scholarly journals Understanding the Relationship Between Physical Therapist Participation in Interdisciplinary Rounds and Hospital Readmission Rates: Preliminary Study

2016 ◽  
Vol 96 (11) ◽  
pp. 1705-1713 ◽  
Author(s):  
Zahra Kadivar ◽  
Alexis English ◽  
Brian D. Marx
Keyword(s):  
Physical Therapists ◽  
Physical Therapist ◽  
Interdisciplinary Team ◽  
Small Sample ◽  
Discharge Process ◽  
Readmission Rates ◽  
Medical Diagnoses ◽  
Discharge Disposition ◽  
The Relationship

Abstract Background Providing patients with optimal discharge disposition and follow-up services could prevent unplanned readmissions. Despite their qualifications, physical therapists are rarely represented on the interdisciplinary team. Objective This study aimed to determine the relationship between the participation of physical therapists in interdisciplinary discharge rounds and readmission rates. Methods In this retrospective observational study, patients discharged by 2 interdisciplinary teams with or without a physical therapist's participation were followed for 5 months. Adherence to the physical therapist's recommendations for follow-up services and unplanned 30-day readmissions were tracked. Multiple logistic regression and random forest models were used to determine factors contributing to 30-day readmission rates. Results The odds of 30-day readmissions were 3.78 times greater when a physical therapist was absent from the interdisciplinary team compared with the odds of 30-day readmissions when a physical therapist participated in the interdisciplinary team. In addition, the odds of 30-day readmission for patients discharged to their home were 2.47 times greater than those who were not discharged to their home. An increased lack of postdischarge services was noted when a physical therapist was not included in the interdisciplinary team. Limitations The nonrandom selection of patients into groups, the small sample size, and the inability to adjust risk for unknown factors (eg, medical diagnoses, comorbidities, funding, and functional measures) limited interpretation of the results. Conclusion Significantly higher readmission rates were noted for patients whose interdisciplinary team did not have a physical therapist and for those patients who were discharged to their home. These preliminary findings suggest that discharge from the acute care setting is an elaborate process and should be designed carefully. In order to identify the optimal discharge process, future research should account for patient complexities in addition to the composition of the interdisciplinary discharge team.

scholarly journals The Relationship of Role-Related Variables to Job Satisfaction and Commitment to the Organization in a Restructured Hospital Environment

2002 ◽  
Vol 82 (10) ◽  
pp. 984-999 ◽  
Author(s):  
Rosalie B Lopopolo
Keyword(s):  
Job Satisfaction ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Professional Role ◽  
Positive Influence ◽  
Hospital Environment ◽  
Occupational Commitment ◽  
Hospital Restructuring ◽  
The Relationship ◽  
Role Behaviors

AbstractBackground and Purpose. Many factors in today's hospitals can influence how physical therapists view their work experience. Changing roles, with the accompanying stress, and professionalism may contribute to a therapist's perception of his or her job and the organization in which he or she works. In this study, the relationship between changes in physical therapist role behaviors following hospital restructuring and 2 work-related outcomes—job satisfaction and commitment to the organization—was studied. The influence of stress and occupational commitment on these outcomes also was examined. Subjects and Methods. Through a survey of 273 hospital-based physical therapists, changes in physical therapist role behaviors, levels of stress, occupational commitment, job satisfaction, and commitment to the organization following restructuring were identified and examined. Results. Six role behavior dimensions reflecting professional and organizational responsibilities were identified from the data. After controlling for sample demographics, the professional role behaviors, specifically those reflecting interaction and integration with other practitioners, appeared to exert a small, but positive, influence on job satisfaction and commitment to the organization. In addition, occupational commitment had a positive influence, whereas stress had a negative influence on job satisfaction and commitment to the organization. Discussion and Conclusion. Multiple aspects of a clinician's role could influence job satisfaction and commitment to the organization following hospital restructuring. The most influential factor was stress, which often accompanies organizational change. However, the positive influence of occupational commitment and the role behaviors that involve increased interaction with other people were noted and reflect professional role characteristics described in the Guide to Physical Therapist Practice.

