Physical and occupational therapy (PT/OT) services are a limited resource in the inpatient setting. PT/OT consults ordered by resident physicians on patients who do not need them take time and resources away from patients more deserving of skilled rehab services.
Our objective was to understand utilization of PT/OT services on our medical floors, identify opportunities for improvement, and implement interventions that would help deliver PT/OT services to patients who need them most. In particular, we aimed to decrease inappropriate consults, that is, consultations requested on patients who did not need PT/OT services for reasons outlined below. We also sought to evaluate what effect this would have on time taken for PT/OT personnel to complete consultations they received, as we had observed that several evaluations were delayed beyond the ideal 24‐hour period.
We started by collecting data on all physician orders for PT/OT services placed on our hospital's general medical floors over a 5‐week period. For every order, a therapist subjectively evaluated the appropriateness of consultation and collected other data points using predefined objective criteria (data collection tool below). We detected several areas for improvement including inappropriate consults, time to consult completion, and down‐prioritization of consults because of volume. We intervened by undertaking additional resident physician education and implementing daily collaboration between residents and physical/occupational therapists. We subsequently collected postintervention data. We collected data on 306 PT/OT consults before intervention and 296 consults postintervention. We noticed a reduction in inappropriate consults from 18% to 12% after our interventions. The major reasons consults were deemed inappropriate was that the patients were either too independent or too dependent to warrant PT/OT services. There was a reduction in the number of consults, in which time to consult completion > 48 hours went from 33.5% to 25.7%. A significant number of consults continued to be down‐prioritized by volume (∼56%).
We improved certain aspects of the PT/OT consult process, which could potentially decrease duration of hospitalization and cost. There continued to be room for improvement in facilitating consult completion within 24 hours and reducing down‐prioritization. We plan to continue resident education regarding the process as a means of facilitating efficient utilization of PT/OT services. We found it difficult to sustain daily collaboration between residents and therapists given work schedule and geographic constraints.