Date Presented 04/03/2025
This project outlines a study on optimizing OT referral orders in acute care through the electronic medical record by adding mandatory reasons for referral. Ten reasons, such as acute balance impairment, were identified to improve care and clarify OT’s roles for providers.
Primary Author and Speaker: Courtney Turner
Additional Authors and Speakers: Autumn Rebillot
PURPOSE: Reason for referral is considered a fundamental element of documentation (AOTA, 2018). Currently, acute care OT orders received through the EMR indicate ‘evaluate and treat’ only. This makes guiding evaluation difficult within OT’s vast scope. This may impact therapists’ productivity, order efficiency, and can result in delays in addressing patients’ needs. Order optimization by including reason for referral could better guide evaluations, support physicians’ plan of care, and provide meaningful, patient-centered care. Evidence shows that including reason for OT referrals has led to positive outcomes in various acute care settings (Loubani, et al., 2024) (Powell, Kimura, 2016).
DESIGN: Qualitative action research.
METHODS: OTs were surveyed for appropriate/inappropriate reasons for referrals. Survey results were compiled, then therapists collaborated with researchers to draft top reasons for referral. Therapy representatives across the larger hospital system (Rehab Council) reviewed and voted on top reasons for referral that would be appropriate across Health Standards Organizations (HSOs).
RESULTS: The Rehab Council approved the top 10 reasons for OT referral, which are now under review by the physician committee. If approved, EPIC optimization for OT orders will mandate a hard stop reason for referrals across HSOs. Physicians may refer patients for the following: mobility & transfer evaluations, home safety recommendations, decreased activity tolerance, post-stroke & post-surgical evaluations, gait impairment requiring DME assessment, acute balance impairment, fall risk assessment, weakness affecting functional mobility, and other concerns.
CONCLUSION: This project invites acute care therapists to assess and optimize their current referral processes. It offers a direct example of how OT orders can be enhanced through an EMR. This project also provides an opportunity to educate stakeholders such as management/physicians to better understand OT’s scope.
References
American Occupational Therapy Association. (2018). “Guidelines for documentation of occupational therapy.” American Journal of Occupational Therapy, 72(Suppl. 2), 7212410010. https://doi.org/10.5014/ajot.2018.72S203
Powell, D. & Kimura, L. (2016, June 1). ”Building a Better Referral-Management Process.” American Physical Therapy Association. www.apta.org/apta-magazine/2016/06/01/building-a-better-referral-management-process
Loubani, K., Polo, K. M., Baxter, M. F., & Rand, D. (2024). Identifying facilitators of and barriers to referrals to occupational therapy services by Israeli cancer health care professionals: A qualitative study. American Journal of Occupational Therapy, 78, 7801205050. https://doi.org/10.5014/ajot.2024.050414
CMS. (n.d.). “Fact sheet #1 inpatient rehabilitation facility classification.”... https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/downloads/fs1classreq.pdf
