1. HEART OF FLORIDA REGIONAL MEDICAL CENTER Physical, Occupational and Speech Therapy

2. ACUTE THERAPY SERVICES Acute phase of patient’s hospital stay. Focused on the skilled aspect of patient care and determining discharge disposition. The key is to use our resources appropriately. Other: Therapy services are also delivered in rehab facilities, skilled nursing homes, home health, outpatient etc. Goals depend on the setting.

3. SKILLED SERVICES Services that require skills of a therapist to perform Requires the judgment, knowledge and skills of a licensed therapist/therapist assistant to evaluate and treat patients to improve functional outcomes Must meet frequency, duration and treatment standards that are considered reasonable, necessary and effective for the patient’s condition Requires predictable improvement in a reasonable timeframe Requires ongoing assessments Requires a physician referral

4. Inpatient therapy gym

5. UNSKILLED SERVICES Services that do not require skills of a therapist to perform Routine Services –General maintenance feeding, dressing, transferring or mobilization –Sitting a patient up in a chair or Out of bed orders –Maintenance PROM (Passive Range of Motion) Conditions that are transient or easily reversible without professional skills. –UTI, elevated blood sugars Patients at baseline level of functioning Patients unable to demonstrate new learning Dementia, LOC, combative, disorientation, sedated, unable to follow commands Maintenance of skills or preventing decline

7. SCREENS Nursing completes functional screens for each patient: There must be a RECENT CHANGE and REASONABLE EXPECTATION FOR IMPROVEMENT to trigger therapy. Speech therapy is indicated if there has been a recent change in communication and swallowing. Occupational therapy is indicated if there has been a recent change in strength and movement of the upper body or functional abilities. Physical therapy is indicated if there has been a recent change in mobility, functional abilities, strength and movement and a history of falls. We can only view record and speak to patient, family and staff during a screen we are not allowed to evaluate.

8. CONSULTS ARE NOT INDICATED IF: Patient is on paralytics Sedated and unable to follow commands Unstable vital signs Unstable medically Agitated and combative No diagnosis established Patient has been immobile and no prognosis for improvement Pending test results to rule out acute cardiac or neuro changes, fractures or DVT Patient at prior level or baseline level Simply wanting to get patient OOB.

9. Skilled Acute OT, PT & ST Patient Care Decision Tree Is Patient at baseline level of functioning? Is Patient at highest level of function based on anticipated discharge? Is Patient’s prognosis for improvement fair or greater? Is Patient able to retain therapeutic education / intervention? Is a caregiver able to follow through with therapeutic intervention / training? YES NO No therapy recommended YES No therapy recommended No therapy recommended Provide skilled therapy Provide skilled therapy and Continue education Is Patient making significant functional improvement with therapy? YES Continue skilled intervention NO Will Patient deteriorate without intervention? NO YES Designate maintenance program: Floor ambulation, home program, ambulation program Provide education to Patient / caregiver No therapy recommended NO

10. ActivitySkilled for therapy Unskilled for therapy Patient Positioning X Patient positioning for tone reductionX Development of an exercise programX Passive range of motion other than post surgery X Performance of established exercise program for deconditioning X Bed mobility trainingX Getting patient out of bed X Bed to chair transfer training X Assisting a patient to the BSC X Bathing the patient X Instructing patient/family in use of adaptive equipment (reacher, long shoe horn...)X Dressing the patient X Gait training X walking the pt in the room/hallway X Instruction on use of assistive device (walker, cane…)X Feeding patient an established modified diet X Instructing patient/family on swallowing precautionsX Determination of correct diet level for patientX Communication trainingX Follow through with memory strategies X

11. General information We need new orders when a patient moves to a higher level of care eg. Medical to ICU. We do not need new orders when a patient moves to a lesser level of care eg. ICU to PCU. We need physician clearance to continue services after certain procedures. Patients are placed on hold pending test results to rule out fracture, stroke, DVT etc. or with unstable vital signs and medical condition.

12. Outaptient Programs Sport injury rehab Post surgical rehab Orthopedic and total joint rehab

14. Outpatient Programs Vestibular rehab Mobility and balance programs Wheelchair fitting

15. Outpatient Programs Stroke and Neuro rehabilitation Back and neck rehabilitation Hydrotherapy

16. Outpatient Programs Hand and upper extremity rehab Amputee and prosthetic limb training Custom orthotics

17. Patient education is priority

18. Hands on therapy

20. Custom Orthotics

21. Contact us Heart of Florida Therapy Center 40100 HIGHWAY 27, DAVENPORT,FLORIDA 33837 TEL. (863) 419 2500 or 422 4971 FAX (863) 419 2503 WWW.HEARTOFFLORIDA.COM

22. REFERENCE Vanessa Sandarusi, MHSA, MBA, Joseph Tod, Lisa Holscher, PT, Anita Marie Greer, SP, Daniel McNulty, OT (2010), Acute Therapy Practice changes presentation for Miami Valley Hospital Premier health Partners