MO508HEMATOCRIT, UREA AND GENDER (HUGE) EQUATION AND CARDIOVASCULAR EVENTS: A PROSPECTIVE STUDY IN SPANISH POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Bárbara Cancho Castellano ◽  
Nicolas-Roberto Robles Perez-Monteoliva ◽  
Francisco Javier Felix Redondo ◽  
Luis Lozano ◽  
Daniel Fernandez-Berges
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Small Sample ◽  
Major Adverse Cardiovascular Events ◽  
Free Survival ◽  
And Gender ◽  
A Prospective Study ◽  
The Relationship

Abstract Background and Aims To evaluate the relationship between chronic kidney disease (CKD) diagnosed by the hematocrit, urea and gender (HUGE) equation and the incidence of major adverse cardiovascular events and cardiovascular mortality in a sample of Spanish general population. Method The sample consisted of 2,668 subjects (mean age, 50.6±14.5 years; 54.6% were female). Of them, 55 patients have a HUGE score > 0. The median follow-up was 81 (75-89) months. Serum creatinine, urea and haematocrit were analyzed after overnight fast.  The HUGE formula score was calculated for all subjects.  Results Event-free survival was 98.4 % at three years and 97.1% at five years of follow-up for patients with a HUGE score < 0. For patients with a estimated HUGE score higher than 0 survival was 88.9% at three years and 87.0 at five years of follow-up. (p<0.0001). Cardiovascular death survival was 94.4 % at three and 88.0 at five years of follow-up for patients with a HUGE score higher than 0. For patients with a estimated HUGE. score lower than 0 survival was 99.3% at three years, and 99.0% at five years of follow-up. (p<0.001). Conclusion A significantly increased cardiovascular risk was associated to the diagnosis of CKD through HUGE formula. This effect on survival could be detected despite of a very small sample of CKD patients. This relationship was close to those obtained using MDRD estimated GFR in a bigger sample of patients. HUGE formula may be a useful tool for diagnosing CKD and to evaluate the cardiovascular risk of these patients.

scholarly journals Simulation Experience Enhances Physical Therapist Student Confidence in Managing a Patient in the Critical Care Environment

2013 ◽  
Vol 93 (2) ◽  
pp. 216-228 ◽  
Author(s):  
Patricia J. Ohtake ◽  
Marcilene Lazarus ◽  
Rebecca Schillo ◽  
Michael Rosen
Keyword(s):  
Critical Care ◽  
Student Satisfaction ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Small Sample ◽  
Care Environment ◽  
Skill Performance ◽  
Physical Therapist Students ◽  
Physical Therapist Student ◽  
Student Confidence

Background Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. Objective The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. Design A one-group, pretest-posttest, quasi-experimental design was used. Methods Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Results Students' confidence in their technical, behavioral, and cognitive skill performance increased from “somewhat confident” to “confident” following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations Limitations of the study were the small sample from one university and a control group was not included. Conclusions Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.

Abstract WP388: Inpatient Teleneurology Follow-Up Has Similar Outcomes to In-Person Neurology and Provides an Alternative to Transfer

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alyssa D Trevino ◽  
Alicia M Zha ◽  
Christy M Ankrom ◽  
Kristie M Chu ◽  
Michele M Joseph ◽  
...  
Keyword(s):  
Stroke Care ◽  
Stroke Severity ◽  
Complication Rates ◽  
Acute Stroke Care ◽  
Readmission Rates ◽  
Discharge Disposition ◽  
Care Access ◽  
Black Patients ◽  
Hispanic Patients

