Reducing the number of hospital readmissions that occur within 30 days of discharge is a major quality improvement goal. Recently we wrote about the issues physical therapists face in acute hospital settings, namely, that roles are not well defined and the skills and involvement of PTs aren’t being used to their fullest potential.
According to a recent paper, published in Journal of the American Physical Therapy Association, in terms of hospital readmissions, this is also the case. Apparently, the skills of PTs are not being used to analyze and assess functional predictors such as strength, gait speed, activities of daily living, among other things. Predictors that often result in readmissions and could potentially be addressed by PTs during inpatient stay.
The major issue is that the link between assessment of functional abilities and their relationship to readmission risk seems to be an area of discharge that is missed in many cases.
What role can physical therapists play in reducing hospital admissions?
The following outlines some statistics and possibilities.
According to research, approximately 66-88% of discharge summaries are still not available at the first scheduled community follow-up visit. This obviously dramatically influences care delivery to patients. Though not directly related to PTs in this case, overall, summaries need to be disseminated faster and PTs could play a more predominant role in this regard.
Physical therapist participation has not been standardized into reporting during inpatient hospitalization and into discharge summaries. If PTs were involved in a standardized assessment of functional status, this could help foster increased communication regarding physical function that could decrease readmissions and ensure information gets communicated to the right community providers for follow-up.
Mismanagement of medication is a primary cause of readmissions. Researchers propose PTs could play a much greater role here also. For instance, providing information about heart rate and blood pressure changes during activity and how this may influence medications such as anticoagulant meds that could increase fall risk and so forth.
Despite palliative care being used by 50%+ older adults, PTs are rarely involved in advanced planning processes. Researchers recommend PTs should be involved in recognizing when a patient may need ongoing PT services. And act as an advocate for the patient when they are in need of receiving maintenance PT care.
39% of older adults are transferred between 2 or more different settings during the 30 day discharge period. Being that this is the case, continuity of care is often fragmented. It is proposed that PTs can improve continuity of care by being involved in standardized reporting (as mentioned above) so that communications are streamlined to coordinated care. And also in the development of standards to ensure provider continuity during the 30-day transition period.
Evidence indicates a patient’s physical function is only included in 19 to 26% of discharge summaries. Further to this, PT recommendations are completely missing from an average 55% of discharge summaries. This impacts the coordination of community rehab services and results in readmissions. This is particularly the case for elderly adults where the unresolved functional biomarkers can lead to further disability, readmission and even death.
Discharge planning is one of the most important factors in successful transition for patients. It has been proposed that PTs should play a greater role in the provision of discharge education during the patient’s stay. For instance, PTs are equipped to communicate complex conditions to patients in a way that people understand.
Overall, there is a need for PTs to assume a larger role, particularly in regard to older adults and their functional capacity. And for other professionals such as physicians, nurses, and pharmacists to recognize the role that PTs can play so everyone can work collaboratively to reduce avoidable hospital readmissions.