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Arch Phys Med Rehabil. 2015 Nov;96(11):1966-72.e3. doi: 10.1016/j.apmr.2015.07.013. Epub 2015 Aug 5.

Omission of Physical Therapy Recommendations for High-Risk Patients Transitioning From the Hospital to Subacute Care Facilities.

Author information

  • 1Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI.
  • 2Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI; Geriatric Research Education and Clinical Center, William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI.
  • 3Geriatric Research Education and Clinical Center, William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI; School of Nursing, University of Wisconsin-Madison, Madison, WI.
  • 4Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI; Geriatric Research Education and Clinical Center, William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI; School of Nursing, University of Wisconsin-Madison, Madison, WI; School of Pharmacy, University of Wisconsin-Madison, Madison, WI. Electronic address: ajk@medicine.wisc.edu.

Abstract

OBJECTIVES:

To assess the quality and explore the potential impact of the communication of physical therapy (PT) recommendations in hospital discharge summaries/orders for high-risk subacute care populations, specifically targeting recommendations for (1) maintenance of patient safety, (2) assistance required for mobility, and (3) use of assistive devices.

DESIGN:

Medical record abstraction of retrospective cohort comparing discharge recommendations made by inpatient PT to orders included in written hospital discharge summaries/orders, the primary form of hospital-to-subacute care communication. Data were linked to Medicare outcomes from corresponding years for all Medicare beneficiaries in the cohort.

SETTING:

Academic hospital.

PARTICIPANTS:

All hospitalized patients (N=613 overall) 18 years and older with primary diagnoses of stroke or hip fracture, with an inpatient PT consultation and discharged to subacute care during the years 2006 to 2008; 366 of these were Medicare beneficiaries.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Combined rehospitalization, emergency department visit, and/or death within 30 days of discharge.

RESULTS:

Omission of recommendations for maintaining patient safety occurred in 54% (316/584) of patients; for assistance required for mobility, in approximately 100% (535/537); and for use of assistive devices, in 77% (409/532). As compared with those without patient safety restriction/precaution omissions, Medicare beneficiaries with such omissions demonstrated a trend toward more negative 30-day outcomes (26% vs 18%, P=.10). Similar, albeit nonsignificant, outcome trends were observed in the other omission categories.

CONCLUSIONS:

PT recommendations made during a hospital stay in high-risk patients are routinely omitted from hospital discharge communications to subacute care facilities. Interventions to reliably improve this communication are needed.

Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Communication; Delivery of health care; Patient discharge; Patient discharge summaries; Patient readmission; Patient safety; Physical therapy specialty; Physicians; Rehabilitation; Subacute care

PMID:
26253350
[PubMed - indexed for MEDLINE]
PMCID:
PMC4628558
[Available on 2016-11-01]
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