title: Omission of Physical Therapy Recommendations for High-Risk Patients Transitioning From the Hospital to Subacute Care Facilities.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Brock
authors.initials: B
authors.lastname: Polnaszek
authors.affiliation: 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.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Mirr
authors.affiliation: 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.
authors.forename: Rachel
authors.initials: R
authors.lastname: Roiland
authors.affiliation: 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.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gilmore-Bykovskyi
authors.affiliation: 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.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hovanes
authors.affiliation: 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: ajk@medicine.wisc.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Kind
mesh_terms: D000046:Academic Medical Centers; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D061214:Patient Safety; D010360:Patient Transfer / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty; D012189:Retrospective Studies; D018570:Risk Assessment; D012656:Self-Help Devices; D000071939:Stroke Rehabilitation; D019467:Subacute Care / Q000706:statistics & numerical data*; D014481:United States
keywords: Communication; Delivery of health care; Patient discharge; Patient discharge summaries; Patient readmission; Patient safety; Physical therapy specialty; Physicians; Rehabilitation; Subacute care