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PTA Blog Talk

Sense of Urgency

Published March 29, 2012 5:22 PM by Jason Marketti

We had a patient come to us and there were no therapy orders on the admission paperwork. We asked, faxes were sent to the MD and surgeon but there was no response. A week later the immediate need for an evaluation from all disciplines was demanded when orders finally arrived. Emphasis on demanded.

The person who coordinates admissions missed something (important) and then demands we suddenly jump because orders were received. The patient is not aware of this aspect of health care and probably thought therapy was not coming. Nursing did not get the patient up enough and was not sure what to do with him. Therapy knew what to do but was not able to do the job they were trained to do because no orders were received from the doctor. The MDs most likely thought therapy was involved because the patient was seen by therapy in the hospital and why would those orders change in the SNF?

I spoke a while back about facilities having standing orders for all therapy disciplines when entering a SNF. In this instance it would have worked. Therapy could evaluate and assess the needs of the patient at admission and professionally determine a course of action without a delay in treatment. This patient has lost a week with us. I wonder if the insurance company cares about this delay? Will therapy get an extra week because someone didn't check the little box that says therapy can evaluate the patient? Probably not.


The insurance company cares about this only if it affects reimbursement.  Since therapies are often the "skilled services" required to be admitted to a SNF and therapies were delayed a week the claim may be denied.  In my experience that means the SNF will eat the cost.  There's nothing new about that except that it could have been avoided in this case.  

I wonder if anything will be said to the person who caused the delay in the first place.

Toni March 29, 2012 7:33 PM

I have a saying for times like this:

"A failure to plan on your part does not constitute an emergency on my part."

Of course I'd probably get fired if i actually used my outdoor voice when I said it. The problem is it is the patient who suffers for an admin mistake.

Even direct access wouldn't have fixed this one. I like your ideas about standing orders.

Dean Metz March 29, 2012 2:28 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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