Physical Therapy Nontreatment Events in the Acute Hospital Setting

A Descriptive Study

Abstract

Background: 

In acute care hospitals, scheduled physical therapy visits not resulting in treatment (nontreatment) may increase the patient's length of stay and the financial burden to the hospital. Previous literature has not fully evaluated the occurrence of these events, nor have any associated factors been identified.

Objective: 

To describe nontreatment events in an acute hospital.

Design: 

This was a retrospective review of physical therapist documentation at a suburban hospital.

Methods: 

Data were collected from records of 1084 patients for their second scheduled session of physical therapy. The rate of nontreatment was calculated on the basis of several variables.

Results: 

The nontreatment rate for all second scheduled sessions was 15.04%. Therapist documentation for nontreatment indicated that 39% were due to unknown reasons, 26% were due to the patients' medical condition, 15% were due to the patients' refusal to participate, and 11% were due to insufficient staffing. Individual therapists had nontreatment rates ranging from 0% to 20%; 37.9% of nontreatment events did not have documentation indicating which therapist attempted treatment. Sunday had the poorest nontreatment rate (26.26%) and Tuesday had the best (6.98%). A wide range of nontreatment rates were found among patients with different diagnoses, ranging from 7.23% for those with musculoskeletal diagnoses to 22.69% for those with pulmonary diagnoses.

Discussion and Conclusions: 

Therapist-documented reasons for nontreatment were most often based on patients' condition or patients' willingness to participate; however, different therapists had a wide range of nontreatment rates, indicating that the therapist may have influence on how often these reasons result in nontreatment. Patients with pulmonary diagnoses were more likely to experience nontreatment than patients with neurological, musculoskeletal, or genitourinary/renal diagnoses. This may be reflective of the impact these diagnoses have on activity and exercise. Complete documentation of all scheduled sessions including which therapist attempted treatment will improve understanding of nontreatment. Future studies should consider all scheduled sessions and other variables related to the therapist.