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

Authors
  • Polnaszek, Brock1
  • Mirr, Jacquelyn2
  • Roiland, Rachel3
  • Gilmore-Bykovskyi, Andrea3
  • Hovanes, Melissa2
  • Kind, Amy4
  • 1 Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI.
  • 2 Department 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. , (United States)
  • 3 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. , (United States)
  • 4 Department 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: [email protected] , (United States)
Type
Published Article
Journal
Archives of physical medicine and rehabilitation
Publication Date
Nov 01, 2015
Volume
96
Issue
11
Identifiers
DOI: 10.1016/j.apmr.2015.07.013
PMID: 26253350
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. Academic hospital. 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. Not applicable. Combined rehospitalization, emergency department visit, and/or death within 30 days of discharge. 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. 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.

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