Their Own Twist
From what his occupational therapists tell him, Vijay Rajput, MD, FACP, senior hospitalist at Cooper University Hospital in Camden, N.J., concurs. “If the patient has been in a nursing home for 10 years and is completely custodial and bed-bound, when that patient comes to the hospital and a hospitalist has ordered an occupational therapy consult … , the occupational therapist then has to assess it, and there are no [achievable] goals of care in terms of occupational therapy, then the therapists think that is a [poor use of their] time.”
In that case, however, the family may benefit from a home visit that will provide maintenance or training.
When Quinney receives what she believes is an inappropriate referral from a hospitalist or other provider, she encourages her therapists to say that back to the hospitalist in a direct, to-the-point communication. Therapists are encouraged to say, “This is what I saw with patient X. I’m not seeing any skilled therapy needs. Is there something else I’m missing?”
“We always give [the provider] the benefit of the doubt of having done an assessment in their mind,” explains Quinney.
How consults are written: Quinney’s team has discussed whether to ask hospitalists to be specific about what they are referring for, so “we as therapists are able to affect the whole person. Because if they only give a referral for a specific task, then it makes it more limiting,” she explains. “If they write a referral for ‘functional ability’ or [one] that says ‘concerned with balance,’ that [allows us] to do some problem-solving.”
Tiffani Morales, LOTR, the occupational therapy team leader at Our Lady of Lourdes Regional Medical Center in Lafayette, La., agrees. “We’ve only had hospitalists for about a year, and the three that we have are really doing a good job, [including the way in which] they’re writing their consults,” says Morales. “They’re leaving it open and trusting us to make recommendations, and they’re going along with them.”
Because hospitalists write the chart note as “Consult,” occupational therapy “gives us leeway to make any equipment recommendations or, actually, any of the treatments that may be warranted versus having to call them back, which takes time to keep giving an order over the phone,” explains Morales.
Geography of patient assignments: The system or structure by which patients are assigned will usually differ between occupational therapists and hospitalists. For instance, at Cooper University Hospital, a 520-bed academic, tertiary hospital in Camden, N.J., where Dr. Rajput began the hospitalist program, the six occupational therapists are assigned patients on a geographical basis, according to floor in a 10-story building. But the group of 25 hospitalists, which has grown from four since 1999, is not assigned that way.