Introduction: Community emergency departments (EDs) often transfer ischemic stroke (IS) patients for lack of neurology coverage, burdening patients and accepting facilities. Telestroke (TS) improves acute stroke care access, but data lack on inpatient teleneurology follow-up (TNF) care. We hypothesized that IS patients evaluated in the ED via TS, then admitted and managed by TNF, have similar outcomes to those seen by in-person neurology follow-up (IPF) after admission. Methods: In our spoke EDs, 4069 IS patients were seen via TS (9/2015-12/2018). Figure 1 demonstrates hospital stroke designations and patient triage patterns. Transfer was at ED discretion. We compared baseline demographics, clinical characteristics, and hospital outcomes in patients with TNF vs IPF. Results: There were 447 (23%) patients with TNF and 1459 (77%) IPF. Both groups presented with similar stroke severity (Table 1). In multivariate analysis, there were no significant differences in discharge disposition, stroke readmission rates, or 90-day mRS; length of stay was shorter with TNF. tPA-only patients showed no differences in outcomes and similar complication rates. TNF patients less likely received tPA or endovascular therapy. TNF resulted in a 3% transfer rate for higher level of care. There remained no difference in outcomes in a sub-analysis without CSCs. A higher proportion of non-Hispanic Black patients and lower proportion of Hispanic patients in the TNF group were possibly due to spoke demographics. Conclusion: TNF resulted in comparable outcomes to IPF and few transfers after admission. For select IS patients, TNF provides an alternative to transfer for hospitals lacking neurology coverage.

scholarly journals A241 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 118-119
Author(s):  
F Dang ◽  
P Habashi ◽  
Z Gallinger ◽  
G C Nguyen
Keyword(s):  
Medication Adherence ◽  
Hospital Discharge ◽  
Hospital Readmission ◽  
Practice Nurse ◽  
Intervention Group ◽  
Small Sample ◽  
Control Group ◽  
Post Discharge ◽  
Readmission Rates

Abstract Background Hospital readmission rates are high in the IBD population, with 20% of patients readmitted within the same calendar year. Hospital discharge processes are not routinely standardized and deficiencies in the transition of care after discharge puts patients at increased risk of illness, hospital utilization and healthcare cost. In addition to increased healthcare expenditure, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism and infection. Aims We hypothesize that implementing standardized follow-up by an IBD practice nurse and electronic health outcome monitoring through NoviSurvey can reduce the risk of hospital readmission compared to current approaches of hospital discharge alone. Methods This parallel randomized control trial is powered for N=400 and will include patients admitted for an IBD flare without requiring surgical intervention from the gastroenterology service or consulted from general internal medicine. Patients randomized to the control arm are discharged with usual standard of care. Patients in the intervention group will be eligible for usual post-discharge care in addition to organized telephone follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. In addition, these patients will receive bi-weekly correspondence from NoviSurvey to complete a short questionnaire on clinical disease severity and medication adherence. Based on telephone interaction and survey scores, the IBD nurse may arrange readmission or expedited ambulatory visit for high-risk patients. Results 15 patients are currently enrolled into our study, with 7 randomized to the intervention and 8 to the control group. In the control group, 25% of patients were readmitted to hospital within 30 days of discharge and 13% failed to follow their steroid taper. There were no patients in the intervention group who were readmitted to hospital within 30 days and none who failed their steroid taper. In both the control or intervention group, there were no occurrences of deep vein thrombosis within 30 days post-discharge. Conclusions The preliminary findings in our small sample study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates to hospital, better patient satisfaction and better medication adherence. Funding Agencies CCC

A Performance Improvement Initiative for Implementing an Evidence-Based Discharge Bundle for Lung Transplant Recipients

2020 ◽  
Vol 30 (3) ◽  
pp. 281-285
Author(s):  
Sarah Fitz ◽  
Lauren Diegel-Vacek ◽  
Erin Mahoney
Keyword(s):  
Hospital Readmission ◽  
Lung Transplant ◽  
Discharge Process ◽  
Day Hospital ◽  
Transplant Recipients ◽  
Readmission Rates ◽  
Team Members ◽  
Hospital Readmission Rates ◽  
Lung Transplant Recipients

Background: Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates. Local Problem: A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population. Methods: A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team. Interventions: The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge. Results: The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle. Conclusions: Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.

scholarly journals The relationship of posture and dental health

1991 ◽  
Vol 17 (3) ◽  
pp. 8-10
Author(s):  
Dawn MacConkey
Keyword(s):  
Health Problem ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Dental Health ◽  
The Body ◽  
Relationship Of ◽  
The Relationship ◽  
Over Time ◽  
Dental Professionals

Summary: Poor posture is not thought of as an injury or health problem. However, over time, the dysfunction can lead to degeneration and its net effect can be as damaging as an injury. When the occlusion is malaligned, a compensating effect takes place through the postural chain and the body must adjust. This can often affect the work of dental professionals, possibly causing a failure in their procedures if not addressed. Early postural screening by a physical therapist can aid in the prevention of postural dysfunctions. Physical therapists should be an integral part of the program for dental professionals.

