Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services

Carmen E. Capo-Lugo, Kevin H. McLaughlin, Bingqing Ye, Kelly Daley, Daniel Young, Annette Lavezza, Michael Friedman, Erik H. Hoyer

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services. Design: Retrospective cohort analysis of admissions from December 2016 to September 2019 Setting: Medicine, neurology, and surgery units (n=47) at a tertiary hospital. Participants: We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients). Interventions: Not applicable. Main Outcome: We examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit. Measures: Patient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or “6 clicks”) inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting). Results: Using an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults. Conclusions: Nursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.

Original languageEnglish (US)
Pages (from-to)1402-1408
Number of pages7
JournalArchives of physical medicine and rehabilitation
Volume104
Issue number9
DOIs
StatePublished - Sep 2023

Keywords

  • Health services research
  • Hospital medicine
  • Patient safety
  • Quality improvement (D058996)
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

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