Determining the timing of consultations with physical and occupational therapists (PT/OT), the appropriate objective measure to use, and justification for discharge to inpatient post-acute rehab are all complexities care teams share. The initiation of therapy during a hospital stay is influenced by the acuity and stability of the medical concern, alongside the perceived gap between patients’ current and baseline functioning. These factors, however, may not provide the best gauge of when to assess patients’ functioning to determine where they can pursue functional rehabilitation after acute care. After the pioneering work by the Cleveland Clinic team, we establish a need to reconsider timing of therapy as it relates to recommendations for post-acute care (Johnson et al., 2024).
After a needs assessment survey, the rehabilitation and nursing teams identified a need to educate the frontline team on the AMPAC 6 Clicks. This involves raising awareness during discharge planning huddles with a PT Clinical Educator. The Educator leads discussions on therapy consults and discharge plans based on patients' functional deficits using the AMPAC. Retrospective and prospective data were gathered before and concurrently with this process. A comparative analysis of both data sets was conducted by the Clinical Educator and the PT Supervisor.
Admission & Rehab Consultation dates, AMPAC scores, and Discharge Destination data were collected from 2023 and 2024 samples (n=100 yearly). AMPAC minimal clinically significant difference is 4.5 (Hoyer et al., 2018).
2023 data showed that PT consultations were requested 2 days from admission, with 1.38 point average increase in their reported AMPAC at discharge. The typical discharge recommendation was for sub-acute rehab.
In 2024 the length of stay was 8 days; 1 day average from Admission to Rehab consultation. Change in the AMPAC scores was 2.39. Discharge to Sub-acute Rehab is most common.
This data collection and analysis had shown the need to quantify descriptors of function in relation to a patient’s mobility or lack thereof. Education and facilitated discussions with multi-disciplinary team during ‘huddles’ showed improved communication and timely consults by PT/OT when utility of AMPAC was optimized. This demonstrated a decrease in length of stay and curtailed further debility during the hospital admission.
The findings challenge the common assumption that discharge planning and rehabilitation services move along but separately from medical optimization. The proposal is to synchronize discharge planning and medical optimization from admission and subsequently dovetail to rehabilitation services consults for medically stable patients, with objective measures of function that ultimately reflect resolving medical need. This approach has the potential to enhance patient throughput and reduce unnecessary costs in patient care.
Discharge Planning
Quality Improvement
