Caseload Auto-Prioritization
The EHR ranks new therapy orders by diagnosis, so patients most likely to need an acute inpatient rehab recommendation are seen first, and their referral starts while there's still time to get a bed.
- Audience
- Therapists, schedulers, EHR team
- Built on
- CMS IRF qualifying conditions
- Format
- Priority rules, list mockup, intake design
- Pairs with
- Rehab Check, IRF vs. SNF
The problem
A first-in, first-seen list misses the patients who can't wait
Most therapy caseloads are worked roughly in the order orders arrive. A stroke patient whose order came in at 2 pm can wait until tomorrow behind follow-ups that could safely move.
For that patient, a late OT and PT evaluation means a late rehab recommendation, a late IRF referral, and sometimes a delayed discharge or a missed IRF bed. The diagnosis already tells us who is likely to need rehab. The EHR can use it to sort the list.
The project · Caseload prioritization
Priority rules
Three tiers, driven by diagnosis
The priority diagnoses closely match the CMS inpatient rehabilitation facility "60% rule" qualifying conditions, which gives the proposal regulatory backing.
Likely IRF candidates
- Stroke
- Spinal cord injury
- Traumatic brain injury
- Polytrauma
- Hip fracture (see split below)
- Amputation
- Neurological disorders such as Guillain-Barré, Parkinson's, MS
- Burns
- Joint replacement that is bilateral, BMI 50 or more, or age 85 or older
Other new evaluations
- New orders without a priority diagnosis
- Single joint replacement without the CMS modifiers
Follow-up treatments
- Patients already evaluated with a plan in place
Hip fracture, pending surgery
Flagged and scheduled for the first session after surgery and medical clearance, rather than ranked for today.
Hip fracture, conservative management
Ranked in Tier 1 now, with weight-bearing orders shown so the evaluation can start right away.
Other ranking factors
| Factor | Effect on the list |
|---|---|
| Order expiration or mandated evaluation time frame | Moves up as the deadline nears, so no order expires unseen |
| Anticipated discharge date | Moves up when discharge is today or tomorrow |
| New order vs. follow-up | New evaluations rank above follow-ups in the same tier |
| High prior level of function | Moves up within its tier, since a high PLOF supports an IRF recommendation |
| Therapist or scheduler override | Always allowed, with a reason, so clinical judgment can move any patient up or down |
Mockup
The ranked caseload
Color tiers and diagnosis tags show why each patient is where they are. Schedulers see the same order when assigning therapists.
| # | Rm | Patient | Why this rank | Order | |
|---|---|---|---|---|---|
| 1 | 412-1 | Patient A, 78 F | StrokeHigh PLOFNew eval · order expires in 6 hrs | OT eval | Move |
| 2 | 510-2 | Patient E, 69 M | Hip fx · conservativePLOF follow-up neededNew eval · WBAT | OT eval | Move |
| 3 | 421-1 | Patient D, 86 F | Joint replacement · age 85+New eval · POD 1 | OT eval | Move |
| 4 | 415-2 | Patient B, 64 M | Discharge todaySepsis · new evalMoved up by scheduler: home today, needs DME | OT eval | Move |
| 5 | 402-1 | Patient F, 58 F | CHF exacerbation · new eval | OT eval | Move |
| 6 | 418-1 | Patient C, 51 M | Follow-up · plan in place | OT tx | Move |
| — | 507-1 | Patient G, 81 F | Hip fx · pending surgeryScheduled for first session after surgery | OT eval | Move |
Prior level of function at intake
PLOF as a structured field, not free text
Ranking by PLOF only works if the EHR can read it. Intake asks one to three quick questions and records who answered.
The questions
- Before this, did you live at home?Home alone · Home with others · Facility
- Did you walk on your own, with a device, or not at all?On my own · With a cane or walker · Wheelchair or not at all
- Did you need help with dressing or bathing?No help · Some help · A lot of help
Who answered
- "Unable to obtain" never counts as a low PLOF and never drops priority. Diagnosis still drives the rank.
- It creates a follow-up flag so the therapist or case manager collects PLOF later, from family, outside records or the facility the patient came from.
- Check whether the admission nursing assessment already asks some of this, so the proposal adds to an existing form instead of creating a new one.
Protecting ER nurses
The ER nurse is the last resort, not the default
Adding a question to every ER admission would add work for nurses who are already stretched. The design fills PLOF from other sources first, in this order.
- Existing recordsPrior therapy notes, past admissions, home health, SNF and shared outside records. Shown pre-filled for a one-tap confirm.
- EMS run sheetParamedics often note living situation, devices and who was home.
- Patient or familyA QR code, tablet or portal questionnaire with plain-language, picture-supported choices.
- Other staffRegistration, ED techs, ED case managers or social workers.
- Floor admissionThe admitting nurse on the unit, as part of the existing assessment.
- TherapistCollected at the evaluation if nothing else filled it.
- Only when it mattersAsked only for patients with a priority diagnosis, not every ER patient.
- Never a hard stopSkippable with "Unable to obtain" in one tap. It can wait until the floor or the evaluation.
- ER nursing input firstReview the design with ER nursing before proposing it. It respects their workload and makes approval more likely.
Result
How a pilot would be measured
- Order to evaluationHours from therapy order to evaluation for Tier 1 patients
- Time to recommendationHours from admission to a documented rehab recommendation
- IRF referral timingReferrals sent before the anticipated discharge date
- PLOF completionShare of Tier 1 patients with PLOF on file at evaluation, and its source
The CMS qualifying conditions list includes joint replacement only in specific cases, which is why it ranks with modifiers here. Check current CMS guidance before proposing, and build the rules with the hospital's EHR team, rehab leadership and scheduling.