Variability of referrals for physical/occupational therapy intervention in the Neonatal Intensive Care Unit

Research Objectives: 1. To determine referral patterns for PT and OT intervention in NICU infants
2. To explore variability in referral decision-making and terminology in neonatal therapy practice.

Design: The study was a cross-sectional online survey which explored discipline, state, NICU level and % workload, overall referral policy, referral criteria, and open-ended questions.

Setting: NICU

Participants: Eligible respondents were NICU clinical team members familiar with PT/OT referral guidelines.

Interventions: There were no interventions as this was a cross-sectional study investigating current practice.

Main Outcome Measures: Responses to the survey were tabulated and analyzed descriptively.

Results: A total of 234 NICU clinicians responded in 38 different US states. Most were PTs (73%) and OTs (22%), and 58.6% worked in a level III NICU in the previous 2 years. PT/OT were regularly available in 88% of NICUs, with consultation in others. In 42% of NICUs, there were standard PT/OT referral guidelines, with the rest case-by-case or through screening. Automatic referral guidelines varied widely. Although 64.2% of units used gestational age for automatic referral, the referral threshold varied from 27 to 37 weeks gestation, with the most common < 32 weeks (19.8%). Similarly, 41.4% of units used birth weight as automatic referral criterion, but thresholds ranged from < 500g to < 2500g with the most common threshold 1500g (24.7%). Similar patterns were observed for intraventricular hemorrhage and congenital cardiovascular or neuromuscular diseases, which were inconsistently triaged for referral by level or diagnosis. Variability for non-automatic referral was even higher; and inconsistent terminology was used to justify referrals. Overall, open comments emphasized this variability, particularly with referral changes initiated during the Covid-19 pandemic that limited direct intervention opportunities.

Conclusions: Infants in the NICU are likely to be at risk for developmental delay and can benefit from direct therapeutic intervention. Infants who need PT/OT should be identified promptly and consistently, so services can be initiated timely. This study indicates that there is a need for more unified guidelines and consistent referral policies based on current evidence regarding neonatal therapy practice.

Author(s) Disclosures: N/A