Entry and Exit Criteria

Admission/Entry, Exclusion, Continued Stay, and Discharge/Transition/Exit Criteria

1. Purpose

Individuals seeking outpatient rehabilitation services will be considered candidates for services when certain criteria are met. The admission criteria include, but are not limited to, the below.

2. Admission or Entry Criteria

The criteria for providing outpatient rehabilitation services include the following:

1. There must be an order for rehabilitation services, except for patients seen through direct access.
2. Services are deemed to be reasonable and necessary.
3. Services require the skilled services of a licensed healthcare personnel.
4. The person served must:
   • Be medically stable to the degree that participation in treatment is safe and beneficial.
   • The treatment which is under TPT&RH scope of services.
     Demonstrate a significant functional limitation including but not limited to:
     • Mobility/ADL impairment (orthopedic, sports injuries)
     • Speech/swallowing disorders
     • Lymphedema (Stage 1-2, no active infection)
     • Vestibular/balance deficits (stable, no acute vertigo)
     • Pain VAS 2-10/10 (musculoskeletal, post-op)
   • Be expected to make significant functional improvement within a reasonable period of time as defined by the healthcare personnel in the rehabilitation plan of care.
   • Have the ability to understand and benefit from rehabilitation, if not able to understand must be accompany by family members or authorized person.
   • Be able to manage his/her own personal care or have a caregiver available to assist.
   • Have the ability to travel and attend appointments as scheduled.

3. Exclusion Criteria for Admission

The criteria for excluding one from receiving outpatient rehabilitation services include, but are not limited to, the following:

1. Client demonstrates aggressive behaviors that post a threat to the safety of him/her or others.
2. Instructed by the referred physician to withhold the services.
3. The treatment which is not under TPT&RH scope of services.
4. Specialty exclusions:
   -Lymphedema: Stage 3-4, active cellulitis, non-compliant with compression
   -Vestibular: Acute vertigo episodes, uncontrolled BPPV requiring Epley
   maneuver
   -Open wounds stage 2+, ventilator dependence, and acute infections

The patients who are ineligible for the services in TPT&RH are referred to Thumbay University Hospital for further follow up and inform the valid reason to the patient/family members and stakeholders.

4. Continuing Stay Criteria

Each of the following conditions must be met in order to justify continuation of services.

1. Services continue to be reasonable and necessary.
2. The patient’s condition and treatment plan require the experience and expertise of a skilled healthcare personnel.
3. The patient is able to tolerate and participate actively in therapy.
4. The patient demonstrates potential for functional improvement.
5. Continuous progress has been demonstrated and documented in the clinical notes.

5. Discharge/Exit Criteria

Patients receiving outpatient rehabilitation services will be discharged from services when certain criteria are met. The discharge criteria include, but are not limited to, the following:

1. The person served has achieved the goals that were established or updated in the most recent plan of care.
2. Services are no longer reasonable and necessary or the services of skilled healthcare personnels are no longer required, except individuals who need maintenance of their functional level.
3. The individual’s progress has slowed or temporarily stopped and he/she is no longer benefiting from the services of the program.
4. The presence of medical, psychological or 9social problems hinders the individual’s ability to participate.
5. An interruption in therapy services has occurred for greater than 30 days unless it is part of the plan of care.
6. The physician requests that therapy services be discontinued.
7. The person served is non-compliant with the program.
8. The person repeatedly exhibits behaviors that cause safety concerns for others.
9. The person served declines to continue care.
10. The care of the person served is being transferred to another provider

6. Transition Criteria

1. Transition can be planned or unplanned to the level of care and within the group or acute care facility.
2. The person served required higher level of care/ intervention, not included in the TPT&RH Scope of services.
3. Person served of TPT&RH requiring emergency medical intervention.

Specialty-specific progress:

– Lymphedema: Documented limb volume reduction, if not then referral to vascular surgeon.

– Vestibular: Improved Dizziness Handicap Inventory scores or independent with maneuvers, if no improvement is noticed, referral to ENT/Neurology if central cause not confirmed.

– Child and adolescent served to be transferred to the educational services for individual tutoring, career training and vocational program

7. We incorporate many skilled intervention approaches to treat condition but not limited to:

Pain Management:

Patient with the following pain with VAS (Visual Analog Scale) ranging from 2-10/10

• Neck Pain
• Shoulder Pain
• Elbow joint Pain
• Wrist Joint Pain
• Pain in interphalangeal joints
• Dorsal Back Pain
• Low Back Pain
• Sacroiliac Joint Pain
• Hip Joint pain
• Knee joint Pain
• Ankle and Foot Joint Pain

Neurological Conditions:

Patient with any kind of Neurological condition which results in loss of motor function, disturbance in sensory system, affects cognitive functions but not limited to:

• Stroke
• TBI
• Spinal Cord injury.
• Parkinsonism
• Multiple sclerosis
• Transverse Myelitis
• Chronic Regional Pain Syndrome
• Motor Neuron Disease/Amyotrophic Lateral Sclerosis
• Guillain-Barre Syndrome
• Cerebral Palsy
• Spina Bifida occulta
• Bell’s Palsy
• Peripheral Neuropathy

Musculoskeletal Conditions:

Patient with musculoskeletal Problems, pre-operative or post-operative condition but not limited to:

• Arthroplasty or Hemi arthroplasty of any joint.
• Fractures treated conservatively or managed by open reduction and internal fixation.
• Post Traumatic stiffness.
• Deformities like scoliosis, kyphosis, Pes planus, Pes caves, Genu Valgus, Genu Varum etc.
• Tendonitis and Bursitis
• Degenerative joint diseases
• Rheumatic Arthritis
• Sports Injuries

Pediatric Conditions:

We incorporate many skilled intervention approaches to treat condition but not limited to:

• Cerebral Palsy
• Autistic Spectrum Disorder
• Developmental Co-ordination Disorder
• Down Syndrome
• Rehabilitation of children and adolescents post sports injuries or surgeries.
• Developmental delays
• Genetic disorders and syndromes
• Congenital anomalies
• Orthopedic disabilities/injuries
• Cardio-Pulmonary rehabilitation in Pediatric conditions
• Juvenile rheumatoid arthritis
• Birth defects such as spina bifida, Hydrocephalus, etc.
• Acute trauma-Spinal cord injury
• Traumatic Brain injury
• Neuro-Muscular disorders: Muscular dystrophy, Spinal Muscular Atrophy, etc.
• Metabolic disorders in children leading to developmental delays, etc.

Speech Therapy

We incorporate many skilled intervention approaches to treat condition but not limited to:

• Childhood Apraxia of Speech
• Orofacial Myofunctional Disorders
• Speech Sound Disorders/Articulation Disorders
• Stuttering and Other Fluency Disorders
• Receptive Disorders
• Autism-Related Speech Disorders
• Resonance Disorders
• Selective Mutism
• Brain Injury-Related Speech Disorders/Dysarthria
• Attention Deficit/Hyperactivity Disorder Symptoms

8. Review of Entry and Exit Criteria:

Entry and Exit Criteria shall be reviewed at least on an annual basis.