How can I assess the need for referral to a rehabilitation specialist for a patient with post-operative complications?

To assess the need for referral to a rehabilitation specialist for a patient experiencing post-operative complications, use a person-centred, individualised, and holistic approach to evaluate the impact of the complications on the patient's functional abilities and rehabilitation needs. This assessment should be integrated early in the care pathway and involve discussions with the patient and their family or carers about rehabilitation goals to inform shared decision making. Consider the following key factors:

• Evaluate physical impairments affecting activities of daily living, involving occupational therapy for advice on aids, equipment, and adaptations.
• Assess for cognitive or psychological issues such as confusion, agitation, memory problems, or communication changes, and provide immediate psychological support or refer to psychology services as needed.
• Identify any complex rehabilitation needs that exceed the skills of the current multidisciplinary team, such as management of sensory loss, nerve injury, or use of bespoke splints and orthoses.
• Use validated tools like the rehabilitation complexity scale (RCS), patient categorisation tool (PCAT), or complex needs checklist (CNC) to determine the complexity of rehabilitation needs and the urgency of specialist referral.
• Refer promptly if the patient has difficulties managing activities of daily living, ongoing functional impairment, or if self-directed rehabilitation is insufficient to meet rehabilitation goals.
• Consider referral for specialist assessment if there are complications such as external fixation for fractures, or if the patient has newly acquired sensory deficits or balance and coordination issues.

Overall, referral to a rehabilitation specialist is indicated when the patient’s rehabilitation needs are complex, when the multidisciplinary team lacks the expertise to manage specific complications, or when the patient cannot achieve rehabilitation goals through standard care pathways ¹.