Understanding the role of the physiatrist and how to improve the continuum of care for trauma patients: a qualitative study

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.

Implications for Rehabilitation

• 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.

Keywords:

• Wounds and injuries
• physiatrists
• physical and rehabilitation medicine
• continuity of patient care
• qualitative research

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.

Additional information

Funding

The funding for this study was provided by the Sunnybrook Alternative Funding Plan (AFP) Innovation Fund (Grant# 410004228).