Improving Access to Physical Therapy Services in an Acute Care Setting

Background The role of physical therapy (PT) in the acute care setting is to facilitate discharge planning and promote mobility, as well as provide follow-up treatment sessions to maximize patients’ functional status prior to discharge. A hospital workgroup, created to increase patient discharges to home, identified that PT was not meeting the recommended frequencies for treatment sessions. This prompted further investigation on how to best increase PT presence and in turn positively impact metrics such as discharge to home and reduced length of stay. A new multidisciplinary workgroup was established for this project to assess the current workflows and to identify areas of opportunity for process improvement. Local Problem In fiscal year 2023 (FY23, July 1, 2022, to June 30, 2023), our hospital met only 43% of recommended PT treatment frequencies for medical and medical-surgical patients prior to discharge. The workgroup also found that providers were placing preselected orders stating “deconditioning” as the reason for 40% of the total PT consults. To address these problems, our initiative aimed to increase PT treatment sessions to 60% and eliminate the vague deconditioning referrals to mitigate inappropriate consults, thereby standardizing the consult process and optimizing PT utilization. Methods The improvement capability model of the Institute for Healthcare Improvement (IHI) was used to create the framework, and Plan-Do-Study-Act (PDSA) was applied to test any changes in ideas. Our strategy focused on a framework of engagement and implementation. Interventions Engagement targeted a multidisciplinary team that met monthly, resident town halls, individual departmental staff meetings, and email communication to explain the project and prepare referring providers that they would be required to input clearly identified reasons for consulting PT. The implementation phase established criteria for providers and residents on appropriate reasons for a PT consult and required them to physically examine the patient prior to generating a PT consult. Optimizing the workflow with the consult process reduced unnecessary consults and increased opportunity for PT follow-up/treatment sessions prior to discharge. By implementing these changes, physical therapists were able to improve their efficiency with the chart review process to triage consults, leaving increased opportunity to follow up with patients on the existing caseload. Results In June 2024, one year after the project launched, the treatments completed by physical therapists increased from 43% to 66%. In addition, stating deconditioning as the reason for consult decreased from 40% to 1%. This initiative successfully boosted follow-up PT treatments and reduced vague deconditioning referrals by improving consult clarity and triage protocols. Conclusion Our project demonstrates that standardization of provider consults is an effective organizational strategy to reinforce the necessity of physical examination prior to generating a consult, as it reduces the occurrence of unnecessary consults that ultimately limit the efficiency of the interdisciplinary team. These results suggest that specific PT orders and clear workflows enhance resource allocation, which warrants continued efforts and broader implementation to sustain improvements and assess long-term impacts on patient outcomes regarding length of stay and discharge environment. Plain Language Summary Physical therapy (PT) is an important step on patients’ journey to recovery after receiving care in the hospital. The right amount of PT is different for each patient, but it can improve their mobilization and outcomes, while decreasing the length of their hospital stay and the likelihood of having to return to the hospital. So, when a workgroup at one acute care facility realized that they were not providing the recommended frequencies of PT treatment, they formed a multidisciplinary team to understand why and suggest improvements. The team determined that there were no standard protocol or clear workflows for PT consults, leading to inefficient and inappropriate treatment; for example, 40% of PT consults were being ordered generically with the preselected reason “deconditioning.” Recognizing the need for PT referrals that reflect the patients’ specific challenges and the therapies needed to address them, the facility created criteria for PT consults, updated order sets (including removing deconditioning as a reason for referral), and educated providers on best practices. These interventions to enhance efficiency and resource allocation reduced the number of vague or inappropriate consults from 40% to as low as 1% and increased the proportion of PT treatment sessions from 43% to 66%—surpassing the team’s goal of 60%.