Abstract
Purpose
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.
Methods
Four focus groups were conducted with 21 trauma acute care and rehabilitation staff, and data were analyzed via content analysis.
Results
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).
Conclusions
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.
Early 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.
Implications for Rehabilitation
Acknowledgements
The project team thanks the study participants for their time and support of this work.
Disclosure statement
Sander L. Hitzig, Lesley Gotlib Conn, Stephanie R. Cimino and Lawrence R. Robinson are employed staff at the Sunnybrook Research Institute. Dr. Robinson is the Chief of Rehabilitation at St. John’s Rehab and is the principal investigator on the funding grant for this project. Sara J.T. Guilcher has no conflicts of interest to declare.