Background: As the aging population with multiple comorbidities continues to grow in our country, appropriate resource utilization and efficiency of care remain a priority for many acute care facilities to reduce hospital acquired debility, healthcare costs, and improve patient experience. The physical therapist’s assessment of the patient’s functional capacity plays a crucial role in discharge planning and determining post-hospitalization disposition. Delays in assessment by physical therapy can lead to increased debility and length of stay (LOS) in the hospital. The “6 Clicks” functional assessment tool is a survey consisting of 12 questions, developed by the researchers at Boston University. It has been independently validated to assess 2 functional domains: the patient’s basic mobility and daily activities. The basic mobility questions address physical movement from one place to another such as rolling over in bed. The daily activities assess the ability to toilet, dress and perform other activities of daily living (ADLs). The “6 Clicks” functional assessment tool can be used by nursing staff or personal care assistants (PCAs) and its scores have shown to accurately predict post-hospitalization disposition.
Purpose: Our objective was to implement the “6 Clicks” functional assessment tool and assess its impact on the utilization, efficiency of physical therapy, and hospital LOS on our unit.
Description: The “6 Clicks” functional assessment tool was piloted on a 40 bed medical surgical unit at our hospital. Our project involved a multidisciplinary team approach including the nurses, physical therapy, lead hospitalist and case management. The unit nurse completed the functional assessment questionnaire for every patient on a daily basis from admission to discharge. The patient’s “6 Clicks” mobility score was recorded in the electronic medical record and discussed during daily interdisciplinary rounds (IDR) led by the lead hospitalist on the unit. Subsequently, a determination was made by the IDR team on whether or not the patient required a formal assessment by physical therapy. A score of less than 20 triggered a physical therapy consult unless the patient was bedbound. If the score was 20 to 24, the decision to place a physical therapy consult was at the discretion of the IDR team based on their clinical assessment of the patient. If the patient’s score was close to their baseline functional status, enrollment in our early ambulation program ensued.
Conclusions: Over the course of a 6 month period, we observed the number of “flags” or expedited physical therapy requests decreased by 15% after the implementation of the “6 Clicks” functional assessment tool on our unit. The overall rates of physical therapy consults decreased as well from 56% to 54%. In addition, the lag time between when the physical therapy consult was placed and the initial assessment completed was reduced from 37 hours to 27 hours. The average inpatient LOS, however, remained unchanged during the pre and post intervention periods. Therefore, the use of “6 Clicks” functional assessment tool and incorporating it into our daily IDR helped to mitigate the overutilization of physical therapy consults. Consequently, we were able to improve the efficiency with which the physical therapists were able to evaluate our patients.