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Omission of Physical Therapy Recommendations for High-Risk Patients Transitioning from the Hospital to Sub-Acute Care Facilities.
Arch Phys Med Rehabil. 2015 Aug 4;
Authors: Polnaszek B, Mirr J, Roiland R, Gilmore-Bykovskyi A, Hovanes M, Kind A
Abstract
OBJECTIVE: 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 sub-acute care populations, specifically targeting recommendations for (1) maintaining patient safety, (2) assistance required for mobility, and (3) use of assistive devices. Prior research suggests that sub-acute care nurses perceive hospital-to-sub-acute care communication of these items to be poor, but this perception has not been verified via direct quality assessment.
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-sub-acute 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 sub-acute care, 2006-2008; 366 of these were Medicare beneficiaries.
MAIN OUTCOME MEASURE(S): Combined rehospitalization, emergency room visit and/or death within 30 days of discharge RESULTS: Omission of recommendations for patient safety restrictions/precautions occurred in 54% (316/584) of patients; for level of assistance with sitting to standing in ∼100% (535/537); and for medical assistive devices in 77% (409/532). As compared to those without patient safety restriction/precaution omissions, Medicare beneficiaries with such omissions demonstrated a trend towards more negative 30-day outcomes (26% versus 18%, p-value = 0.10). Similar, albeit non-significant, outcome trends were observed in the other omission categories.
CONCLUSION: PT recommendations made during a hospital stay in high-risk patients are routinely omitted from hospital discharge communications to sub-acute care facilities. Interventions to reliably improve this communication are needed.
PMID: 26253350 [PubMed - as supplied by publisher]