Discharge Decision Making and the Contemporary Weighting of Clinical and Contextual Factors: A Survey of Acute Care Physical Therapists

Importance Physical therapists routinely make discharge recommendations for patients in the hospital, yet the reasoning that drives these decisions is poorly characterized. Objective The objective was to describe contemporary acute care physical therapists’ discharge reasoning and examine associations between reasoning constructs and recommended discharge intensity. Design This study used a cross-sectional clinical vignette-based survey. Therapists provided a discharge recommendation and supporting rationale. Free-text rationales were analyzed using directed content analysis, and quantitative associations between coded reasoning constructs and discharge recommendation intensity were examined using regression modeling. Setting The survey was conducted electronically with United States physical therapists practicing in hospitals. Participants Participants were eighty-nine acute care physical therapists who completed discharge recommendations and free-text rationales for 10 vignettes. Interventions none Main outcomes The three main outcomes for this study included: (1) Frequency and co-occurrence of coded reasoning constructs; (2) therapist-level reasoning profiles; and (3) associations between constructs and discharge intensity. Results Across 1604 construct code applications, 3 constructs dominated discharge reasoning: therapist prior experience (29.6%), patient functioning and disability (26.3%), and patient life context (25.3%). The majority (69.7%) of therapists demonstrated mixed reasoning patterns while less than one-third demonstrated a dominant reasoning profile. Patient functioning and disability was the only construct statistically associated with recommending more intensive post-acute care in ordered (OR = 1.70; 95% CI = 1.22–2.39) and binary (OR = 2.21; 95% CI = 1.30–3.74) models. Conclusions Acute care discharge reasoning concentrates on functional status, professional experience, and patient life context, with other domains functioning mainly as situational amplifiers. Relevance A refined framework for discharge reasoning may support clearer interdisciplinary communication, inform targeted education, and guide efforts to optimize post-acute care utilization.