PMR Consult Service
PM&R Residency Program Manual
PM&R Resident Rotation Descriptions
PM&R Adult Inpatient Consult Service – Dr. Mary Bryant
During this 3-month rotation, PM&R residents learn to evaluate inpatients, determine their rehabilitation needs, the appropriate setting for rehabilitation (acute inpatient rehabilitation, sub-acute rehabilitation, day rehabilitation, outpatient rehabilitation, home health services) and make recommendations regarding therapies and modalities. Residents learn how to minimize complications that can occur from long hospitalizations such as DVT, contractures, pressure ulcers and deconditioning.
During the first 2 weeks of the rotation the resident will perform a chart review, examine the patient and document their findings. The resident will then discuss the patient with the attending physician, the patient will be examined jointly and the assessment and recommendations will be formulated. As progress is made and the resident feels more comfortable with the formation of the assessment and plan, he or she will begin to make this documentation before the consult is staffed. Throughout this rotation, the resident will be introduced to a wide variety of patients including those with spinal cord injuries, burns, amputations (pre- and post-amputation), multiple trauma, traumatic brain injury and stroke.
A major goal of this rotation is to learn to work as a part of the team on the acute services. Prognosis and expectations after inpatient rehabilitation will be discussed with families. The consult resident and attending physicians are often asked to meet with teams and families for educational sessions.Appropriate billing for consults and Medicaid and Medicare criteria for acute inpatient rehabilitation services will be reviewed.
The PM&R consult resident rotates at University Hospital and at the Kluge Children’s Rehabilitation Hospital. The consult resident rounds on patients on the consult list and should be aware of the patient’s medical stability and treatment plan by the primary team. The resident also works closely with the rehabilitation nurse liaison to facilitate transfers to the UVA-HealthSouth Rehabilitation Hospital. Close communication between the consult resident and residents at the Rehabilitation Hospital is expected for continuity of care. At the end of the rotation there is an examination that will measure progress.
Goals and Objectives:
- To demonstrate skills in the early acute rehabilitative management of patients with diagnoses including multiple trauma, joint replacement, brain injury, stroke and amputation.
- To describe the continuum of rehabilitative care services.
- To list the HCFA guidelines for admission to acute inpatient rehabilitation.
- To understand the role of the physiatrist as a hospital consultant.
- To establish short and long term functional goals of a rehabilitation program.
- To discuss predictors of functional outcome.
- To describe factors one examines to help determine the most appropriate level of rehabilitative care following acute hospitalization.
- To discuss the management of complications of acute illness/injury including spasticity, contracture, heterotopic ossification, bladder/bowel incontinence, agitation, autonomic dysreflexia and skin breakdown.
- To describe the complications of bedrest and inactivity.
- To discuss management of swallowing and communication disorders.
- To have a basic understanding of case management issues.
- To gain teaching experience through the education of medical students, and neurology residents rotating on the consult service.