Inpatient Rehab/LTLD

Referral Guidelines
 Table of Contents

Introduction…………………………………………………………………………………….. 3

Inpatient Rehab Referral Guidelines - Quick Reference Guide ………………………………. 4

Inpatient Rehab Referral Guidelines:

Determining if a patient is a candidate for inpatient rehabilitation ……………………… 5

Determining Medical Stability …………………………………………………………... 5

Determining Rehab Readiness ………………………………………………….……….. 5

Determining Timing of Submission of Application for Rehab ………………………..…. 6

Determining Number of Referrals to be Submitted …………………………….………… 6

Determining Timing of Responses to Referrals …………………………..……………… 7

Appendix: Provincial Alternate Level of Care (ALC) Designation …………………………….. 8

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 Introduction
The Inpatient Rehab Referral Guidelines are intended for general application across multiple
rehab populations in need of high tolerance short duration or low tolerance long duration (i.e.
slow stream) inpatient rehabilitation.

To optimize the rehab referral process, these guidelines are organized around patient-specific
criteria related to the determination of patients suitable for rehab, their medical stability and
readiness for rehab.

The benefits of these guidelines are:

 to ensure that rehab referrals are submitted in a timely and appropriate manner
 to minimize the number of days that patients are waiting in Alternate Level of Care
(ALC).

Application of each and every component of these guidelines should result in the timely
submission of rehab referrals, preferably at or before ALC designation.

(Further information regarding ALC designation can be found in the Appendix.)

Recognizing that each rehab program has its own set of admission criteria, these guidelines are
to be considered in their entirety and used in conjunction with the specified admission
criteria of individual inpatient rehabilitation programs.

Detailed information about the admission criteria of individual rehab programs can be found
using the admission information tool, Rehab Finder, available on the GTA Rehab Network
website (see: www.gtarehabnetwork.ca).

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 QUICK REFERENCE GUIDE FOR INPATIENT REHAB/LTLD REFERRALS

Step 1: Determine if
patient is a candidate
for inpatient rehabilitation

Does the
NO patient meet all YES
4 criteria?

Reassess Step 2: Determine if

candidacy for patient is medically
rehabilitation at a stable
later date

Does the
YES
patient meet all NO
5 criteria?

Step 3: Determine if Reassess medical

patient is rehab ready stability at a later
date

Does the
NO patient meet all YES
9 criteria?

Submit rehab
Step 4: Submit
application once all
Reassess rehab appropriate rehab
three criteria are
readiness at a later application to a minimum
met
date of 3 rehab programs*

Are all 3 criteria

YES met with the timing NO
Designation of the referral?
of ALC

Step 5: Response to
rehab application (Refer
to guidelines for timing of
responses to referrals)

Cancel outstanding
rehab applications

Referral will be Referral will be

Referral is accepted redirected to another sent back/decision
Referral is accepted pending
& waitlisted program within the Referral is denied
organization

*A minimum of 3 applications may not be required in hospitals with internal rehab beds (as per organization-specific policies) or for some
specialized rehab programs.

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 Inpatient Rehab/LTLD Referral Guidelines
DETERMINING IF A PATIENT IS A CANDIDATE FOR INPATIENT REHABILITATION …
 Patient demonstrates by documented progress the potential to return to
premorbid/baseline functioning or to increase in functional level with participation in
rehab program.
 There is reason to believe that, based on clinical expertise and evidence in the literature,
the patient’s condition is likely to benefit from the rehab program/service.
 Goals for rehabilitation have been established and are specific, measurable, realistic and
timely.
 The patient or substitute decision-maker has consented to treatment in the program
and demonstrates willingness and motivation to participate in the rehab program.
(Exception: patients with reduced motivation/initiation secondary to diagnosis e.g. brain
injury, depression).

DETERMINING MEDICAL STABILITY …

 A clear diagnosis and co-morbidities have been established.
 At the time of discharge from acute care, acute medical issues have been addressed;
disease processes and/or impairments are not precluding participation in the rehab
program.
 Patient’s vital signs are stable.
 No undetermined medical issues (e.g. excessive shortness of breath, falls, congestive
heart failure).
 Medication needs have been determined.

DETERMINING REHAB READINESS …

 Patient meets the criteria of a rehab candidate as defined in guideline above.
 Patient meets the criteria of medical stability as defined in guideline above.
 All medical investigations have been completed or a follow-up plan is in place at time of
referral and follow-up appointments made by time of discharge.
 Patient’s special needs have been determined.
 Patient is able to meet the minimum tolerance level of the rehab program as defined by
its admission criteria.
 There are no behavioural issues limiting the patient’s ability to participate at the
minimum level required by the rehab program.

