Reducing Physical Therapy Consults for Patients With High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Difference Analysis.
Maylyn Martinez, Matthew Cerasale, Mahnoor Baig and 9 others
PMID 37669704WHAT IT FOUND
Embedding a mobility score alert in physician notes reduced physical therapy consults for high-mobility patients by 7% without worsening their functional recovery.
This suggests clinicians can safely withhold PT referrals for these patients if they use objective mobility data to guide decisions.
Key findings
01The intervention group had 27% lower odds of PT referrals for patients with high basic mobility compared to controls after the tool implementation.
02There was no significant difference in mobility change during hospitalization for high-mobility patients who did not receive PT referrals before versus after the intervention.
03The clinical decision support tool was designed to provide daily education to ordering providers rather than blocking PT consults at the point of ordering.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study coincided with the start of the COVID-19 pandemic, which may have independently changed PT ordering practices and patient behaviors, although statistical weighting attempted to adjust for this. The tool provided education and suggestions but did not block PT orders, so providers could still override the recommendation. The study did not assess long-term outcomes such as discharge destination, readmission rates, or post-discharge disability. Results may not generalize to institutions without existing standardized AM-PAC training for nursing staff. The study excluded oncology and hepatology services, so findings apply to general medical, transplant, and cardiology patients.
Declared interests
The study was supported by the National Institutes of Health (Extramural). No other conflicts of interest were reported.
The easy way to misread this
Do not assume that withholding PT is safe for all high-mobility patients. The benefit was seen only when providers used objective AM-PAC scores to identify patients at functional baseline. Without this data-driven approach, or for patients with new deficits despite high scores, reducing PT could miss necessary rehabilitation.