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

POLNASZEK B; MIRR J; ROILAND R; GILMORE BYKOVSKYI A; HOVANES M; KIND A
ARCH PHYS MED REHABIL , 2015, vol. 96, n° 11, p. 1966-1972
Doc n°: 177910
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.apmr.2015.07.013
Descripteurs : KA - KINESITHERAPIE, HE3 - PRESTATIONS DE SOINS
Article consultable sur : http://www.archives-pmr.org

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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