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  • From PTJ: Study of 1 Hospital Finds Nearly 16% of Scheduled Physical Therapy Sessions Don't Happen

    In brief:

    • Study focused on a single hospital and reviewed 6,246 scheduled physical therapy sessions
    • Overall, 15.9% of scheduled sessions never occurred
    • Nontreatment was highest on Sundays (33.8%)
    • Authors caution against "quick fixes" such as prohibiting Sunday sessions; assert that PTs need to exercise clinical judgment to schedule when needed

    Researchers who tracked a hospital found that, on average, more than 15%--and as many as 1in 3--hospital physical therapy sessions never actually took place, depending on the reason for hospitalization and the day of the week treatment was scheduled. Authors of the study say that's too many, and if other facilities are facing the same issue, fixing the problem will require hospitals to address their "internal culture and weekend staffing policies" and not just look for quick fixes.

    Researchers examined all scheduled physical therapy sessions in a suburban community hospital to ascertain whether patient characteristics, as well as diagnosis and day-of-week, were associated with care not being provided. In addition, they surveyed the physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy technicians to obtain demographic data and information about their jobs, such as length of employment and number of evaluations performed per week. Results were published in the January issue of Physical Therapy (PTJ), APTA's scientific journal.

    Overall, of the 6,246 scheduled physical therapy sessions for 1,252 patients, 995 (15.9%) scheduled sessions did not result in treatment. Therapists did not document a reason for nontreatment in 38.8% of those instances. Patients with musculoskeletal conditions were slightly more likely to receive treatment, with an 89.17% rate of follow-through. Patients with other conditions received scheduled treatment around 80% of the time. Among all scheduled sessions, only 1.3% of the first scheduled sessions were never accomplished, but that rate rose to nearly 20% for remaining sessions.

    When broken down by day of scheduled treatment, researchers found that some days are better bets for receiving care than others. Tuesdays, for example, were more closely associated with receiving scheduled treatment, with an 87% follow-through rate. Sundays, however, were another story: researchers found that a staggering 33.88% of sessions scheduled for a Sunday never occurred. Because a high percentage of Sunday sessions also were not associated with a particular therapist, authors speculate that the greater percentage of per diem staff on weekends may be a factor in nontreatment.

    Authors acknowledge several limitations to the study, including the fact that data was limited to a single hospital (albeit 1 with a sizable dataset). Also not explored: the possibility that the therapists "spent a considerable amount of time attempting to find and schedule therapy with a patient before success, with multiple efforts to schedule and reschedule being involved."

    In calling for further research into the issue, the authors point to earlier studies that clearly support the benefits to both patients and the hospital system of providing physical therapy during a hospital stay. Those studies make the case that patients who receive physical therapy while in the hospital have reduced length of stay, lower rates of readmission, and fewer prescribed activity restrictions. As a result, health care costs decrease as well.

    But authors caution against looking for a “simple solution,” such as simply not scheduling patients for physical therapy on Sunday, in this hospital’s case. Doing so would limit the PT’s professional judgment regarding the “frequency and intensity of treatment,” they write, noting that weekend physical therapy, as well as early physical therapy for critically ill patients, have been proven to be beneficial to patients.

    The January issue of PTJ marks the publishing debut of APTA's partnership with Oxford University Press. PTJ is now housed on a new website that is responsive across all devices.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • Good morning, I'm curious to know if this study was done on hospital in patients only, or did the study combine in and out physical therapy patients? Thank you for your time. Regards, Bridgette Ireland

      Posted by Bridgette Ireland on 1/26/2017 8:12 AM

    • Thanks for the question Bridgette. This study was just hospital inpatients and did not consider their outpatient clinic. I did publish another paper which discusses this same type of issue in outpatient. Bokinskie J, Johnson P, Mahoney T, Young DL. Examination of the Failure of Patients to Show for Scheduled Appointments ( FSSA ) in Outpatient Physical Therapy Settings : A National Survey. PTJ-PAL. 2016;16(2):J1-J10.

      Posted by Daniel Young on 1/26/2017 7:13 PM

    • About 5 years ago I did a study for a Six Sigma training and found even more of a "cancel" rate for inpatient PT. We had therapists note reasons and had a very large sample size even though it was done in one hospital inpatient setting. We saw 25% "cancel" rate! Reasons had to do with patient not in room (at X-ray etc), with another provider when PT visited, patient refusal, patient sick.......etc. My original theory was that we need to schedule patient PT time in hospitals and coordinate with other providers, let patients know when we would be there, and hopefully decrease the "cancel" rates. PT's were NOT interested in that solution as they felt it was not possible and I think they liked to be less tied to a schedule which gave them a more flexible work day. Only the ortho floor and rehab unit scheduled patients and the "cancel" rates on those units were much lower.

      Posted by Ricci Susick -> AHSZC on 1/29/2017 6:47 PM

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