Can physical therapy intervention in the emergency department positively influence patient-reported falls and return visits for the same condition?

Transcription

1 Can physical therapy intervention in the emergency department positively influence patient-reported falls and return visits for the same condition? Stacie Fruth, PT, DHSc, OCS Megan Dennis, PT, DPT Kyle Katz, PT, DPT Kirstin Stein, PT, DPT Michael Brickens, PT Kirk Mulroney, PT, DPT, MPH

2 Introduction Physical therapy practice in the emergency department (ED) is not widely understood What do you do there? Paucity of published research Many descriptive in nature emains valuable as the practice evolves Experimental studies needed

3 Introduction esearch specific to PT in the ED Evidence suggests: High patient satisfaction (Lau 2008, Sheppard 2010) educed wait time or LOS in the ED (Lau 2008, Taylor 2011) Free MDs for more critical patients (Jibuike 2003, Croft 2006) High ED MD satisfaction with ED PT (Lebec 2010, Fruth 2015) Independent mgmt of low-urgent conditions (degruchy 2015) Little evidence: Hospital admissions, return visits, cost effectiveness, long-term outcomes (Lau 2008, Jesudason 2012, ichardson 2005)

4 Introduction Falls are a common reason for ED visits Every 14s an older adult has a fall-related ED visit (NCOA 2014) Some preventable if underlying reasons addressed (NIH 2012) Fall prevention intervention is typical PT practice Unscheduled return visits International concern >15% related to musculoskeletal complaints (White 2010) PTs considered musculoskeletal experts (Childs 2005, Lebec 2009) Some return ED visits may be avoidable (ising 2014, Uscatescu 2014)

5 Study Purposes 1. Determine patient satisfaction with aspects of ED PT encounter 2. Compare reported falls prior to and following ED PT intervention 3. Compare reported return ED visit for same problem prior to and following ED PT intervention

6 Methods Participants recruited from IU-Methodist Hospital Level 1 trauma center PT coverage in the ED: ~80 hours/week >2500 patients seen by ED PTs/year Inclusion criteria: 18 years of age Understood English Available via phone for follow up eferred to ED PT

7 Methods Intake Demographics Falls in 3 months pre ED visit ED visits (same problem) in 3 months pre ED visit 2 weeks post ED visit Patient satisfaction with PT encounter Medical or rehabilitative follow up 3 months post ED visit Falls in 3 months post ED visit ED visits (same problem) in 3 months post ED visit

8 Data Analysis Descriptive statistics Demographic data Frequency analyses Satisfaction ratings Chi-squared tests Fallers vs. non-fallers Multi-visit users (same condition) vs. one-time users McNemar tests Pre- to post- within group differences

9 esults Intake (n = 224) Mean Age 47.3 years (18 101) {SD = 17.9} Female Male 144 (64%) 80 (36%) Insured Uninsured 140 (63%) 84 (37%) Had PCP No PCP 146 (65%) 78 (35%) Employed Unemployed Fell past 3 mo. No fall past 3 mo. 123 (55%) 101 (45%) 76 (34%) 148 (66%) X age = 54.8 X age = 43.5 } p = ED same problem (3 mo.) No ED same problem 64 (29%) 160 (71%)

10 esults 2-week follow-up 156 (69.7%) completed phone survey Satisfaction with ED PT encounter Survey Question ating 0 5 Likert scale (5=highly satisfied) Mean SD (ange) Information provided by ED PT ( ) ED PT ability to answer your questions ( ) ED PT level of care and concern ( ) Helpfulness of PT intervention ( ) Level of improvement since ED visit ( ) Overall satisfaction with PT ED encounter ( )

11 esults 2-week follow-up (n = 156) 66 (42.3%) sought follow-up care Discipline Primary care 33 Chiropractor 1 OP Physical therapist 28 Specialist 32 Emergency/Urgent Care 6 Number who sought care

12 esults 3-month follow-up (n = 129; 57.9% retention) Intake Data All subjects (n=224) etained (n = 129) Mean Age Female Male Insured Uninsured Had PCP No PCP Employed Unemployed Fell past 3 mo. No fall past 3 mo. ED same problem (3 mo.) No ED same problem 47.3 years (18 101) {SD=17.9} 144 (64%) 80 (36%) 140 (63%) 84 (37%) 146 (65%) 78 (35%) 123 (55%) 101 (45%) 76 (34%) 148 (66%) 64 (29%) 160 (71%) 48.8 years (18 92) {SD=17.1} 85 (66%) 44 (34%) 76 (59%) 53 (41%) 87 (67%) 42 (33%) 70 (54%) 59 (46%) 38 (30%) 91 (70%) 36 (28%) 93 (72%)

13 eported Falls Fell in the 3 months pre ED visit Intake (n = 224) Intake (n = 129) Fell in the 3 months post ED visit 3-month follow-up (n = 129) (34%) (30%) (11%) p = p = 0.000

14 eported ED Visit for Same Problem ED for same problem in the 3 months pre ED visit Intake (n = 224) Intake (n = 129) ED for same problem in the 3 months post ED visit 3-month follow-up (n = 129) (29%) (28%) (5%) p = p = 0.000

15 Discussion ED use is increasing ~1% yearly while hospital beds are decreasing (McClelland 2014) Prevention of unnecessary use, unnecessary repeat use is critical Falls are a common reason for ED visits Medical management identifies and treats injuries (Kalula 2006, Miller 2009) ED PT intervention: Underlying reason, education/prevention/safety, OP PT referral Patients satisfied with interventions and education esults: ED PT intervention may influence fall recurrence

16 Discussion Efforts to reduce return visits to the ED for the same condition are prevalent Common reasons for unscheduled returns (ising 2014, Uscatescu 2014) Fear or uncertainty about a condition Unanswered questions Not knowing path for follow up in the healthcare system ED PT intervention often focuses on educating about condition, identifying/reducing fears, and referral to OP PT as appropriate esults: ED PT intervention may influence return visits Patients happy with intervention and education

17 Limitations 42% lost to follow up (reasons) Lack of control group Falls and return visits were reported so could have been inaccurate eduction in falls and return visits could be due to natural course of improvement esults not generalizable to all EDs

18 Conclusions Patients are highly satisfied with ED PT care ED PT intervention may positively influence: ecurrence of falls Unscheduled return visits to the ED More research required

19 Acknowledgements University of Indianapolis IU-Methodist Hospital

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