Interdisciplinary communication in inpatient rehabilitation facility: evidence of under-documentation of spatial neglect after stroke

Abstract

Purpose: Spatial neglect commonly occurs after stroke and predicts poor rehabilitation outcomes. However, this disorder is under-recognized in clinical practices, which may result from the failure to document its presence. This study aimed to identify the predictors for documentation of spatial neglect in inpatient rehabilitation facilities. Method: We performed a comprehensive chart review to investigate whether the presence of spatial neglect was documented in 74 neglect patients’ clinical notes recorded by physicians, nurses, or occupational therapists (OTs), or in team conference notes. Independent variables included neglect severity, length of stay, Functional Independence Measure at admission and discharge. Results: Of the 74 neglect patients, 75.7% were documented by OTs, 63.5% by physicians, and 17.6% by nurses. Although 93.2% of neglect patients were recognized by at least one clinician group, only 31.1% were discussed in multidisciplinary team conferences. Neglect patients who were documented by physicians were more likely to be documented in team conferences. While no factors predicted whether a neglect patient would be documented by nurses or OTs, we found significant predictors for neglect documentation in physician and team conference notes. The odds of being documented by physicians were increasingly greater with poorer efficiency of cognitive rehabilitation (odds ratio = 0.70). The odds of being discussed in team conferences were increasingly greater with more severe neglect (odds ratio = 0.98), and with longer stay in hospitalization (odds ratio = 1.06). Conclusions: Multidisciplinary care may not involve as much interdisciplinary communication as needed to document important disease states. Stroke rehabilitation professionals should be able to recognize spatial neglect independently and document it consistently.

Implications for Rehabilitation

• Occupational therapists detected and documented more neglect cases than physicians or nurses. Nurses’ documentation rate of spatial neglect was much lower than physicians or occupational therapists.

• Spatial neglect was more likely to be documented by physicians if the patients had poor efficiency in cognitive outcome improvement.

• Stroke patients with more severe neglect or with longer stay were more likely to be documented in team conference notes.

• No neglect patient was coded with the ICD-9-CM code (781.8), suggesting that using such code for institutional or nation-wide prevalence research on spatial neglect is likely to be unfruitful.

Keywords::

• Interdisciplinary teamwork
• spatial neglect
• stroke
• team conference

Acknowledgments

The authors thank A. M. Barrett for her comments and the Stroke Rehabilitation Research Laboratory staff at the Kessler Foundation Research Center for participant recruitment, neglect assessment administration, and data organization.

Declaration of Interest: This work was supported by the Kessler Foundation, the Eunice Kennedy Shriver National Institute of Child Health & Human Development (Chen, 1R03HD063177, PI: Chen) and the National Institute of Neurological Disorders and Stroke (Chen, R01 NS055808, PI: Barrett). The authors declared no conflict of interest.