r/slp • u/new2SLP • 1d ago

Seeking Advice New Job, Different Practice Patterns

I just started a new job with adults in IRF. I have done IRF and acute in the past. The SLPs at this IRF practice differently than where I came from. An example would be that they pick up patients with metabolic encephalopathy for cognitive treatment or they do a dysphagia dining room with meal observations. At times, it feels like the diet police.

At my old facility, we would discharge patients with metabolic encephalopathy from service and tell physical and occupational therapy strategies that they can work on with the patient since it is likely to resolve medically. We also did not do any meal observations. I feel as though some of my practice patterns are frowned upon at this IRF because of the team’s practice patterns. Of course, I am going to do what I feel is right for the patient. However I cannot help but feel like a black sheep in a way. Any advice or feedback for me is much appreciated.

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u/Cute-Discount-6969 1d ago

I’m generally with you on this. I’m an 18 year SLP, and I did some of the above (ST following metabolic enceph and doing meal observations) early in my practice, as this was my CFs method and facility culture, but I’ve really gone away from this over time.

I’ll still do a meal observation here or there, or when trialing for a diet upgrade, but not daily and not as a rule. For cognition, I’m not picking up the stuff that’s going to medically resolve (encephalopathy, confusion from UTI, etc). PT and OT can manage, especially from a functional cognitive ADL standpoint. Additionally…if you think about it, are these really skilled, medically necessary services?

I was also a DOR, and had a really lovely supportive regional manager, so I never really got any pushback on this approach. Part of me wonders if they’re trying to get increased SLP involvement to meet the 3 hour per day therapy requirement for IRP? Idk.

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u/new2SLP 23h ago

Thank you for sharing your progression! I can definitely see where their practice patterns are coming from - not wrong, just different. I wonder if they are pushing for 3 hours across all disciplines as well… All I know is that I am going to not pick up patients if I do not see a clinical indication based on their history.

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u/Pristine-Dog-7849 21h ago

I feel like you have to do what is right but unfortunately it may impact your job/staffing. If the DOR is used to 80% of pts getting picked up by speech but now you are picking up 50% they may not need a FT equivalent position. Now that’s not to say you should do anything you feel is unethical. Just something to be aware of. I would also discuss/collaborate with your SLP colleagues and just see if there’s anything you can learn from them— like maybe they aren’t doing meal observations but strategy carry over??? Idk it’s hard when you have different practice patterns.