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  There are no psychiatric issues limiting the patient’s ability to participate at the
minimum level required by the rehab program.
 Treatment for other co-morbid illnesses/conditions does not interfere with the patient’s
ability to participate in rehab (e.g. dialysis or active cancer treatment).
 Patient’s discharge options following rehab have been discussed.

DETERMINING TIMING OF SUBMISSION OF APPLICATION FOR REHAB …

 Patient meets the criteria of a rehab candidate as defined in the guideline above.
 Patient meets the criteria of medical stability as defined in the guideline above or
patient’s date of medical stability can be identified within the next 1-2 days of
submission of application.
 Patient meets the criteria for rehab readiness as defined in the guideline above or the
date for rehab readiness can be identified.

Note I: Once it is determined that a patient is rehab candidate, medically stable and the
date of rehab readiness is known, the referral to rehab should be submitted.
Planning for discharge should begin prior to ALC designation.

Note II: Referrers should notify rehab facilities of the cancellation of the referral in the
event that the referral is no longer required.

DETERMINING NUMBER OF REFERRALS TO BE SUBMITTED …

 Organizations should send referrals to a minimum of 3 rehab programs as appropriate.1

Detailed information about the admission criteria of individual rehab programs can be
found using the admission information tool, Rehab Finder, available on the GTA Rehab
Network website (see: www.gtarehabnetwork.ca).

This web-based resource provides a comprehensive listing of all publicly-funded and fee-
for-service rehab programs/services provided by hospitals and community access centres
that are members of the GTA Rehab Network.

1
Please note that a minimum of 3 applications may not be required in hospitals with internal rehab beds (as per organization-
specific policies) or for some specialized rehab programs.
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 Rehab Finder allows you to search for rehab programs by:
Patient Population (including age) Service Setting Local Health
Organization Special Needs Integration Network

Information on Rehab Finder includes:

Description of the program Information about wait list
Admission and Exclusion criteria management
Application process and forms Contact details

DETERMINING TIMING OF RESPONSES TO REFERRALS …

 Responses to referrals should be given within 2 business days of receipt of application.

 Responses to referrals should be specific to one of the following response categories:

Referral is accepted (Provide date of admission)

Referral is accepted and waitlisted. (Provide estimated date of admission).

Reason(s) for waitlisting due to:
 Current bed availability
 Current resource availability to accommodate complex patient needs
 Infection control issues

Referral will be redirected to another program within the organization. (Provide

name of program.)

Referral will be sent back and decision is pending because:

 referral form is incomplete
 information is insufficient/inconsistent to make a decision regarding rehab
readiness
 patient’s current status does not indicate rehab readiness. Update required.

Referral is denied because:

 referral is cancelled
 patient does not meet program criteria/requirements
 patient needs a secured unit
 program cannot accommodate medical needs
 program cannot accommodate behavioural issues
 program cannot accommodate psychiatric issues
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 APPENDIX
Provincial Alternate Level of Care (ALC) Definition For implementation in all acute and post-acute hospitals*
(Adapted from the Wait Time Information Strategy)

Provincial ALC Definition Note 1

The healthcare system aspires to deliver care in a setting that is The patient’s care goals have been met or
congruent with the clinical needs of a patient as defined by the – progress has reached a plateau or
patient’s health status, treatment plan and goals. – the patient has reached her/his potential in that program/level of care or
– an admission occurs for supportive care because the services are not accessible in the
The definition applies to all patient populations waiting in all community (e.g. “social admission”).
patient care beds in an acute or post acute care hospital in This will be determined by a physician/delegate, in collaboration with an interprofessional team,
Ontario. when available.
Note 2
Definition: Discharge/transfer destinations may include, but are not limited to:
When a patient is occupying a bed in a hospital – home (with/without services/programs),
– rehabilitation (facility/bed, internal or external),
and does not require the intensity of – complex continuing care (facility/bed, internal or external),
resources/services provided in this care setting – transitional care bed (internal or external),
(Acute, Complex Continuing Care, Mental Health – long term care home,
or Rehabilitation), the patient must be designated – group home,
– convalescent care beds,
Alternate Level of Care (ALC)1 at that time by the – palliative care beds,
physician or her/his delegate. The ALC wait – retirement home,
period starts at the time of designation and ends – shelter,
– supportive housing.
at the time of discharge/transfer to a discharge
destination2 (or when the patient’s needs or This will be determined by a physician/delegate, in collaboration with an interprofessional team,
when available.
condition changes and the designation of ALC no
Final Note
longer applies).
The definition does not apply to patients:
– waiting at home,
*as of July 1, 2009 – waiting in an acute care bed /service for another acute care bed/service (e.g., surgical bed to a
medical bed),
– waiting in a tertiary acute care hospital bed for transfer to a non tertiary acute care hospital bed
(e.g., repatriation to community hospital).

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