Patterns of referral to a university hospital consultation service: failure to accurately predict need for physiatric services.
The purpose of this study was to determine the predictive value of screening the narrative sections of the consultation request form to determine the need for physiatric intervention rather than PT intervention alone. We conducted a review of 107 requests for consultation from various acute care services at our hospital. After reviewing the referring physician's narrative summaries, we determined that 36% of 107 patients would require physiatric evaluation, and that the remaining patients could be "passed through" to PT for treatment. After evaluation of the medical records and examination of the patients, 54% of patients required physiatric assessment and only 45% could be "passed through" to PT. The hypothesis that this narrative information would be an adequate predictor of need for physiatric consultation was rejected at the p less than 0.005 level (chi 2 = 18.63; df = 1). In addition, the referring service indicated whether it wished PT or physiatry to evaluate the patient on the consultation form. The hypothesis that screening for the need for physiatric intervention by the indicated preference of the referral was rejected at the p less than 0.0005 level (chi 2 = 20.45; df = 1). We concluded that we could not reliably predict when patients required physiatric or only PT intervention based on the consultation request narrative. Ongoing physiatric involvement on a consultative basis, educational conferences, and other forms of education for house staff and attending physicians may serve to improve understanding of physiatric services and physiatric utilization.
Davidoff
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G
Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48109-0042.
Stolp-Smith
K A
KA
Waring
W P
WP
Cole
T M
TM
D006301:Health Services Needs and Demand; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D008824:Michigan; D010814:Physical Therapy Department, Hospital; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D010810:Physical and Rehabilitation Medicine; D055656:Prescriptions; D012017:Referral and Consultation; D012046:Rehabilitation