Cluster headache is associated with an increased risk of depression: A nationwide population-based cohort study

Cephalalgia ◽  
2012 ◽  
Vol 33 (3) ◽  
pp. 182-189 ◽  
Author(s):  
Jen-Feng Liang ◽  
Yung-Tai Chen ◽  
Jong-Ling Fuh ◽  
Szu-Yuan Li ◽  
Chia-Jen Liu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cluster Headache ◽  
Population Based ◽  
Small Sample ◽  
Cross Sectional ◽  
Increased Risk ◽  
Taiwan National Health Insurance ◽  
Small Sample Sizes ◽  
The Relationship

Objective To investigate whether cluster headache (CH) was a risk factor for depression in a nationwide population-based follow-up study. Background There are few studies about the relationship between CH and depression, and prior research has been limited by cross-sectional studies or small sample sizes. Methods We identified 673 CH patients from the Taiwan National Health Insurance database between 2005 and 2009. The two comparison cohorts included age-, sex- and Charlson’s score-matched migraine patients ( n = 2692) and controls (patients free from migraine or CH, n = 2692). The cumulative incidence of depression was compared among these three cohorts until the end of 2009. We also calculated predictors of depression in the CH cohort. Results After the median 2.5-year follow-up duration, the CH cohort had a greater risk for developing depression compared to the control cohort (adjusted hazard ratio; aHR = 5.6, 95% CI 3.0–10.6, p < 0.001) but not the migraine cohort (aHR = 1.1, 95% CI 0.7–1.7, p = 0.77). Of the CH patients, the number of cluster bout periods per year was a risk factor for depression (aHR = 3.8, 95% CI 2.6–5.4, p < 0.001). Conclusion Our results showed that CH is associated with an increased risk for depression. The strength of this association is similar to that of migraine.

scholarly journals Physical Therapist Practice in the Emergency Department Observation Unit: Descriptive Study

2015 ◽  
Vol 95 (2) ◽  
pp. 249-256 ◽  
Author(s):  
Laura Plummer ◽  
Sowmya Sridhar ◽  
Marianne Beninato ◽  
Kristin Parlman
Keyword(s):  
Emergency Department ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Massachusetts General Hospital ◽  
Patient Characteristics ◽  
Descriptive Study ◽  
Observation Unit ◽  
Billing Data ◽  
Medical Diagnoses ◽  
Discharge Disposition

Background An upward trend in the number of hospital emergency department (ED) visits frequently results in ED overcrowding. The concept of the emergency department observation unit (EDOU) was introduced to allow patients to transfer out of the ED and remain under observation for up to 24 hours before making a decision regarding the appropriate disposition. No study has yet been completed to describe physical therapist practice in the EDOU. Objective The objectives of this study were: (1) to describe patient demographics, physical therapist management and utilization, and discharge dispositions of patients receiving physical therapy in the EDOU and (2) to describe these variables according to the most frequently occurring diagnostic groups. Design This was a descriptive study of patients who received physical therapist services in the EDOU of Massachusetts General Hospital during the months of March, May, and August 2010. Methods Data from 151 medical records of patients who received physical therapist services in the EDOU were extracted. Variables consisted of patient characteristics, medical and physical therapist diagnoses, and physical therapist management and utilization derived from billing data. Descriptive statistics were used to analyze data. Results The leading EDOU medical diagnoses of individuals receiving physical therapist services included people with falls without fracture (n=30), back pain (n=27), falls with fracture (n=22), and dizziness (n=22). There were significant differences in discharge disposition, age, and total physical therapy time among groups. Limitations This was a retrospective study, so there was no ability to control how data were recorded. Conclusions This study provides information on common patient groups seen in the EDOU, physical therapist service utilization, and discharge disposition that may guide facilities in anticipated staffing needs associated with providing physical therapist services in the EDOU.

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