Page 47 - Rehab 2020

Determining the appropriate frequency and duration of treatment is a decision reached by the therapist in
collaboration with the patient/family and the physician. Emphasis can be placed on maximizing
treatment in the firsts few weeks and tapering down closer to discharge; for example, seeing a patient
3x/week for the first 2 weeks and then decreasing to 2x/week for the next two weeks addressing needs
early on the treatment.

Some post-op patients may be part of the Intensive Rehab Program wherein patients are discharged home
instead of being transferred to a rehab facility. The referring physician may request up to 7x/week of PT
for one to two weeks before starting out-patient therapy. The request for up to 7x/week is usually
documented in the medical records or discussed directly with the physician.

The duration of therapy is based on the therapist’s estimate of how many weeks it will take for the
patient/caregiver to achieve the goals. The therapist should continually evaluate the progress in order to
decide if there is still a need for skilled care. Once the patient reaches the point where they no longer need
the skilled services of the therapist (the patient has achieved the therapy goals, the need is no longer
skilled, is no longer homebound, or has reached a plateau in function) the treatment must be
discontinued.

After the therapist has decided the appropriate frequency and duration and confirmed it with the
physician, the next step is to reflect it in the NEW ORDERS section. Keep in mind that these are the
legal orders for treatment that will be signed by the physician. So, if the orders for Physical Therapy read
th
3x/week for 4 weeks, the P.T. would not be legally covered if they saw the patient for a 4 visit during the
th
week or for a visit on the 5 week. This means that the therapist must be aware of what the orders read
and keep track of how often and for how long they are visiting the patient. The frequency and duration
must match the verbal order received from the MD.

*Care Week*

The Care Week is the week wherein services are rendered to the patient and is the basis for the frequency
of care. The care week is fixed from Sunday to Saturday, i.e. if the orders are for 3x/wk., then the
clinician must make 3 visits from Sunday to Saturday.

CLINICAL PATHWAYS

Clinical Pathways are care delivery “road maps” which are goal-directed and evidence based with patient
independence as the primary goal. Clinical Pathways improve teamwork, supports defined standards of
care, optimizes resources, and standardizes the quality of care delivered to VNSNY patients. The Clinical
Pathways for Rehab are classified into 5 major categories, based on patient diagnosis:

- Total Joint/Hip Fracture

- Spine
- Cardiac
- Neurological
- General Medical

For each Clinical Pathway, a recommended number of visits per discipline is indicated, phases of
treatment with corresponding goals for each phase, and recommended interventions. Also included are
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