St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.
Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.
Disabil Rehabil. 2021 Oct;43(20):2846-2853. doi: 10.1080/09638288.2020.1719215. Epub 2020 Feb 4.
Transitions across care settings can be stressful for trauma patients, and when poorly executed, can lead to poor outcomes. Early physical medicine and rehabilitation (PM&R) consults in acute care settings can optimize the continuum of care for trauma patients, but there is a need for additional insight on its impact. This study aimed to better understand how early PM&R consults influence the continuum of care between acute and rehabilitation trauma settings.
Four focus groups were conducted with 21 trauma acute care and rehabilitation staff, and data were analyzed via content analysis.
The main themes identified were: (1) patient-level considerations (i. readiness for rehab [mental health]; ii. patient education and expectations for rehab); (2) clinical-team considerations (i. physiatry role clarity and role limitations; ii. access and accuracy of information; iii. departmental silos); and (3) system-level considerations (i. occupancy and discharge pressures; ii. inter-facility coordination and patient flow).
Although both acute and rehabilitation care staff find early PM&R consults as being important to support the recovery of trauma patients, there is a need for greater role clarity of the physiatrist across settings and a more refined implementation approach to better meet the communication needs of clinical staff. Implications for RehabilitationEarly physical medicine and rehabilitation consults are seen by acute care and rehabilitation front-line staff as valuable for optimizing the continuum of trauma care.There is a lack of clarity on the role of physiatrists among acute care and rehabilitation clinical staff.The physiatrist plays an important role to help prepare trauma patients for rehabilitation. For patients with complex physical and/or mental health challenges, the physiatrist can also serve as an advocate for access to rehabilitation services.
创伤患者在转至不同医疗场所时可能会面临压力，如果处理不当，可能会导致不良后果。在急性护理环境中尽早进行物理医学与康复（PM&R）会诊，可以优化创伤患者的连续护理，但仍需要更多关于其影响的深入了解。本研究旨在更好地了解早期 PM&R 会诊如何影响急性和康复创伤环境之间的连续护理。
对 21 名创伤急性护理和康复工作人员进行了 4 次焦点小组讨论，并通过内容分析对数据进行了分析。
确定的主要主题包括：（1）患者层面的考虑因素（i. 康复准备[心理健康]；ii. 患者教育和对康复的期望）；（2）临床团队层面的考虑因素（i. 物理治疗师角色的明确性和角色限制；ii. 获取和准确信息；iii. 部门隔阂）；以及（3）系统层面的考虑因素（i. 入住率和出院压力；ii. 机构间协调和患者流动）。
尽管急性护理和康复护理人员都认为早期 PM&R 会诊对支持创伤患者的康复很重要，但需要在不同环境中更明确物理治疗师的角色，并采用更精细的实施方法，以更好地满足临床工作人员的沟通需求。
急性护理和康复一线工作人员认为早期物理医学与康复会诊对于优化创伤护理的连续性很有价值。
急性护理和康复临床工作人员对物理治疗师的角色缺乏明确性。
物理治疗师在帮助创伤患者为康复做准备方面发挥着重要作用。对于有复杂身体和/或心理健康挑战的患者，物理治疗师还可以作为获得康复服务的倡导者。
