SHM Converge Scientific Abstract ePoster Gallery-Reducing Inappropriate Inpatient Physical Therapy Consults: A Novel Approach

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This study addressed inappropriate inpatient physical therapy (PT) consultation, which can waste a limited resource, increase costs, and delay care for patients who most need PT. At baseline, an academic hospital found that about 23.9% of PT consults were inappropriate, defined by an AM-PAC “6-Clicks” Basic Mobility score of 22 or higher. The project aim was to reduce inappropriate PT consults to below 10% across all inpatient services.<br /><br />The team analyzed retrospective electronic medical record data from April 2020 to November 2021, mapped the PT ordering process, and conducted a multidisciplinary root cause analysis involving nurses, physical therapists, informaticists, and physicians. Three main causes were identified: providers were unfamiliar with the AM-PAC tool, routine patient interactions did not always reveal true mobility status, and PT was often ordered at the bedside nurse’s request.<br /><br />A two-phase intervention was designed. First, the electronic health record PT order was modified with help from a clinical informaticist. Second, PT ordering responsibility was shifted primarily to nursing staff, while other providers could still order PT if needed.<br /><br />Results showed that the EMR change alone did not significantly reduce inappropriate consults. However, after the nursing-based intervention was implemented, inappropriate PT consults dropped sustainably to 10%, with statistical significance (p = .0019).<br /><br />The study concluded that combining clinical decision support with redistribution of ordering responsibility to nurses can significantly improve appropriate PT use. Future work will examine effects on hospital length of stay and staff satisfaction.

Asset Subtitle

Tiffany A. Gardner

Meta Tag

Author List Angela Keniston, Christopher White, Emily Gottenborg, Moksha Patel, Tiffany A. Gardner

Category Research

Concept Inappropriate Inpatient Physical Therapy Consult

Concept AM-PAC 6-Clicks Basic Mobility Score

Concept Cost

Concept Delay in Care

Concept Resource Utilization

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Tiffany A. Gardner

Track Quality Improvement

Keywords

inpatient physical therapy

inappropriate consults

AM-PAC 6-Clicks

electronic medical record

clinical informatics

nursing intervention

root cause analysis

hospital resource utilization

care delays

consult ordering process

Inappropriate Inpatient Physical Therapy Consult

AM-PAC 6-Clicks Basic Mobility Score

Cost

Delay in Care

Resource Utilization