Rehab Check
A proposal for the hospital's EHR to run each patient's chart through a rehab-specific check before therapy, and show the results as plain-language prompts right in the therapist's patient list.
- Audience
- Hospital EHR team, rehab leadership
- Users
- Acute care OTs and PTs
- Format
- Rules table, alert mockup, pilot plan
- Pairs with
- Caseload auto-prioritization, Alarm priority icons
The problem
Every session starts with a chart hunt
Before seeing a patient, an acute care therapist checks the latest labs, vitals, nursing notes and behavior flags to decide whether it's safe to treat. Then they dig through older encounters looking for how the patient functioned before admission.
That review is repeated for every patient on the caseload, every day, and it's easy to miss something on a busy morning. The EHR already has this information. It just doesn't put it in front of the therapist.
The result is time lost to chart review, missed holds that are found only at the bedside, and evaluations that start without a prior level of function.
The project · Rehab Check
Proposed rules
Four checks, written the way a therapist would say them
Each check gives a prompt, not a decision. The therapist still makes the call to treat, modify or hold.
| Check | What the EHR looks for | Prompt shown | Why it helps |
|---|---|---|---|
| Troponin | Elevated troponin result in the current admission | Proceed unless patient is symptomatic (e.g., chest pain) | Highlights the result without turning every elevated value into an automatic hold |
| MAP | Most recent mean arterial pressure below 65 | Patient may be a hold due to MAP | Catches low pressure before the therapist reaches the room |
| Behavior | Active violence or behavior flag | Patient may be a hold due to behaviors | Protects staff and prompts a plan with nursing before entering |
| Prior level of function | PLOF documented in earlier records: therapy notes, past admissions, outside records | Previously documented PLOF, with how long ago, the date and the source | Saves chart-hunting through old encounters before the evaluation |
Thresholds and wording would be checked against hospital policy and approved by medical staff before the proposal goes forward.
Mockup
Rehab Check in the therapy patient list
Prompts appear as a column in the patient list the therapist already uses. Selecting a patient opens the detail, including the previously documented PLOF.
| Rm | Patient | Dx | Order | Rehab Check |
|---|---|---|---|---|
| 412-1 | Patient A, 78 F | L CVA | OT eval | Troponin: proceed unless symptomaticPLOF on file · 7 mo |
| 415-2 | Patient B, 64 M | Sepsis | OT eval | May be a hold due to MAP (58)No PLOF on file |
| 418-1 | Patient C, 51 M | ETOH withdrawal | OT tx | May be a hold due to behaviors |
| 421-1 | Patient D, 83 F | R hip fx | OT eval | PLOF on file · 2 yr · may be outdated |
Previously documented PLOF
Three possible results, each with a next step
The PLOF search is the same one used by the EHR auto-prioritization intake, so the information is collected once and used in both places. The date always shows, so the therapist can judge whether it's still accurate and confirm it with the patient or family.
Found and recent
The therapist confirms it at the evaluation instead of searching for it.
Found but older
Older than the department's set limit, such as 6 or 12 months, or followed by a new hospital stay or diagnosis. The therapist re-checks it.
Nothing found
Prompts the therapist to ask the patient or family during the evaluation.
Rollout
Pilot and measurement plan
- Review rules and thresholds with rehab leadership, nursing and medical staff, and align them with hospital policy and the acute care safety checklist.
- Bring the approved rules to the EHR workflow committee and build them in a test environment.
- Time therapists' morning chart review for two weeks as a baseline.
- Turn on Rehab Check for one unit's therapists for six weeks, then compare.
- Chart review timeMinutes per patient before the first session
- Holds found at the bedsideHolds discovered only after reaching the room
- PLOF at evaluationEvaluations started with PLOF already on screen
- Prompt accuracyPrompts therapists marked as wrong or not useful