What Is a Rehab Screen and How Often Should Your Team Be Doing Them?
The purpose of a rehab screen is to determine if a therapy evaluation is warranted. The therapy screen should determine if the patient has a decline in function that puts the patient at risk of further decline or injury, such as falls or decubitus ulcers. It may also determine that the patient is exhibiting potential to improve, which they may not have previously exhibited.
Typically described as a “hands off” procedure, the therapy screen often begins with a review of the medical record and should include communication with the patient, the patient’s caregivers, and/or even the patient’s family. It may also include observing the patient performing daily activities that the caregiver identified as declining.
A screen does not require a physician order, but can be initiated by a therapy or nursing team member. An order written by the medical doctor (MD), nurse practitioner (NP), or physician assistant (PA) as a “therapy consult” is treated as a screen. If after completing the screen the therapist determines that therapy is indeed indicated, then they request an MD order for a physical therapist (PT), occupational therapist (OT), and/or speech-language pathologist (SLP) to “evaluate and treat as indicated”.
The hope is that by screening patients on a regular basis, we can catch issues before they turn into a more serious event. For example: determining that a patient has a new onset of weakness or decline in balance before they have a fall, determining the patient has a decrease in range of motion (ROM) before it becomes an irreversible contracture, or in the case of speech therapy, determining that a patient has a new swallowing problem before the patient suffers from an aspiration event or pneumonia.
During a routine screen, a PT may determine that a patient needs an OT or SLP eval, or during a speech therapy screen, the therapist may find that the patient needs an OT eval. That’s fine too. The important thing is that a skilled rehabilitation professional is putting eyes on the patient to determine their needs before they suffer an unwanted event. Conversely, a therapy screen may indicate that the patient now has potential to improve that they previously did not have. For example, imagine a patient who was discharged from therapy after being treated for a new onset of cerebrovascular accident (CVA) due to a lack of progress secondary to an inability to participate in the plan of care. Six months later, the patient is exhibiting improvement in cognition and ability to participate in a plan of care, which demonstrates an increased potential for rehab. In this case the therapist would request a new order for therapy evaluation due to the patient’s improvement, not a decline.
So how often should screens be performed? While there is no hard and fast rule, it is often customary for therapy to screen each resident of a SNF community on a quarterly basis. This usually allows therapy to find issues before they become insurmountable problems. Using an MDS calendar to track quarterly assessments (usually in conjunction with the OBRA quarterly MDS schedule) is often helpful and doesn’t require reinventing the wheel. An additional benefit is that when the patient is determined to need skilled therapy, the therapy can be included on the MDS quarterly assessment. In case-mix states, this helps ensure that reimbursement is equivalent to the level of care that we are providing.
What other ways are patients identified for screens? Some examples include: when a certified nursing assistant (CNA) reports to their supervising nurse that a patient is exhibiting a new decline in performance, when a patient has a fall or a near fall, when a patient has experienced weight loss or difficulty maintaining their positioning in their chair, or when a patient has a new complaint of pain or increased pain. It is a time for a screen anytime a change in condition warrants the skills of a therapist to assess the patient’s need.
Ultimately the desired goal is for us to maintain the highest level of independence and quality of life for our residents, and performing regular therapy screens is an integral part of that process.
Written by: Elizabeth Johnson, PT, CDP, RAC-CT
