title: Implementing treatment frequency and duration guidelines in a hospital-based pediatric outpatient setting: administrative case report.
abstract: OBJECTIVE
  Determining treatment frequency and duration of physical therapist services is an important component of outpatient pediatric physical therapist practice, yet there is little research available to inform these decisions. Treatment frequency guidelines (TFG) can assist decision making in guiding pediatric physical therapy. The purpose of this project was to examine the feasibility and application of implementing TFG in hospital-based pediatric outpatient physical therapy.
  
  
  METHODS
  Previously developed TFG were modified for use in our pediatric outpatient physical therapy department to include duration and were referred to as treatment frequency and duration guidelines (TFDG). In order to successfully implement the TFDG, there were 2 phases to the project. In phase 1, the staff were provided the guidelines and procedures in a staff meeting and via email using a PowerPoint presentation. Phase 2 was initiated due to the poor response of the staff in implementing the guidelines in their practice after phase 1. The format was changed to include formal re-education via small-group and one-on-one education sessions (phase 2). Chart reviews were completed to assess therapists' adherence to using TFDG.
  
  
  RESULTS
  Therapists' adherence to use of TFDG increased following re-education: phase 1 (n=225 charts, 31% adherence) and phase 2 (n=197 charts, 90% adherence).
  
  
  CONCLUSIONS
  Treatment frequency and duration guidelines may assist in guiding frequency and duration decisions in pediatric physical therapy. Education via in-person meetings may improve adherence among staff.
authors.affiliation: H. Hanson, PT, DPT, PCS, Step by Step Developmental Services, Rochester, New York. At the time this case report was written, Dr Hanson was affiliated with the Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Heather
authors.initials: H
authors.lastname: Hanson
authors.affiliation: A.T. Harrington, PT, DPT, PhD, PCS, Department of Physical Therapy, The Children's Hospital of Philadelphia.
authors.forename: Ann Tokay
authors.initials: AT
authors.lastname: Harrington
authors.affiliation: K. Nixon-Cave, PT, PhD, PCS, Doctor of Physical Therapy Program and Post Professional Experiential Learning, Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, 901 Walnut St, Room 522, Philadelphia, PA 19107 (USA). At the time this case report was written, Dr Nixon-Cave was affiliated with the Department of Physical Therapy, The Children's Hospital of Philadelphia. Kim.Nixon-Cave@jefferson.edu.
authors.forename: Kim
authors.initials: K
authors.lastname: Nixon-Cave
mesh_terms: D017050:Episode of Care; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D019982:Organizational Case Studies; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010814:Physical Therapy Department, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D016730:Program Development; D058996:Quality Improvement