Probasco John C, Lavezza Annette, Cassell Andre, Shakes Tenise, Feurer Angie, Russell Holly, Sporney Hilary, Burnett Margie, Maritim Chepkorir, Urrutia Victor, Puttgen H Adrian, Friedman Michael, Hoyer Erik H
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.
Neurohospitalist. 2018 Apr;8(2):53-59. doi: 10.1177/1941874417729981. Epub 2017 Sep 12.
Although many hospitalized neuroscience patients have physical and occupational therapy (rehabilitation) needs, patients with none or minimal physical impairments frequently receive rehabilitation consultation, diverting from patients with greatest need.
A multidisciplinary team on the general and cerebrovascular neurology acute inpatient services mapped the rehabilitation consultation process, resulting in multiple implemented interventions including physician education on appropriate acute rehabilitation consultations, modification of multidisciplinary rounds, and discussion of patient rehabilitation needs throughout hospitalization. Nurses used the same functional impairment measurement tool used by physical and occupational therapists, the Activity Measure for Post-Acute Care Inpatient Short Forms (Basic Mobility and Activity domains).
The rate for initial rehabilitation consults for patients with no limitations in mobility or activity during the 6-month baseline period was 12%, which was decreased to 7% and 10% during the 6-month intervention and sustain periods, respectively ( < .001). The baseline rate for patients with no limitations receiving both physical therapy and occupational therapy consultations was 62% and was decreased to 21% and 39% in the intervention and sustain periods, respectively ( < .001). Rehabilitation sessions per hospital day increased for patients with high functional impairments, from 0.52 at baseline to 0.64 in the intervention and 0.66 in the sustain periods ( = .02), which equated to 1 more rehabilitation visit per patient hospitalization.
A multifaceted intervention led to improved utilization of acute inpatient rehabilitation consultation while increasing the frequency of rehabilitation treatment for patients with highest functional impairment.
尽管许多住院的神经科学患者有物理治疗和职业治疗（康复）需求，但身体无损伤或损伤极小的患者却经常接受康复会诊，这使得最需要康复治疗的患者得不到相应治疗。
一个由普通神经内科和脑血管神经内科急性住院服务部门组成的多学科团队梳理了康复会诊流程，实施了多项干预措施，包括对医生进行关于适当急性康复会诊的教育、调整多学科查房方式，以及在患者整个住院期间讨论其康复需求。护士使用了与物理治疗师和职业治疗师相同的功能障碍测量工具，即急性后期护理住院患者简表（基本活动能力和活动领域）。
在6个月的基线期，行动或活动无限制的患者进行首次康复会诊的比例为12%，在6个月的干预期和维持期分别降至7%和10%（P<0.001）。行动无限制且同时接受物理治疗和职业治疗会诊的患者，基线期比例为62%，在干预期和维持期分别降至21%和39%（P<0.001）。功能障碍严重的患者，每天的康复治疗次数从基线期的0.52次增加到干预期的0.64次和维持期的0.66次（P=0.02），这相当于每位患者住院期间多接受了1次康复治疗。
多方面干预措施提高了急性住院康复会诊的利用率，同时增加了功能障碍最严重患者的康复治疗频率。
