities do they do regularly? How much exercise are they getting during the week? Are they using any resistance to exercise? These are red flags for physical/occupational therapy referral.

What about those patients you have not heard from in a while? When was the last time you followed up?

Keep the caregiver in mind, too. If the caregiver is looking burned out, rehab may be able to provide some support! These are red flags for a physical/occupational/speech-language pathologist referral.

How Do I Know Which Discipline To Refer?

Our website is a great resource.

How to Prevent Patient Falls

Physical and occupational therapy can reduce patient fall risk and reduce hospitalizations through disease management, vitals management, medication management, weight management, and pain management.

If your patient needs vitals management, pain management, has a cognitive disorder, has a fear of falling, has a history of falling, performs a TUG in 12 or more seconds (see below for reference), or scores 4 or more on the MAHC 10 (see below for reference).

Consider having your patient or caregiver fill out the MAHC-10 while waiting for their visit to begin:

How Can I Do That?

Refer us! FOX can cover your patient’s physical/occupational/speech-language-pathology needs. Here’s a PDF for quick referrals.

How Can Physicians Support The Transition To FOX And Help Us All Manage Patient Expectations?

Please have an in-person conversation (if you can) to directly discuss the referral to FOX, including which specialty/specialties you are referring, and why. Not everyone is aware of the various disciplines of rehab or understands what skills are provided by each discipline. By introducing the recommendation to rehabilitation you will be facilitating a smooth transition, and we thank you!

Please be sure to make clear that rehab is a commitment to support a lifestyle change. Each discipline has the autonomy to create an appropriate plan of care and schedule with the patient and caregiver/family directly. We work as a team, but we are responsible for only our own specialty area. Refer with purpose. Each discipline should be referred to by your practice for a reason. We are not interchangeable and we do not support redundant services between disciplines. However, we do work to support each other’s goals and interventions. We may incorporate pieces of each other’s plans to facilitate carryover of each discipline’s education and training for your patient’s best outcome.

Also, sometimes we are a little backed up! If you have a more anxious patient, perhaps call us ahead of the referral and ensure we can see the patient soon or can provide an estimated start date. We strive to be transparent, please help us.

One last thing before you submit that referral, please make sure your patient/caregiver understands the reason for the referral and is agreeable to the referral. If the recommendation is not reasonable to the patient/caregiver, we cannot expect a positive experience or therapeutic outcome.

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