Defining Potential Overuse of PT Consults on Hospital Medicine Services
Clinical question: Are physical therapy (PT) consults overused in patients who are at low risk for loss of mobility during hospitalization?
Background: Hospital-associated disability can be dangerous and costly, but can be prevented by early mobilization. PT, a constrained inpatient resource, is primarily responsible for the mobilization of hospitalized patients. No studies have used a validated physical function tool to measure the impact of PT consults on discharge mobility or destination.
Study design: Retrospective cohort study
Setting: University of Chicago Medical Center, Ill.
Synopsis: Calculating the Activity Measure-Post Acute Care Inpatient Mobility (AM-PAC) score for 3,592 patients admitted to direct-care hospital medicine teams over a one-year period, this study found that of the patients with a high AM-PAC score (>43.63) on admission, 89% (P <0.001) were discharged home with physical therapy being consulted on 38% of these patients. Additionally, the authors found patients admitted with a low AM-PAC score (≤43.63) gained mobility during their hospitalization (+5.69 on discharge AM-PAC score). Patients at high risk for loss of mobility during hospitalization will be most impacted by a physical therapy consult.
Bottom line: Using a standardized mobility scoring system on admission, such as AM-PAC, may help to appropriately allocate PT resources for patients whose outcomes will be impacted.
Dr. Apodaca
Citation: Martinez M, et al. Defining potential overutilization of physical therapy consults on hospital medicine services. J Hosp Med. 2021;18. doi: 10.12788/jhm.3673.
Dr. Apodaca, @krystleapodaca, is a nurse practitioner hospitalist and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.