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

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.

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

Figure 1

Prevalence of PT Recommendations in Discharge Summaries/Orders as Compared to the Prevalence of PT Recommendations in PT Consultation Notes for Each Recommendation Category

Figure 2

Rehospitalization, Emergency Department Visit and/or Death within 30 Days of Hospital Discharge by Omission Category for Medicare Beneficiaries within the Study Sample *P-value=0.10 †Each category reflects only events for those patients with such recommendations made by inpatient physical therapy