Background: Currently, Physical and Occupational Therapy (PT/OT) documentation dictates next site of care. PT/OT recommends how much therapy is needed upon discharge and where the therapist believes these services should be provided, which is often a Skilled Nursing Facility (SNF). This practice eliminates meaningful conversations between provider and patient regarding the patient’s wishes on next site of care choices. Patients would most often choose home instead of a SNF. This pilot goal was to eliminate PT/OT next site of care recommendations, decrease discharges to a SNF and increase discharges to home within three months post implementation.

Methods: A multidisciplinary team consisting of PT/OT Leadership, Hospitalist service, Care Management, Home Health and Hospital Administration was assembled. The team provided input to assist PT/OT Leadership in making changes to their documentation. From Nov 1, 2016 through Jan 31, 2017 PT/OT altered their Electronic Medical Record template for all patients to eliminate next site of care recommendations. New therapy documentation focused on how much and often therapy would be needed at discharge. Meetings were held to educate Hospitalists and Care Managers by providing examples of new therapy documentation. PT/OT documentation no longer included a next site of care recommendations, so emphasis was placed on provider and patient conversations to optimize home discharges using the new therapy documentation. The baseline period was defined from January 2016 through September 2016. There were 1170 and 371 patients in Baseline and Comparison periods respectively.

Results: In the comparison period there was a decrease in patients that were discharged to a SNF (25% to 20%, p=0.03) and increase in patients that were discharged to home (54% to 61%, p=0.032) (See Figure 1).

Conclusions: Hospital administration found the new process to be successful and thus it is being adopted by other facilities as a best practice. Many providers however, mistakenly believe that if they do not follow PT/OT recommendations they might be liable. Therefore, ongoing education is imperative. Work will continue to be done on early patient mobilization to decrease PT/OT evaluation orders, increase home health utilization, and optimize home discharges. We were able to engage the PT/OT Leadership by sharing data on SNF discharges, readmissions and outcomes. This pilot has become a sustained change in practice at our site and we recommend piloting this change in therapy documentation at additional sites.

IMAGE 1: Discharges to Skilled Nursing Facilities and Home Before and After Pilot Implementation