Development of a Unique Triage System for Acute Care Physical Therapy and Occupational Therapy Services: An Administrative Case Report

BACKGROUND AND PURPOSE: This administrative case report documents the development of a mechanism by which systematic triage was used to assign patients to therapists in acute care settings. The primary objective was to develop a triage tool to improve patient access to medically necessary therapy services. CASE DESCRIPTION: A unique triage tool and a decision tree were developed to determine which patients referred to therapists for acute care therapy required skilled services. The triage tool was used to examine therapy referrals for patients from 2 large academic hospitals; 6 criteria were used to determine which evaluations should be cancelled. During the trial period, the predictive ability of individual triage criterion items was analyzed, the tool was modified and validated, and a decision tree was established. Descriptive and chi-square analyses were performed on all variables of interest. OUTCOMES: The systematic triage system reduced the number of therapy evaluations that were not appropriate by 29%, resulting in an improvement in the availability of therapy services for patients who required skilled care. The average number of patients per therapist per workday decreased from 18.9 to 12.1 and from 15.1 to 12.8 in the 2 hospitals. An improvement in a newly developed "workload index" related to missed patient visits also indicated the success of this project. DISCUSSION: A novel systematic triage system reduced the number of therapy evaluations that were not appropriate, resulting in an improvement in the availability of therapy services for patients who require skilled intervention.